Abstract and Introduction
Abstract
Objective We compared the clinical efficacy of barium therapy and conservative therapy in preventing recurrence in patients with diverticular bleeding.
Background Previous case reports have indicated that barium impaction therapy provides initial hemostasis for diverticular bleeding and prevention against rebleeding.
Methods After spontaneous cessation of bleeding, patients were randomly assigned to conservative treatment (n = 27) or high-dose barium impaction therapy (n = 27). Patients were followed up for 1 year after enrollment of the last patient. The main outcome measure was rebleeding.
Results Median follow-up period was 584.5 days. The probability of rebleeding at 30-day, 180-day, 1-year, and 2-year follow-up in all patients was 3.7%, 14.8%, 28.4%, and 32.7%, respectively. By group, probability at 1 year was 42.5% in the conservative group and 14.8% in the barium group (log-rank test, P = 0.04). After adjustment for a history of hypertension, the hazard ratio of rebleeding in the barium group was 0.34 (95% confidence interval, 0.12–0.98). No complications or laboratory abnormalities due to barium therapy were observed. Compared with the conservative group, the barium group had significantly (P < 0.05) fewer hospitalizations per patient (1.7 vs 1.2), units of blood transfused (1.9 vs 0.7), colonoscopies (1.4 times vs 1.1 times), and hospital stay days (15 days vs 11 days) during the follow-up period. No patients died and none required angiographic or surgical procedures in either group.
Conclusions High-dose barium impaction therapy was effective in the long-term prevention of recurrent bleeding, and reduced the frequency of rehospitalization and need for blood transfusion and colonoscopic examination. ClinicalTrials.gov Identifier, UMIN 000002832.
Introduction
Acute lower gastrointestinal bleeding (LGIB) has an estimated annual incidence rate of 20.5 patients/100,000, and is a common reason for hospitalization. The most common cause of LGIB is colonic diverticular bleeding (CDB), which accounts for approximately 40% of cases.
Approximately 76% to 92% of cases of CDB resolve with rest, sedation, and blood transfusion. However, the rebleeding rate is reported to be as high as 14% to 43%. Even when a definitive diagnosis of CDB is made and therapeutic procedures are successful, rebleeding still occurs in 11% to 38% of patients within 30 days after endoscopic therapy, and in 30% after angiography. Recurrence requires frequent examination, hospitalization, and blood transfusion, and it decreases quality of life, and an effective means of prevention is urgently required.
Among therapeutic procedures for CDB, a number of articles have reported that high-dose barium enema use provides better clinical outcomes for initial hemostasis and long-term prevention of rebleeding than conservative therapy. To date, however, effective preventive treatment against the recurrence of CDB has not been established. We hypothesized that barium impaction therapy has better long-term efficacy in preventing recurrence than conservative therapy alone. Here, we conducted a randomized controlled trial with extended follow-up to determine the efficacy and safety of barium impaction therapy for CDB.