Evaluation of the Jichi Medical University diverticular hemorrhage score in the clinical management of acute diverticular bleeding with emergency or elective endoscopy: A pilot study.

Abstract

BACKGROUND AND AIMS:

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 (Jichi 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.

• Authors: Takeshi Uehara, Satohiro Matsumoto, Hiroyuki Tamura, Masahiro Kashiura, Takashi Moriya, Kenichi Yamanaka, Hakuei Shinhata, Masanari Sekine, Hiroyuki Miyatani, Hirosato Mashima
• Journal: PloS one (PLoS One) Vol. 18 Issue 8 Pg. e0289698 ( 2023) ISSN: 1932-6203 [Electronic] United States
• PMID: 37611042 (Publication Type: Journal Article)
• Copyright: Copyright: © 2023 Uehara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Chemical References

• Hemostatics

Topics

• Humans
• Pilot Projects
• Aftercare
• Universities
• Patient Discharge
• Endoscopy, Gastrointestinal
• Diverticular Diseases (complications)
• Diverticulum
• Hemorrhage
• Hemostatics