PDF(Pubmed)
Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
目的：结肠憩室出血的急诊内镜止血可有效预防严重后果。然而,出血源的低识别率使得手术对患者和提供者来说都是繁重的。我们的目标是建立一个有效和安全的紧急内窥镜系统。
方法：我们根据过去病例的经验，前瞻性评估了评分系统（Jichi医科大学憩室出血评分：JD评分）的有用性。使用四个标准确定JD评分：对比剂外渗的CT证据，3分；口服抗凝剂（任何类型）使用，2分；C反应蛋白≥1mg/dL，1分;共病指数≥3,1分。根据JD的分数,接受急诊或择期内镜检查的急性憩室出血患者分为JD≥3组或JD<3组,分别。主要和次要终点是出血源识别率和临床结局。
结果：JD≥3和JD<3组包括35和47例患者，分别。出血源识别率，接着是止血程序,JD≥3组明显高于JD<3组(77%vs.23%,p<0.001)，较高的JD评分与较高的出血源识别率相关。在临床结果方面，两组之间没有观察到显著差异，除了JD≥3组比JD<3组在出院后1个月再出血的发生率更高,且需要介入放射学的患者数量更高.亚组分析显示，成功识别出血源和止血有助于缩短住院时间。
结论：我们建立了治疗结肠憩室出血的安全有效的内镜评分系统。JD分数越高,出血来源识别越高，导致成功的止血程序。当生命体征稳定时，JD<3组可以进行选择性内镜检查。
方法：我们根据过去病例的经验，前瞻性评估了评分系统（Jichi医科大学憩室出血评分：JD评分）的有用性。使用四个标准确定JD评分：对比剂外渗的CT证据，3分；口服抗凝剂（任何类型）使用，2分；C反应蛋白≥1mg/dL，1分;共病指数≥3,1分。根据JD的分数,接受急诊或择期内镜检查的急性憩室出血患者分为JD≥3组或JD<3组,分别。主要和次要终点是出血源识别率和临床结局。
结果：JD≥3和JD<3组包括35和47例患者，分别。出血源识别率，接着是止血程序,JD≥3组明显高于JD<3组(77%vs.23%,p<0.001)，较高的JD评分与较高的出血源识别率相关。在临床结果方面，两组之间没有观察到显著差异，除了JD≥3组比JD<3组在出院后1个月再出血的发生率更高,且需要介入放射学的患者数量更高.亚组分析显示，成功识别出血源和止血有助于缩短住院时间。
结论：我们建立了治疗结肠憩室出血的安全有效的内镜评分系统。JD分数越高,出血来源识别越高，导致成功的止血程序。当生命体征稳定时，JD<3组可以进行选择性内镜检查。
