Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage.
Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage.
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DOI：
10.1055/s-0034-1392215
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发表时间：
2015-10
影响因子：
2.6
通讯作者：
Fujita Y
中科院分区：
文献类型：
--
作者：
Ikeya T;Ishii N;Nakano K;Omata F;Shimamura Y;Ego M;Takagi K;Nakamura K;Fukuda K;Fujita Y
背景和研究目的：内镜下套扎术（EBL）已被用于结肠憩室出血的止血。然而，在某些病例中报告了早期再出血（EBL后< 30天）。 本研究的目的是阐明EBL治疗结肠憩室出血后早期再出血的危险因素。 患者和方法：回顾性队列研究纳入了2009年6月至2014年10月期间使用EBL治疗的101例明确憩室出血患者，并根据是否存在早期再出血分为再出血组和非再出血组。回顾性评估各组患者的年龄、共病、近期出血（SRH）的体征[活动性出血（AB）、非出血性可见血管（NBVV）或粘附性凝块（AC）]、出血性憩室的位置和EBL后憩室的外翻。 结果：15例术后出现早期再出血。早期再出血发生的中位时间（范围）为5天（范围，2 h至26天）。 早期再出血可通过保守和/或内镜治疗，但1例手术除外。多因素分析显示，年龄小于50岁（调整OR，8.7; 95%CI 1.6 - 52.5; P = 0.014）和AB（调整OR，4.21; 95%CI 1.15 - 18.1; P = 0.03）是显著的危险因素。 右侧结肠的风险低于左侧（调整后的OR，0.21; 95%CI 0.04 - 0.84; P = 0.028）。 结论：年龄小、SRH AB和左侧病变被确定为EBL治疗结肠憩室出血后早期再出血的危险因素。
Background and study aims: Endoscopic band ligation (EBL) has been used for hemostasis of colonic diverticular hemorrhage. However, early rebleeding (< 30 days after EBL) has been reported in some cases. The aim of this study was to elucidate risk factors for early rebleeding after EBL in treatment of colonic diverticular hemorrhage. Patients and methods: A total of 101 patients with definite diverticular hemorrhage treated using EBL from June 2009 to October 2014 were included in the retrospective cohort study and divided into rebleeding and non-rebleeding groups, depending on the presence or absence of early rebleeding. Patients’ ages, comorbid diseases, stigmata of recent hemorrhage (SRH) [active bleeding (AB), non-bleeding visible vessel (NBVV), or adherent clot (AC)], locations of bleeding diverticula, and eversions of the diverticula after EBL were retrospectively evaluated in each group. Results: Early rebleeding occurred in 15 cases. The median time (range) of early rebleeding occurrence was 5 days (range, 2 h to 26 days). Early rebleeding could be managed conservatively and/or endoscopically, except in one case in which surgery was done. Multivariate analysis revealed that age under 50 (adjusted OR, 8.7; 95 % CI 1.6 – 52.5; P = 0.014) and AB (adjusted OR, 4.21; 95 % CI 1.15 – 18.1; P = 0.03) were shown to be significant risk factors. The right side of the colon carried less risk than did the left side (adjusted OR, 0.21; 95 % CI 0.04 – 0.84; P = 0.028). Conclusions: Younger age, AB of SRH, and leftsided lesions were identified as the risk factors for early rebleeding after EBL in the treatment of colonic diverticular hemorrhage.