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High-Dose Barium Impaction Therapy for the Recurrence of Colonic Diverticular Bleeding

2014; Lippincott Williams & Wilkins; Volume: 261; Issue: 2 Linguagem: Inglês

10.1097/sla.0000000000000658

1528-1140

Naoyoshi Nagata, Ryota Niikura, Takuro Shimbo, Naoki Ishizuka, Kazuyoshi Yamano, Kyoko Mizuguchi, Junichi Akiyama, Mikio Yanase, Masashi Mizokami, Naomi Uemura,

Gastrointestinal Bleeding Diagnosis and Treatment

In Brief Objective: We compared the clinical efficacy of barium therapy and conservative therapy in preventing recurrence in patients with diverticular bleeding. Background: Previous case reports have indicated that barium impaction therapy provides initial hemostasis for diverticular bleeding and prevention against rebleeding. Methods: After spontaneous cessation of bleeding, patients were randomly assigned to conservative treatment (n = 27) or high-dose barium impaction therapy (n = 27). Patients were followed up for 1 year after enrollment of the last patient. The main outcome measure was rebleeding. Results: Median follow-up period was 584.5 days. The probability of rebleeding at 30-day, 180-day, 1-year, and 2-year follow-up in all patients was 3.7%, 14.8%, 28.4%, and 32.7%, respectively. By group, probability at 1 year was 42.5% in the conservative group and 14.8% in the barium group (log-rank test, P = 0.04). After adjustment for a history of hypertension, the hazard ratio of rebleeding in the barium group was 0.34 (95% confidence interval, 0.12–0.98). No complications or laboratory abnormalities due to barium therapy were observed. Compared with the conservative group, the barium group had significantly (P < 0.05) fewer hospitalizations per patient (1.7 vs 1.2), units of blood transfused (1.9 vs 0.7), colonoscopies (1.4 times vs 1.1 times), and hospital stay days (15 days vs 11 days) during the follow-up period. No patients died and none required angiographic or surgical procedures in either group. Conclusions: High-dose barium impaction therapy was effective in the long-term prevention of recurrent bleeding, and reduced the frequency of rehospitalization and need for blood transfusion and colonoscopic examination. ClinicalTrials.gov Identifier, UMIN 000002832. Patients with both definitive and presumptive diverticular bleeding are at high risk of recurrence. High-dose barium impaction therapy is effective in the long-term prevention of rebleeding, and also decreases the rehospitalization, repeated blood transfusion, and reexamination. Barium therapy appears safe and well tolerated by patients.