Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage

Background: Although endoscopy is often used to diagnose and treat acute up per gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain. Methods: We studied the role of urgent colonoscopy in the diagnosis and tre atment of 121 patients with severe hematochezia and diverticulosis. All pat ients were hospitalized, received blood transfusions as needed, and receive d a purge to rid the colon of clots, stool, and blood. Colonoscopy was perf ormed within 6 to 12 hours after hospitalization or the diagnosis of hemato chezia. Among the first 73 patients, those with continued diverticular blee ding underwent hemicolectomy. For the subsequent 48 patients, those requiri ng treatment received therapy, such as epinephrine injections or bipolar co agulation, through the colonoscope. Results: Of the first 73 patients, 17 (23 percent) had definite signs of di verticular hemorrhage (active bleeding in 6, nonbleeding visible vessels in 4, and adherent clots in 7). Nine of the 17 had additional bleeding after colonoscopy, and 6 of these required hemicolectomy. Of the subsequent 48 pa tients, 10 (21 percent) had definite signs of diverticular hemorrhage (acti ve bleeding in 5, nonbleeding visible vessels in 2, and adherent clots in 3 ). An additional 14 patients in this group (29 percent) were presumed to ha ve diverticular bleeding because although they had no stigmata of diverticu lar hemorrhage, no other source of bleeding was identified. The other 24 pa tients (50 percent) had other identified sources of bleeding. All 10 patien ts with definite diverticular hemorrhage were treated endoscopically; none had recurrent bleeding or required surgery. Conclusions: Among patients with severe hematochezia and diverticulosis, at least one fifth have definite diverticular hemorrhage. Colonoscopic treatm ent of such patients with epinephrine injections, bipolar coagulation, or b oth may prevent recurrent bleeding and decrease the need for surgery. (N En gl J Med 2000;342:78-82.) (C) 2000, Massachusetts Medical Society.