In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 8 ( 2023-8-23), p. e0289698-
Abstract:
Emergency endoscopic hemostasis for colonic diverticular bleeding is effective in preventing serious consequences. However, the low identification rate of the bleeding source makes the procedure burdensome for both patients and providers. We aimed to establish an efficient and safe emergency endoscopy system. Methods We prospectively evaluated the usefulness of a scoring system ( J ichi Medical University diverticular hemorrhage score: JD score) based on our experiences with past cases. The JD score was determined using four criteria: CT evidence of contrast agent extravasation, 3 points; oral anticoagulant (any type) use, 2 points; C-reactive protein ≥1 mg/dL, 1 point; and comorbidity index ≥3, 1 point. Based on the JD score, patients with acute diverticular bleeding who underwent emergency or elective endoscopy were grouped into JD ≥3 or JD 〈 3 groups, respectively. The primary and secondary endpoints were the bleeding source identification rate and clinical outcomes. Results The JD ≥3 and JD 〈 3 groups included 35 and 47 patients, respectively. The rate of bleeding source identification, followed by the hemostatic procedure, was significantly higher in the JD ≥3 group than in the JD 〈 3 group (77% vs. 23%, p 〈 0.001), with a higher JD score associated with a higher bleeding source identification rate. No significant difference was observed between the groups in terms of clinical outcomes, except for a higher incidence of rebleeding at one-month post-discharge and a higher number of patients requiring interventional radiology in the JD ≥3 group than in the JD 〈 3 group. Subgroup analysis showed that successful identification of the bleeding source and hemostasis contributed to a shorter hospital stay. Conclusion We established a safe and efficient endoscopic scoring system for treating colonic diverticular bleeding. The higher the JD score, the higher the bleeding source identification, leading to a successful hemostatic procedure. Elective endoscopy was possible in the JD 〈 3 group when vital signs were stable.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0289698
DOI:
10.1371/journal.pone.0289698.g001
DOI:
10.1371/journal.pone.0289698.g002
DOI:
10.1371/journal.pone.0289698.t001
DOI:
10.1371/journal.pone.0289698.t002
DOI:
10.1371/journal.pone.0289698.t003
DOI:
10.1371/journal.pone.0289698.s001
DOI:
10.1371/journal.pone.0289698.s002
DOI:
10.1371/journal.pone.0289698.s003
DOI:
10.1371/journal.pone.0289698.s004
DOI:
10.1371/journal.pone.0289698.r001
DOI:
10.1371/journal.pone.0289698.r002
DOI:
10.1371/journal.pone.0289698.r003
DOI:
10.1371/journal.pone.0289698.r004
DOI:
10.1371/journal.pone.0289698.r005
DOI:
10.1371/journal.pone.0289698.r006
DOI:
10.1371/journal.pone.0289698.r007
DOI:
10.1371/journal.pone.0289698.r008
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
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