Natural history of definitive diverticular hemorrhage based on stigmata of recent hemorrhage and colonoscopic Doppler blood flow monitoring for risk stratification and definitive hemostasis

• Published in: Gastrointestinal endoscopy 2016-02, Vol.83 (2), p.416-423
• Main Authors: Jensen, Dennis M., MD, Ohning, Gordon V., MD, PhD, Kovacs, Thomas O.G., MD, Jutabha, Rome, MD, Ghassemi, Kevin, MD, Dulai, Gareth S., MD, MSHS, Machicado, Gustavo A., MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Colonoscopy - methods; Diverticulum, Colon - complications; Diverticulum, Colon - diagnostic imaging; Diverticulum, Colon - physiopathology; Endosonography - methods; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - diagnostic imaging; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - physiopathology; Humans; Male; Middle Aged; Monitoring, Physiologic - methods; Prospective Studies; Recurrence; Regional Blood Flow - physiology; Ultrasonography, Doppler, Color - methods
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2015.07.033

Background and Aims Few prospective reports describe the short-term natural history of colon diverticular hemorrhage based on stigmata of recent hemorrhage, and none include blood flow detection for risk stratification or as a guide to definitive hemostasis. Our purposes were to report the 30-day natural history of definitive diverticular hemorrhage based on stigmata and to describe Doppler probe blood flow detection as a guide to definitive hemostasis. Methods Different cohorts of patients with severe diverticular bleeding and stigmata on urgent colonoscopy are reported. For 30-day natural history, patients were treated medically. If severe rebleeding occurred, they had surgical or angiographic treatment. We report natural history with major stigmata (active bleeding, visible vessel, or adherent clot) and no stigmata or flat spots after clots were washed away. We also report Doppler probe detection of arterial blood flow underneath stigmata before and after hemostasis in a recent cohort. Results For natural history, patients with major stigmata treated medically had 65.8% (25/38) rebleeding rates, and 44.7% (17/38) had intervention for hemostasis. Patients with spots or clean bases had no rebleeding. A Doppler probe detected arterial blood flow in 92% of major stigmata—none after hemostasis—and there was no rebleeding. Conclusions (1) Patients with major stigmata treated medically had high rates of rebleeding and intervention for hemostasis. (2) Patients with clean diverticula or only flat spots had no rebleeding. (3) High rates of arterial blood flow were detected under major stigmata with a Doppler probe, but with obliteration by hemostasis no rebleeding occurred.