Efficacy and safety of conservative treatment for colonic diverticular bleeding: A prospective study.

Background and study aims: This prospective study aimed to establish the efficacy and safety of conservative treatment for non-severe cases of colonic diverticular bleeding and to verify whether early colonoscopy is necessary only in limited cases. Patients and methods: Patients who were urgently hospitalized due to hematochezia and were diagnosed with colonic diverticular bleeding were included. During hospitalization, early colonoscopy within 24 h after admission was performed only when both systolic blood pressure <90 mmHg and extravasation on contrast-enhanced computed tomography were observed. However, in patients who failed to recover from hemorrhagic shock, interventional radiology was performed. In other cases, patients received conservative treatment. Results: Of the 172 patients, 15 (8.7%) met the criteria for undergoing early colonoscopy; 12 and 3 attained successful hemostasis via early colonoscopy and interventional radiology, respectively. Meanwhile, 157 patients received conservative treatment, resulting in spontaneous hemostasis in 148 patients (94.3%). The remaining nine patients required hemostatic intervention. No patient died from bleeding. Between the conservative treatment and the urgent hemostasis groups, early rebleeding rate within 30 days (14.6% vs. 33.3%, P=0.0733) and overall 1-year cumulative rebleeding rate after 30 days of hospitalization (9.2% vs. 23.1%, P=0.2271) were not significant. In multivariate analyses, only systolic blood pressure and extravasation were associated with the 24 patients who required hemostatic intervention. Moreover, multivariate analyses showed that patients with a history of diverticular bleeding, patients undergoing hemodialysis, and oral thienopyridine were significantly associated with late rebleeding. Conclusions: Conservative treatment for non-severe colonic diverticular bleeding is appropriate and efficient.