CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(01): E50-E55
DOI: 10.1055/a-1630-6175
Original article

Identification of diverticular bleeding needs early colonoscopy rather than preparation

Akira Mizuki
1   Department of Internal Medicine, Tokyo Saiseikai Central Hospital,Tokyo, Japan
Masayuki Tatemichi
2   Department of Community Health, Tokai University School of Medicine, Isehara, Japan
Atsushi Nakazawa
1   Department of Internal Medicine, Tokyo Saiseikai Central Hospital,Tokyo, Japan
Nobuhiro Tsukada
1   Department of Internal Medicine, Tokyo Saiseikai Central Hospital,Tokyo, Japan
Hiroshi Nagata
3   Department of Internal Medicine, Keiyu Hospital, Yokohama, Japan
Takanori Kanai
4   Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
› Author Affiliations


Background and study aims When patients present with acute colonic diverticulum bleeding (CDB), a colonoscopy is performed to identify stigmata of recent hemorrhage (SRH), but valuable time can be lost in bowel preparation. This study retrospectively examined groups of patients who either had a standard pre-colonoscopy regimen or no preparation.

Patients and methods This study compared data from 433 patients who either followed a lengthy regimen of bowel preparation (prepared group, 266 patients) or had no preparation (unprepared group, 60 patients). We compared the association between time (hours) between admission before starting a colonoscopy (TMS) and identification of SRH using a chi-square test.

Results In 48 of 60 cases (80.0 %) in the unprepared group, a total colonoscopy was performed and the time to identify SRH was decreased. The respective rates of SRH identification in the unprepared and prepared groups were 55.2 % (16/29) vs. 46.7 % (7/15) if the TMS was < 3 hours; 47.1 % (8/7) vs. 36.8 % (35/95) in 3 to 12 hours; 0 % (0/3) vs. 22.0% (13/59) in 12 to 18 hours; and 21.8 % (3/11) vs. 20.6% (42/204) in > 18 hours. There were no significant differences between the two groups. However, the SRH identification rates before and after 12 hours were 42.3 % (66/156) and 20.9 % (58/277) (P < 0.001).

Conclusions Our data suggest that the bowel preparation method before colonoscopy is an independent variable predicting success in identifying SRH among patients with CDB. Decreasing the time before colonoscopy to no more than 12 hours after admission played an important role in identifying SRH.

Publication History

Received: 13 December 2020

Accepted: 02 August 2021

Article published online:
14 January 2022

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  • References

  • 1 Tursi A, Papagrigoriadis S. Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther 2009; 30: 532-546
  • 2 Pasha SF, Shergill A, Acosta RD. et al. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 2014; 79: 875-885
  • 3 Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016; 111: 755
  • 4 McGuire Jr HH. Bleeding colonic diverticula. A reappraisal of natural history and management. . Ann Surg 1994; 220: 653-656
  • 5 Jensen DM, Machicado GA, Jutabha R. et al. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342: 78-82
  • 6 Kominami Y, Ohe H, Kobayashi S. et al. [Classification of the bleeding pattern in colonic diverticulum is useful to predict the risk of bleeding or re-bleeding after endoscopic treatment]. Nihon Shokakibyo Gakkai Zasshi 2012; 109: 393-399
  • 7 Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. . Gastroenterology 1988; 95: 1569-1574
  • 8 Chaudry V, Hyser MJ, Gracias VH. et al. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg 1998; 64: 723-728
  • 9 Schmulewitz N, Fisher DA, Rockey DC. Early colonoscopy for acute lower GI bleeding predicts shorter hospital stay: a retrospective study of experience in a single center. Gastrointest Endosc 2003; 58: 841-846
  • 10 Strate LL, Syngal S. Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding. Am J Gastroenterol 2003; 98: 317-322
  • 11 Mizuki A, Tatemichi M, Hatogai K. et al. Timely colonoscopy leads to faster identification of bleeding diverticulum. Nihon Shokakibyo Gakkai Zasshi 2013; 110: 1927-1933 , Japanese
  • 12 Rossini FP, Ferrari A, Spandre M. et al. Emergency colonoscopy. World J Surg 1989; 13: 190-192
  • 13 Repaka A, Atkinson MR, Faulx AL. et al. Immediate unprepared hydroflush colonoscopy for severe lower GI bleeding: a feasibility study. Gastrointest Endosc 2012; 76: 367-373
  • 14 Roshan Afshar I, Sadr MS, Strate LL. et al. The role of early colonoscopy in patients presenting with acute lower gastrointestinal bleeding: a systematic review and meta-analysis. Therap Adv Gastroenterol 2018; 11 DOI: 10.1177/1756283X18757184.
  • 15 Green BT, Rockey DC, Portwood G. et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol 2005; 100: 2395-2402
  • 16 Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. . Am J Gastroenterol 2010; 105: 2636-2641
  • 17 Niikura R, Nagata N, Yamada A. et al. Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding. Gastroenterology 2020; 158: 168-175
  • 18 Fong SS, Tan EY, Foo A. et al. The changing trend of diverticular disease in a developing nation. Colorectal Dis 2011; 13: 312-316
  • 19 Gostout CJ, Wang KK, Ahlquist DA. et al. Acute gastrointestinal bleeding. Experience of a specialized management team. J Clin Gastroenterol 1992; 14: 260-267
  • 20 Browder W, Cerise EJ, Litwin MS. Impact of emergency angiography in massive lower gastrointestinal bleeding. Ann Surg 1986; 204: 530-536
  • 21 Gayer C, Chino A, Lucas C. et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery 2009; 146: 600-606
  • 22 Umezawa S, Nagata N, Arimoto J. et al. Contrast-enhanced CT for colonic diverticular bleeding before colonoscopy: a prospective multicenter study. Radiology 2018; 288: 755-761