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    • Urgent Contrast-Enhanced Computed Tomography Before Early Colonoscopy in the Management of Colonic Diverticular Bleeding: A Multicenter Randomized Controlled Trial.

    Yuichiro Hirai,Toshio Uraoka， Nobuya Higuchi,Naohiko Harada

    DIGESTION（2024）

    Natl Hosp Org | Gunma Univ | Natl Hosp Org Osaka Natl Hosp | Natl Hosp Org Fukuyama Med Ctr | Natl Hosp Org Disaster Med Ctr | Natl Hosp Org Okayama Med Ctr | Natl Hosp Org Kure Med Ctr | Natl Hosp Org Higashihiroshima Med Ctr | Natl Hosp Org Tsuruga Med Ctr | Natl Hosp Org Fukuokahigashi Med Ctr | Natl Hosp Org Nagoya Med Ctr | Natl Hosp Org Matsumoto Med Ctr | Natl Hosp Org Beppu Med Ctr | Natl Hosp Org Hakodate Natl Hosp | Natl Hosp Org Kochi Natl Hosp | Natl Hosp Org Shibukawa Med Ctr | Natl Hosp Org Tokyo Natl Hosp | Natl Hosp Org Takasaki Gen Med Ctr | Tsuyama Chuo Hosp | Sakamoto Endoscopy Clin | Natl Hosp Org Tokyo Med Ctr | Natl Hosp Org Kyushu Med Ctr

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    Abstract
    Introduction: Contrast-enhanced computed tomography (CE-CT) has been gaining attention as an initial investigation in the management of colonic diverticular bleeding (CDB), yet the role of CE-CT other than its diagnostic yield has not been adequately clarified. We aimed to determine whether the use of urgent CE-CT improves identification of stigmata of recent hemorrhage (SRH) in subsequently performed early colonoscopy (<= 24 h of arrival) or other clinical outcomes of CDB. Methods: We conducted a randomized, open-label, controlled trial at 23 institutions in Japan. Outpatients with suspected CDB were randomly assigned to undergo either urgent CE-CT followed by early colonoscopy (urgent-CE-CT + early-colonoscopy group) or early colonoscopy alone (early-colonoscopy group). The primary outcome was SRH identification. Secondary outcomes included successful endoscopic hemostasis, early (<30 days) and late (<1 year) rebleeding, length of hospital stay, and transfusion requirements. Results: In total, 240 patients, mostly in a hemodynamically stable condition, were randomized. A contrast extravasation on CE-CT was observed in 20 of 115 patients (17.4%) in the urgent-CE-CT + early-colonoscopy group. SRH was identified in 23 of 115 patients (20.0%) in the urgent-CE-CT + early-colonoscopy group and 21 of 118 patients (17.8%) in the early-colonoscopy group (difference, 2.2; 95% confidence interval [CI], -7.9 to 12.3; p = 0.739). Successful endoscopic hemostasis was achieved in 21 patients in each group (18.3% and 17.8%, respectively) (difference, 0.5; 95% CI, -9.4 to 10.4; p = 1.000). There were also no significant differences between groups in early and late rebleeding, length of hospital stay, and transfusion requirements. Conclusion: The use of urgent CE-CT before early colonoscopy did not improve SRH identification or other clinical outcomes in patients with suspected CDB in a hemodynamically stable condition. The routine use of urgent CE-CT as an initial investigation is not recommended in this population, also considering the low rate of extravasation-positive cases (UMIN registry number, UMIN000026865).
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    Key words
    Colonic diverticular bleeding,Contrast-enhanced computed tomography,Early colonoscopy,Lower gastrointestinal bleeding,Stigmata of recent hemorrhage
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    【要点】：本研究通过多中心随机对照试验发现，对于血流动力学稳定的疑似结肠憩室出血患者，紧急增强CT扫描后再进行早期结肠镜检查并未提高近期出血征象的识别率或其他临床结局。
    

    【方法】：在日本23个机构进行了一项随机、开放标签、对照试验，将疑似结肠憩室出血的患者随机分为紧急增强CT扫描后早期结肠镜检查组与仅早期结肠镜检查组。
    

    【实验】：共240名患者参与实验，实验使用的数据集名称为UMIN registry number, UMIN000026865。结果显示两组在近期出血征象的识别率、内镜止血成功率、早期和晚期再出血率、住院天数及输血需求方面均无显著差异。