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• W2977885753 abstract "Purpose: Our purposes were to describe: 1) prevalences of different stigmata of diverticular (TIC) hemorrhage & patient (pt) outcomes for medical-surgical treatment (MED-SURG) or colonoscopic hemostasis (COLO HEMOS), & 2) findings on removal of adherent clots on TICs & treatment recommendations. Methods: From 3 consecutive, prospective cohort studies of lower GI bleeding by the same hemostasis team, all pts with definitive TIC bleeding were analyzed. All had focal active bleeding, a non-bleeding visible vessel-NBVV, or adherent clot-CLOT on urgent colonoscopy after purge. 58 consecutive pts were studied, classified by stigmata & treatment, & 30 day severe rebleeding & emergency surgery (SURG) rates were determined. Chi-squared tests were used for statistical comparisons. Results: For all pts, the mean age was 69 yrs, 27% ingested NSAIDs or ASA prior to bleeding, 36% were females, & 100% had co-morbidities. There were no significant differences for background variables for treatment groups. Prevalences of TIC stigmata for all pts were active bleed 31%, NBVV 22%, & CLOT 47.1%. For 25 MED-SURG pts, rebleed rate was 44% & SURG rate was 36%. Rebleed rates increased from 33% for CLOT, to 50% for NBVV, to 67% for active bleeding TICs. In contrast, for 33 COLO HEMOS pts, significantly less rebleeds (9.1%) or SURG (6.1%) resulted. For 16 pts whose adherent clots were removed, 87.5% had underlying major stigmata (4 NBVV, 5 active bleed, 5 active bleed & VV) & 12.5% had no stigmata. Epinephrine (EPI) injection (1:20,000) prior to cold guillotining off clots significantly reduced active bleeding (to 14%) & facilitated MPEC or hemoclipping compared to our previous technique of forceful clot removal without EPI (active bleed in 67%). Conclusions: Among 58 pts with definitive TIC hemorrhage: 1) Prevalences of TIC stigmata were active bleed 31%, NBVV 22%, & CLOT 47%. 2) EPI pre-injection, cold guillotining off clots, & MPEC or hemoclipping are recommended for CLOT since rebleeding rates were high on medical therapy (33%) & major stigmata were very frequent upon clot removal. 3) Rebleeding & emergency surgery rates @ 30 days were significantly higher for medically treated pts (44% & 36% respectively) than colonoscopic hemostasis (9.1% & 6.1%). Supported by NIH K24 & NIH CURE Human Studies CORE Grants." @default.
• W2977885753 created "2019-10-10" @default.
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• W2977885753 date "2006-09-01" @default.
• W2977885753 modified "2023-09-25" @default.
• W2977885753 title "Prevalences & Outcomes of Different Stigmata of Definitive Diverticular Hemorrhage with Medical-Surgical Treatment or Colonoscopic Hemostasis" @default.
• W2977885753 doi "https://doi.org/10.14309/00000434-200609001-00487" @default.
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