Mo1778 COLONOSCOPY WITHOUT BOWEL PREPARATION IS AN EXACERBATION FACTOR FOR RECURRENT COLONIC DIVERTICULAR BLEEDING

Colonic diverticular bleeding (CDB) is the most common etiological factor for acute lower gastrointestinal bleeding (LGIB). In approximately 75% of patients with CDB, spontaneous hemostasis is achieved, whereas approximately 25% require therapeutic intervention, such as blood transfusion or hemostatic treatment, for persistent bleeding. As an endoscopic finding of CDB, stigmata of recent hemorrhage (SRH) are important. However, no study has reported a decrease in the post-hemostasis rebleeding rate despite accurate identification of SRH and endoscopic hemostasis, and the etiology remains to be clarified. Our aim was to clarify exacerbation factors for rebleeding after colonoscopy and reduce the post-hemostasis rebleeding rate. We performed a retrospective cohort study involving 123 patients admitted under a diagnosis of CDB between March 2015 and September 2018. Patients with recurrence within 30 days after hemostasis were assigned to the recurrent CDB group and those without recurrence to the controlled CDB group. There were 85 males (69.1%). The mean age was 71.3 years. The recurrent CDB group consisted of 33 patients and the controlled CDB group consisted of 90. In the recurrent CDB group, the presence of extravasation-positive images and colonoscopy without bowel preparation were significantly higher (p<0.01). According to multivariate analysis, the presence of extravasation-positive images (odds ratio: 2.84, 95%CI: 1.05-7.68, p=0.040) and colonoscopy without bowel preparation (odds ratio: 2.98, 95%CI: 1.04-8.54, p=0.042) were exacerbation factors. Contrast-enhanced CT is an effective examination for patients with CDB. Though physicians often perform colonoscopy without bowel preparation when extravasation-positive images are observed on contrast-enhanced CT, SRH may have been overlooked in colonoscopy without bowel preparation in patients with CDB. Untreated SRH leads to a high rebleeding rate. Therefore, colonoscopy with bowel preparation is a very important procedure to reduce the rebleeding rate after hemostasis. Conservative treatment as an initial treatment is highly recommended if there are no marked changes in vital signs even in the presence of extravasation-positive images. And when the general condition becomes stable, we should perform colonoscopy with bowel preparation.