Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping.
Gastrointest Endosc
; 76(6): 1175-81, 2012 Dec.
Article
em En
| MEDLINE
| ID: mdl-23021162
ABSTRACT
BACKGROUND:
Predictors of refractory colonic diverticular hemorrhage after endoscopic clipping (EC) remain unclear.OBJECTIVE:
To elucidate the predictors of uncontrolled bleeding after EC.DESIGN:
Retrospective study.SETTING:
Two tertiary referral centers. PATIENTS Eighty-nine patients with colonic diverticular hemorrhage who underwent EC as a first-line treatment were included.INTERVENTIONS:
If bleeding remained uncontrolled after 1 or 2 EC sessions, other interventions (transcatheter arterial embolization, endoscopic band ligation, or surgery) were performed. Patients were divided into EC-controlled and EC-uncontrolled groups; the characteristics of each group were compared. MAIN OUTCOME MEASUREMENTS Comorbidities, location of bleeding diverticula, and EC technique (direct vs indirect placement).RESULTS:
Initial treatment with EC was successful in 87 patients. Early rebleeding (primary failure) occurred in 30 of 87 patients (34%). Secondary failure occurred in 6 of 22 patients treated with reclipping (27%). Cumulatively, 78 patients were successfully managed with EC. Non-EC treatments were required in 11 patients. Location in the right side of the colon, particularly in the ascending colon, was significantly more common in the EC-uncontrolled group than in the EC-controlled group (P = .017 and P = .0029, respectively). Although the difference was not significant, bleeding was successfully managed in all 13 patients treated with direct placement. Bleeding remained uncontrolled after EC in 11 of 52 ascending cases (21%) treated with indirect placement. Diverticular hemorrhage in other locations was managed regardless of EC technique.LIMITATIONS:
Retrospective study.CONCLUSIONS:
Location in the ascending colon is a significant predictor of refractory colonic diverticular hemorrhage after EC. Indirect placement of hemoclips in ascending lesions is ineffective.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Colonoscopia
/
Hemostase Endoscópica
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Doenças do Colo
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Colo Ascendente
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Divertículo do Colo
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Hemorragia Gastrointestinal
Tipo de estudo:
Etiology_studies
/
Evaluation_studies
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Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article