Impact of long-term trends on outcomes in the management of colonic diverticular bleeding: mediation analyses in a large multicenter study.
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Narimatsu Kazuyuki, Ishii Naoki, Yamada Atsuo, Aoki Tomonori, Kobayashi Katsumasa, Yamauchi Atsushi, Omori Jun, Ikeya Takashi, Aoyama Taiki, Tominaga Naoyuki, Sato Yoshinori, Kishino Takaaki, Sawada Tsunaki, Murata Masaki, Takao Akinari, Mizukami Kazuhiro, Kinjo Ken, Fujimori Shunji, Uotani Takahiro, Fujita Minoru, Sato Hiroki, Suzuki Sho, Narasaka Toshiaki, Hayasaka Junnosuke, Funabiki Tomohiro, Kinjo Yuzuru, Mizuki Akira, Kiyotoki Shu, Mikami Tatsuya, Gushima Ryosuke, Fujii Hiroyuki, Fuyuno Yuta, Hikichi Takuto, Toya Yosuke, Manabe Noriaki, Nagaike Koji, Kinjo Tetsu, Sumida Yorinobu, Funakoshi Sadahiro, Kobayashi Kiyonori, Matsuhashi Tamotsu, Komaki Yuga, Hokari Ryota, Kaise Mitsuru, Nagata Naoyoshi
Аннотация
METHODS: We performed a retrospective tendency analysis on a biennial basis, a propensity score-matched cohort study between the first and latter half groups, and mediation analyses to compare the diagnostic and treatment methods between January 2010 and December 2019 (CODE BLUE-J Study).
RESULTS: A total of 6575 patients with CDB were included. While the use of colonoscopy as the initial diagnostic procedure declined, the use of computed tomography (CT) increased in both the trend test and before-and-after comparisons. In hemostasis therapy, the use of endoscopic clips declined and band ligation increased. Interventional radiology remained unchanged; however, the number of surgeries decreased over time. The stigmata of recent hemorrhage (SRH) detection rate and length of hospital stay (LOS) improved significantly. Mediation analyses showed that use of a distal attachment and water-jet scope contributed to an improved SRH detection rate, and use of band ligation contributed to preventing rebleeding within 30 days.
CONCLUSIONS: Management strategies for CDB have changed in the past decade, particularly regarding the increased use of CT and decreased need for surgery. However, the main outcomes, except for the SRH detection rate and LOS, did not improve. The widespread use of distal attachment, water-jet scope, and band ligation could improve outcomes in CDB management.