Successful endoscopic hemostasis compared to transarterial embolization in patients with colonic diverticular bleeding

• Ueda Takashi

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Mori Hideki

  Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven

• Sekiguchi Tatsuya

  Department of Diagnostic Radiology, Tokai University School of Medicine

• Mishima Yusuke

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Sano Masaya

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Teramura Erika

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Fujimoto Ryutaro

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Kaneko Motoki

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Nakae Hirohiko

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Fujisawa Mia

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Matsushima Masashi

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

• Suzuki Hidekazu

  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine

Abstract

Transarterial embolization (TAE) is performed in patients with colonic diverticular bleeding after difficult endoscopic hemostasis or rebleeding. A total of 375 patients with hematochezia at our hospital from 1 April 2016 to 31 March 2020 were retrospectively analysed. Firstly, we compared the group in which hemostasis was achieved by endoscopy alone with the group that eventually underwent TAE. Secondly, we compared the group in which hemostasis was achieved by endoscopy alone, with the group switched to TAE after endoscopic hemostasis failed. The group that eventually underwent TAE had a higher shock index and lower Alb and PT% than the endoscopic hemostasis group. The shock index was correlated with Alb and PT%. When the cut-off value for the shock index was defined as more than 0.740, an OR of 9.500, a positive predictive value (PPV) of 40.0%, a negative predictive value (NPV) of 93.4%, and an accuracy of 80.3% were obtained for predicting a switch to TAE treatment. The greatest risk for TAE was the presence of shock and extravasation on contrast-enhanced CT. A switch to TAE treatment was likely when the shock index was more than 0.740. TAE should be considered in cases with a high shock index and showing extravasation on contrast-enhanced CT.

Journal

• Journal of Clinical Biochemistry and Nutrition

  Journal of Clinical Biochemistry and Nutrition 70 (3), 283-289, 2022

  SOCIETY FOR FREE RADICAL RESEARCH JAPAN

Keywords

• diverticular bleeding
• TAE
• shock index
• extravasation on contrast-enhanced CT examination

Details

• CRID: 1390010457713040128
• NII Article ID: 130008120652
• DOI: 10.3164/jcbn.21-123
• ISSN: 18805086
• ISSN: 09120009
• Web Site: https://www.jstage.jst.go.jp/article/jcbn/70/3/70_21-123/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2023214104
• Text Lang: en
• Data Source:
  • JaLC
  • Crossref
  • CiNii Articles
  • KAKEN
• Abstract License Flag: Disallowed