Urgent Contrast-Enhanced Computed Tomography before Early Colonoscopy in the Management of Colonic Diverticular Bleeding: A Multicenter Randomized Controlled Trial.

IF 3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Digestion Pub Date : 2024-10-15 DOI:10.1159/000541942

Yuichiro Hirai, Toshio Uraoka, Michiko Wada, Hideki Mori, Ai Fujimoto, Yuko Sakakibara, Tatsuya Toyokawa, Takashi Kagaya, Yoshihiro Sasaki, Tomohiko Mannami, Toshio Kuwai, Noriko Watanabe, Hiroshige Hamada, Naoki Esaka, Toshihisa Kimura, Hiroyuki Fujii, Yasuo Hosoda, Masaaki Shimada, Hideharu Miyabayashi, Shinichi Somada, Katsuhiro Mabe, Shuji Inoue, Hiroki Saito, Kensuke Furuya, Norio Kawamura, Tomohiro Kudo, Keisuke Hori, Naoto Sakamoto, Mototsugu Kato, Nobuya Higuchi, Naohiko Harada

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引用次数: 0

Abstract

Introduction: Contrast-enhanced computed tomography (CE-CT) has been gaining attention as an initial investigation in the management of colonic diverticular bleeding (CDB), yet the role of CE-CT other than its diagnostic yield has not been adequately clarified. We aimed to determine whether the use of urgent CE-CT improves identification of stigmata of recent hemorrhage (SRH) in subsequently performed early colonoscopy (≤24 h of arrival) or other clinical outcomes of CDB.

Methods: We conducted a randomized, open-label, controlled trial at 23 institutions in Japan. Outpatients with suspected CDB were randomly assigned to undergo either urgent CE-CT followed by early colonoscopy (urgent-CE-CT + early-colonoscopy group) or early colonoscopy alone (early-colonoscopy group). The primary outcome was SRH identification. Secondary outcomes included successful endoscopic hemostasis, early (<30 days) and late (<1 year) rebleeding, length of hospital stay, and transfusion requirements.

Results: In total, 240 patients, mostly in a hemodynamically stable condition, were randomized. A contrast extravasation on CE-CT was observed in 20 of 115 patients (17.4%) in the urgent-CE-CT + early-colonoscopy group. SRH was identified in 23 of 115 patients (20.0%) in the urgent-CE-CT + early-colonoscopy group and 21 of 118 patients (17.8%) in the early-colonoscopy group (difference, 2.2; 95% confidence interval [CI], -7.9 to 12.3; p = 0.739). Successful endoscopic hemostasis was achieved in 21 patients in each group (18.3% and 17.8%, respectively) (difference, 0.5; 95% CI, -9.4 to 10.4; p = 1.000). There were also no significant differences between groups in early and late rebleeding, length of hospital stay, and transfusion requirements.

Conclusion: The use of urgent CE-CT before early colonoscopy did not improve SRH identification or other clinical outcomes in patients with suspected CDB in a hemodynamically stable condition. The routine use of urgent CE-CT as an initial investigation is not recommended in this population, also considering the low rate of extravasation-positive cases (UMIN registry number, UMIN000026865).

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早期结肠镜检查前紧急造影剂增强计算机断层扫描在结肠憩室出血治疗中的应用：多中心随机对照试验。

导言：对比增强计算机断层扫描（CE-CT）作为结肠憩室出血（CDB）治疗的初始检查手段已越来越受到关注，然而，CE-CT除诊断效果外的作用尚未得到充分阐明。我们的目的是确定使用紧急 CE-CT 是否能在随后进行的早期结肠镜检查（到达时间≤24 小时）中提高对近期出血迹象（SRH）的识别率，或改善 CDB 的其他临床结果：我们在日本的 23 家机构开展了一项随机、开放标签对照试验。疑似 CDB 的门诊患者被随机分配接受紧急 CE-CT 和早期结肠镜检查（紧急 CE-CT + 早期结肠镜检查组）或单独接受早期结肠镜检查（早期结肠镜检查组）。主要结果是SRH鉴定。次要结果包括内镜止血成功率、早期（30 天）和晚期（1 年）再出血、住院时间和输血需求：共有 240 名患者接受了随机治疗，其中大部分患者的血流动力学状况稳定。在紧急CE-CT+早期结肠镜检查组的115例患者中，有20例（17.4%）在CE-CT上观察到造影剂外渗。急诊-CE-CT + 早期结肠镜检查组 115 例患者中有 23 例（20.0%）发现了 SRH，早期结肠镜检查组 118 例患者中有 21 例（17.8%）发现了 SRH（差异为 2.2；95% 置信区间 [CI]，-7.9 至 12.3；P=0.739）。两组各有21名患者（分别为18.3%和17.8%）成功实现了内镜止血（差异为0.5；95% 置信区间[CI]为-9.4至10.4；P=1.000）。各组在早期和晚期再出血、住院时间和输血需求方面也无明显差异：结论：对于血流动力学稳定的疑似 CDB 患者，在早期结肠镜检查前使用紧急 CE-CT 并不能改善 SRH 识别或其他临床结果。考虑到外渗阳性病例的比例较低（UMIN 登记号，UMIN000026865），不建议将紧急 CE-CT 作为此类人群的常规初始检查方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestion 医学-胃肠肝病学

CiteScore

7.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.