Impact of long-term trends on outcomes in the management of colonic diverticular bleeding: mediation analyses in a large multicenter study

Kazuyuki Narimatsu; Naoki Ishii; Atsuo Yamada; Tomonori Aoki; Katsumasa Kobayashi; Atsushi Yamauchi; Jun Omori; Takashi Ikeya; Taiki Aoyama; Naoyuki Tominaga; Yoshinori Sato; Takaaki Kishino; Tsunaki Sawada; Masaki Murata; Akinari Takao; Kazuhiro Mizukami; Ken Kinjo; Shunji Fujimori; Takahiro Uotani; Minoru Fujita; Hiroki Sato; Sho Suzuki; Toshiaki Narasaka; Junnosuke Hayasaka; Tomohiro Funabiki; Yuzuru Kinjo; Akira Mizuki; Shu Kiyotoki; Tatsuya Mikami; Ryosuke Gushima; Hiroyuki Fujii; Yuta Fuyuno; Takuto Hikichi; Yosuke Toya; Noriaki Manabe; Koji Nagaike; Tetsu Kinjo; Yorinobu Sumida; Sadahiro Funakoshi; Kiyonori Kobayashi; Tamotsu Matsuhashi; Yuga Komaki; Ryota Hokari; Mitsuru Kaise; Naoyoshi Nagata

doi:10.1007/s00535-024-02178-9

Impact of long-term trends on outcomes in the management of colonic diverticular bleeding: mediation analyses in a large multicenter study

J Gastroenterol. 2024 Dec 27. doi: 10.1007/s00535-024-02178-9. Online ahead of print.

Authors

Kazuyuki Narimatsu¹, Naoki Ishii², Atsuo Yamada³, Tomonori Aoki³, Katsumasa Kobayashi⁴, Atsushi Yamauchi⁵, Jun Omori⁶, Takashi Ikeya⁷, Taiki Aoyama⁸, Naoyuki Tominaga⁹, Yoshinori Sato¹⁰, Takaaki Kishino¹¹, Tsunaki Sawada¹², Masaki Murata¹³, Akinari Takao¹⁴, Kazuhiro Mizukami¹⁵, Ken Kinjo¹⁶, Shunji Fujimori¹⁷, Takahiro Uotani¹⁸, Minoru Fujita¹⁹, Hiroki Sato²⁰, Sho Suzuki²¹, Toshiaki Narasaka^{22

23}, Junnosuke Hayasaka²⁴, Tomohiro Funabiki^{25

26}, Yuzuru Kinjo²⁷, Akira Mizuki²⁸, Shu Kiyotoki²⁹, Tatsuya Mikami³⁰, Ryosuke Gushima³¹, Hiroyuki Fujii³², Yuta Fuyuno³³, Takuto Hikichi³⁴, Yosuke Toya³⁵, Noriaki Manabe³⁶, Koji Nagaike³⁷, Tetsu Kinjo³⁸, Yorinobu Sumida³⁹, Sadahiro Funakoshi⁴⁰, Kiyonori Kobayashi⁴¹, Tamotsu Matsuhashi⁴², Yuga Komaki⁴³, Ryota Hokari⁴⁴, Mitsuru Kaise⁶, Naoyoshi Nagata^{45

46}

Affiliations

¹ Department of Internal Medicine, National Defense Medical College, Tokorozawa-city, Saitama, Japan. [email protected].
² Division of Gastroenterology, Tokyo Shinagawa Hospital, Shinagawa-ku, Tokyo, Japan. [email protected].
³ Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
⁴ Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan.
⁵ Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan.
⁶ Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
⁷ Department of Gastroenterology, St. Luke's International University, Chuo-ku, Tokyo, Japan.
⁸ Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
⁹ Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, Saga, Japan.
¹⁰ Division of Gastroenterology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.
¹¹ Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara city Hospital, Nara, Japan.
¹² Department of Endoscopy, Nagoya University Hospital, Aichi, Japan.
¹³ Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
¹⁴ Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan.
¹⁵ Department of Gastroenterology, Oita University, Oita, Japan.
¹⁶ Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
¹⁷ Department of Gastroenterology, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan.
¹⁸ Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
¹⁹ Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
²⁰ Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
²¹ Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan.
²² Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan.
²³ Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan.
²⁴ Department of Gastroenterology, Toranomon Hospital, Minato-ku, Tokyo, Japan.
²⁵ Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan.
²⁶ Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
²⁷ Department of Gastroenterology, Naha City Hospital, Okinawa, Japan.
²⁸ Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo, Japan.
²⁹ Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan.
³⁰ Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan.
³¹ Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
³² Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan.
³³ Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
³⁴ Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
³⁵ Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan.
³⁶ Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan.
³⁷ Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan.
³⁸ Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan.
³⁹ Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
⁴⁰ Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan.
⁴¹ Department of Gastroenterology, School of Medicine, Kitasato University, Kanagawa, Japan.
⁴² Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan.
⁴³ Digestive and Lifestyle Diseases, and Hygiene and Health Promotion Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
⁴⁴ Department of Internal Medicine, National Defense Medical College, Tokorozawa-city, Saitama, Japan.
⁴⁵ Department of Gastroenterological Endoscopy, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
⁴⁶ Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan.

PMID: 39730771
DOI: 10.1007/s00535-024-02178-9

Abstract

Background: Despite accumulating evidence and recommendations for management of colonic diverticular bleeding (CDB), the changes in its clinical management and outcomes remain unknown.

Methods: We performed a retrospective tendency analysis on a biennial basis, a propensity score-matched cohort study between the first and latter half groups, and mediation analyses to compare the diagnostic and treatment methods between January 2010 and December 2019 (CODE BLUE-J Study).

Results: A total of 6575 patients with CDB were included. While the use of colonoscopy as the initial diagnostic procedure declined, the use of computed tomography (CT) increased in both the trend test and before-and-after comparisons. In hemostasis therapy, the use of endoscopic clips declined and band ligation increased. Interventional radiology remained unchanged; however, the number of surgeries decreased over time. The stigmata of recent hemorrhage (SRH) detection rate and length of hospital stay (LOS) improved significantly. Mediation analyses showed that use of a distal attachment and water-jet scope contributed to an improved SRH detection rate, and use of band ligation contributed to preventing rebleeding within 30 days.

Conclusions: Management strategies for CDB have changed in the past decade, particularly regarding the increased use of CT and decreased need for surgery. However, the main outcomes, except for the SRH detection rate and LOS, did not improve. The widespread use of distal attachment, water-jet scope, and band ligation could improve outcomes in CDB management.

Keywords: Acute hematochezia; Colonic diverticular bleeding; Colonoscopy; Computed tomography; Endoscopic therapy; Length of hospital stay; Mediation analysis; Mortality; Rebleeding; Transfusion of packed red blood cells.