BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To...BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODS We conducted a single-center retrospective cohort study.Patients who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after colonoscopy.RESULTS We identified 574 CDH cases.Patients were divided into the early(n=328)and elective(n=226)groups.After propensity score matching,191 pairs were generated.The length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.展开更多
BACKGROUND Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world.It is one of the most common gastrointestinal conditions responsible for hospital admi...BACKGROUND Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world.It is one of the most common gastrointestinal conditions responsible for hospital admissions.AIM To identify mortality trends of diverticular disease among adults in the United States,examining regional and demographic variations,as these have not been previously studied.These trends are highly beneficial to studying disease burden and vulnerable populations.METHODS Diverticular disease-related mortality data were extracted as age-adjusted mortality rates(AAMRs)from death certificate data of the CDC WONDER database using International Statistical Classification of Diseases and Related Health Problems-10th Revision codes K57.0 to K57.9 from 1999 to 2020 in adults≥45 years of age per 100000 population.These AAMRs were stratified by gender,ethnicity,and demographics and analyzed using Joinpoint regression to determine annual percent changes(APCs)and assess trend changes.RESULTS Between 1999 and 2020,a total of 114044 diverticular disease-related deaths were reported among adults≥45 years of age.Our analysis reports progressive decline in mortality with AAMR decreasing from 6.7 in 1999 to 6.1 in 2003[APC:-2.60;95%confidence interval(CI):-3.79 to-0.33],after which it further declined to 3.6 in 2013(APC:-5.16;95%CI:-7.26 to-4.74),with a minimal decrease to 3.5 in 2020(APC:-0.65;95%CI:-1.87 to 1.51).Women had a higher AAMR(4.8)than men(3.8)throughout the study period.The racial analysis reported the highest overall AAMR in non-Hispanic(NH)Whites(4.7),followed by NH Black or African American(3.9),Hispanic or Latino(3.1),and Asian or Pacific Islander(1.5),with unreliable data for the American Indian or Alaska Native population.States in the top 90th percentile,such as Wyoming and Vermont,had approximately double the AAMRs compared to states in the bottom 10th percentile.The mortality rate also exhibited regional disparities,with an overall AAMR higher in the Midwest and West regions(4.7)compared to the Northeast and South regions(4.2),and higher in nonmetropolitan areas(5.4)compared to metropolitan areas(4.2).CONCLUSION Although the annual mortality of diverticular disease has decreased since 1999,there are certain demographic and regional disparities,with mortality rates higher in women,NH White and NH Black adults,Western regions,and nonmetropolitan areas.Further research is needed to identify factors responsible for these disparities and plan appropriate interventions.展开更多
BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used ...BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used for hemostasis in patients with CDB.Endoscopic detachable snare ligation(EDSL)has also become an increasingly common treatment option.The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.AIM To study the effectiveness and complications of endoscopic clipping,EBL,and EDSL for CDB.METHODS We conducted a systematic search of PubMed/MEDLINE,Scopus,Web of Science,Embase,Google Scholar,and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping,EBL,or EDSL as treatment methods.The pooled estimates of initial hemostasis,early and late rebleeding,and the need for transarterial embolization or surgery between these groups were calculated.RESULTS We analyzed 28 studies with 5224 patients.Of these,4526 had active CDB and required one of the three endoscopic interventions.The pooled prevalence of early rebleeding was 23.5%,10.7%,and 10.6%in the endoscopic clipping,EBL,and EDSL groups,respectively.Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL[odds ratio(OR)=3.76(95%CI:2.13-6.63)]and EDSL(OR=3.30,95%CI:1.28-8.53).There was no difference in the initial hemostasis between the three groups.The pooled prevalence of late rebleeding was 27.2%in the clipping,followed by 13.8%in the EBL and 2.7%in the EDSL group.Compared to 2.6%in the EBL group,4.0%of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization.These results were consistent in the network meta-analysis.Based on the ranking of the indirect comparison of modalities,the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.CONCLUSION The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.展开更多
BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying ...BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying the stigmata of a recent hemorrhage(SRH)during colonoscopy enables targeted hemostasis and reduces rebleeding.However,no benchmark exists for an appropriate observation duration,resulting in operator-dependent variation.Short observation periods may lead to missed SRH,whereas unnecessarily prolonged procedures,particularly in older patients,can increase patient burden and limit endoscopy unit availability.METHODS We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital.The Observation time was measured from scope insertion to SRH detection(excluding therapeutic time)or withdrawal.The primary outcome,the“5%plateau time”,was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%.Computed tomography(CT)-based stratified analyses were performed by endoscopists who conducted≥10%of procedures.RESULTS Of the 1039 patients who underwent colonoscopy,845(mean age 77±11 years;64.5%male)were included.Nine board-certified endoscopists performed the procedures.SRH was detected in 286 patients(33.8%),with a median detection time of 19 minutes(interquartile range,12-28 minutes).The overall 5%plateau time was 40 minutes and varied according to the CT findings:40,35,and 30 minutes for no extravasation,right-sided extravasation,and left-sided extravasation,respectively.This time point corresponded to when 80%-90%of SRH cases were detected.De-spite variations in SRH detection rates and observation durations among endoscopists,the 5%plateau time was consistently approximately 40 minutes.CONCLUSION Although it varied according to the CT findings,the overall 5%plateau time was 40 minutes.This offers a practical benchmark for the minimum observation time without SRH detection.展开更多
Esophageal diverticulum can be broadly classified into three main types:Phar-yngoesophageal diverticulum located near the upper esophageal sphincter(including Zenker’s diverticulum,Killian-Jamieson diverticulum,and L...Esophageal diverticulum can be broadly classified into three main types:Phar-yngoesophageal diverticulum located near the upper esophageal sphincter(including Zenker’s diverticulum,Killian-Jamieson diverticulum,and Laimer’s diverticulum);Mid-esophageal diverticulum,and epiphrenic diverticulum loca-ted just above the lower esophageal sphincter.Most asymptomatic esophageal diverticulum are incidentally detected during routine imaging studies,such as barium swallow,computed tomography scans,or esophagogastroduodenoscopy.For these patients,regular follow-up is typically sufficient.However,a small subset may experience persistent symptoms such as dysphagia and acid reflux.Patients with symptomatic diverticulum should be assessed for the potential need for surgical intervention to prevent serious complications,including aspiration pneumonia and malnutrition.The treatment options for symptomatic esophageal diverticulum encompass both endoscopic and surgical approaches.Due to the technical complexity and significant risks associated with surgical intervention,endoscopic treatment has gained increasing preference,achieving remarkable results with the advancements in endoscopic instruments and techniques.Given the anatomical location and pathophysiological differences among esophageal diverticulum,a personalized endoscopic strategy is essential to achieve optimal results.This review provides an overview of the characteristics of esophageal diverticulum and offers a comprehensive discussion of diverticular peroral endoscopic myotomy and its related variations as the primary endoscopic treat-ment strategy.展开更多
AIM: To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between A...AIM: To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex. RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7). CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.展开更多
AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, ...AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive out- patients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A （n = 24 patients） received 1 symbiotic sachet Flortec~ （Lactobacillus paracasei B21060） once daily plus high-fibre diet for 6 mo. Treatment B （n = 21 patients） received high-fibre diet alone for 6 rno. The primary endpoint was regres- sion of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. RESULTS： In group A, the proportion of patients with abdominal pain 〈 24 h decreased from 100% at base- line to 35% and 25% after 3 and 6 mo, respectively （P 〈 0.001）. In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively （P = 0.001）. Symptom improvement became statistically sig- nificant at 3 and 6 mo in group A and B, respectively. The proportion of patients with abdominal pain 〉24 h decreased from 60% to 20% then 5% after 3 and 6 too, respectively in group A （P 〈 0.001） and from 33.3% to 9.5% at both 3 and 6 mo in group B （P = 0.03）. In group A the proportion of patients with ab- dominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable （65%） at 6-mo follow-up （P = 0.005） while in group B, no significant changes in abdominal bloating was observed （P = 0.11）. After 6 mo of treatment, the mean visual analogic scale （VAS） values of both short-lasting abdominal pain （VAS, mean ± SD, group A： 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B： 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03） and abdom- inal bloating （VAS, mean ± SD, group A： 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B： 5.3 ±3.2 vs 2.3 ± 1.9, P = 0.006） decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec group, but remained unchanged in the high-fibre diet group （VAS, mean ± SD, group A： 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B： 4.5 ± 3.8 vs 5.5 ± 3.5）. CONCLUSION： A high-fibre diet is effective in relievingabdominal symptoms in symptomatic uncomplicated di- verticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec~.展开更多
AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastro...AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.展开更多
Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in we...Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in western nations.The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum.Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality.In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber.In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development.We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal.We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.展开更多
AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and...AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed.The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology.Rightsided diverticula were classified as those arising from the cecum,ascending colon,and transverse colon,and those from the descending colon,sigmoid colon,and rectum were classified as left-sided diverticulosis.To assess the changing trend of occurrence of diverticulosis,data were compared with two previous studies of 51 patients.RESULTS:The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001,(27.5%vs48.1%,P<0.05).Moreover,no differences in gender,body mass index,multiplicity of the diverticula,fever,or leukocytosis were noted between patients with rightsided and left-sided disease.However,patients with right-sided disease were significantly younger(50.9year vs 64.0 year,P<0.01).Furthermore,left-sided disease was significantly associated with a higher incidence of complicated diverticulitis(89.2%vs 57.5%,P<0.01),combined resection due to extensive inflammation(21.6%vs 5.0%,P<0.05),operative complications(51.4%vs 27.5%,P<0.05),and in-hospital mortality(10.8%vs 0%,P<0.05),along with longer post-operative hospitalization duration(21.3±10.2 d vs 10.6±8.1 d,P<0.05).CONCLUSION:Compared with right-sided diverticular disease,the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.展开更多
AIM:To investigate associations between ethnicity,age and sex and the risk,colon distribution and density scores of diverticular disease(DD).METHODS:Barium enemas were examined in 1000 patients:410 male,590 female;760...AIM:To investigate associations between ethnicity,age and sex and the risk,colon distribution and density scores of diverticular disease(DD).METHODS:Barium enemas were examined in 1000 patients:410 male,590 female;760 whites,62 Asians,44 black africans(BAs),and 134 other blacks(OBs).Risks and diverticula density of left-sided DD(LSDD)and rightsided-component DD(RSCDD=right-sided DD+right and left DD+Pan-DD)were compared using logistic regression.RESULTS:Four hundred and forty-seven patients had DD(322 LSDD and 125 RSCDD).Adjusted risks:(1)LSDD:each year increase in age increased the odds by 6%(95%CI:5-8,SE:0.8%,P<0.001);Asians:odds ratio(OR):0.23(95%CI:0.10-0.53,SE:0.1,P≤0.001)and OBs:OR:0.25(95%CI:0.14-0.43,SE:0.07,P≤0.001)appeared protected vs Whites;(2)RSCDD:each year increase in age increased the odds by 4%(95%CI:2-6,SE:1%,P<0.001);females were 0.60 times(95%CI:0.40-0.90,SE:0.12,P=0.01)less likely than males to have RSCDD;BAs were 3.51 times(95%CI:1.70-7.24,SE:1.30,P<0.001)more likely than Whites to have RSCDD;and(3)DD density scores:each year increase in age increased the odds of highdensity scores by 4%(95%CI:1-6,SE:1%,P<0.001);RSCDD was 2.77 times(95%CI:1.39-3.32,SE:0.67,P<0.001)more likely to be of high density than LSDD.No further signif icant differences were found in the adjusted models.CONCLUSION:Right colonic DD might be more common and has higher diverticula density in the west than previously reported.BAs appear predisposed to DD,whereas other ethnic differences appear conserved following migration.展开更多
AIM:To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.METHODS:We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the ...AIM:To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.METHODS:We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August2010 and March 2012 at Yokohama Rosai Hospital.Twenty patients were included in the review,consisting of 14 men and 6 women.The median age of the patients was 73.5 years.The duration of the followup period ranged from 1 to 19 mo(median:9.8 mo).Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization,6patients who required it for re-bleeding that developed after the patient left the hospital,and 3 patients who required the procedure for the prevention of rebleeding.Barium(concentration:150 w%/v%)was administered per the rectum,and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy.After confirmation that the ascending colon and cecum were filled with barium,the enema tube was withdrawn,and the patient’s position was changed every 20 min for 3 h.RESULTS:Twelve patients remained free of rebleeding during the follow-up period(range:1-19mo)after the therapeutic barium enema,including 9men and 3 women with a median age of 72.0 years.Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years:4developed early re-bleeding,defined as re-bleeding that occurs within one week after the procedure,and the remaining 4 developed late re-bleeding.The DFI(disease-free interval)decreased 0.4 for 12 mo.Only one patient developed a complication from therapeutic barium enema(colonic perforation).CONCLUSION:Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.展开更多
We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hos...We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hospital. Following the transfusion of 4 U of blood and continued hematochezia, a colonoscopy was performed. Active bleeding was seen as continuous arterial spurting from a single diverticulum located in the middle ascending colon. This diverticulum was seamed by four endoclips. The next day, the patient became febrile with a temperature of 39.2℃. Laboratory data included a white blood cell count of 18 100/mm3 and a C-reactive protein level of 3.4 mg/dL. He was diagnosed with sepsis since Escherichia coli was detected in the blood culture. Antibiotics were started. Four days later his fever had improved and laboratory data improved 9 d later.展开更多
AIM: To classify changes over time in causes of lower gastrointestinal bleeding(LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage(DH).METHODS: A tota...AIM: To classify changes over time in causes of lower gastrointestinal bleeding(LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage(DH).METHODS: A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group(EG, 1995-2006, n = 828) and a late group(LG, 2007-2013, n = 975), and specific diseases were compared between groups. In addition, antithrombotic drug(ATD) use and nonsteroidal anti-inflammatory drug(NSAID) use were comparedbetween patients with and without DH. RESULTS: Older patients(≥ 70 years old) and those with colonic DH were more frequent in LG than in EG(P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity(body mass index ≥ 25 kg/m2), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION: Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients.展开更多
AIM To compare gut bacterial diversity and amount of Enterobacteriaceae in colonic mucosa between patients with and without diverticular disease(DD).METHODS Patients in a stable clinical condition with planned electiv...AIM To compare gut bacterial diversity and amount of Enterobacteriaceae in colonic mucosa between patients with and without diverticular disease(DD).METHODS Patients in a stable clinical condition with planned elective colonoscopy were included. Blood samples and colon mucosa biopsies were collected at the colonoscopy. Study questionnaires including questions about gastrointestinal symptoms were completed by the patients and physicians. DNA from mucosa samples was isolated and the amount of Enterobacteriaceae was estimated using PCR assay. Terminal restriction frag mentlength polymorphism was applied to assess microbial diversity. Diversity was estimated by calculations of richness(number of terminal restriction fragments) and Shannon-Wiener and Simpson's indices. RESULTS A total of 51 patients were included, 16 patients with DD [68(62-76) years] and 35 controls [62(40-74) years] without any diverticula. Patients with DD had significantly higher levels of Enterobacteriaceae than those without DD(P = 0.043), and there was an inverse relationship between the amount of Enterobacteriaceae and the Simpson's index(rs =-0.361, P = 0.033) and the Shannon-Wiener index(rs =-0.299, P = 0.081). The Simpson's index(P = 0.383), Shannon-Wiener index(P = 0.401) or number of restrictions fragments(P = 0.776) did not differ between DD and controls. The majority of patients experienced gastrointestinal symptoms, and 22 patients(43.1%) fulfilled the criteria for irritable bowel syndrome, with no difference between the groups(P = 0.212). Demography, socioeconomic status, lifestyle habits, inflammatory biomarkers, or symptoms were not related to the amount of Enterobacteriaceae or bacterial diversity. CONCLUSION Patients with DD had higher amount of Enterobacteriaceae in the colon mucosa compared to patients without diverticula.展开更多
I read with interest the review on the pathogenesis of diverticular disease by Commane et al in World J Gastroenterol 2009;15(20):2479-2488.However,I would like to discuss several important errors that the authors mad...I read with interest the review on the pathogenesis of diverticular disease by Commane et al in World J Gastroenterol 2009;15(20):2479-2488.However,I would like to discuss several important errors that the authors made whilst citing information from previously published work on the neuromuscular dysfunction in the disease.展开更多
Numerous drugs,largely used in the wards or at home,have a significant influence on patients with untreated diverticular disease.The consequences can be disastrous,may require an emergency operation,postoperative inte...Numerous drugs,largely used in the wards or at home,have a significant influence on patients with untreated diverticular disease.The consequences can be disastrous,may require an emergency operation,postoperative intensive care,and overall influence the patient’s length of stay and the final outcomes.Bearing these considerations in mind the routine or chronic administration of pain-killers,steroids and non-steroidal anti-inflammatory should be balanced in patients with known diverticular disease as it normally happens with other conditions potentially affected by these drugs(i.e.,peptic ulcer disease or chronic obstructive pulmonary disease).This is even more important in the old and frail patient where an eventual surgical treatment may not always be possible.展开更多
Diverticula are the most common incidental finding during routine colonoscopy,and their prevalence increases with patient age.The term“diverticular disease”encompasses the range of clinical manifestations and compli...Diverticula are the most common incidental finding during routine colonoscopy,and their prevalence increases with patient age.The term“diverticular disease”encompasses the range of clinical manifestations and complications that can occur with colonic diverticula,including diverticular bleeding,diverticulitisassociated strictures,and acute diverticulitis.Colonoscopy is a vital tool in the diagnosis and management of diverticular disease and can be useful in a variety of regards.In this editorial,we concisely delineate the current approach to and practices in colonoscopic management of diverticular disease.In particular,we discuss treatment options for diverticular bleeding,propose consideration of colonic stenting as a bridge to surgery in patients with diverticulitis-associated strictures,and the need for diagnostic colonoscopy following an episode of acute diverticulitis in order to rule out underlying conditions such as colonic malignancy or inflammatory bowel disease.In addition,we offer practical tips for performing safe and successful colonoscopy in patients with dense diverticulosis coli.展开更多
AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underw...AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized data base. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the other undergoing acute surgery (acute group). RESULTS: Two hundred and ninety-nine patients were admitted between 2000 and 2007. One hundred and seventy-eight patients underwent acute surgery and 121 patients received elective operations. The median age of the 121 patients was 69 years (range: 28-94 years), significantly higher in acute patients (P = 0.010). Laparoscopic resection was performed in 31% of elective patients. In the acute setting, 61% underwent a Hartmann procedure. The overall morbidity and mortality were 51% and 10%, and 60% and 16% in the acute group, which were significantly higher than in the elective group (36% and 1%). Only 35% of the temporary ostomies were restored. CONCLUSION: This study gives a picture of current surgical practice for DD in the Netherlands. New developments are implemented in daily practice, resulting in acceptable morbidity and mortality rates.展开更多
Diverticular disease(DD) of the colon is very common in developed countries and is ranked the fifth most important gastrointestinal disease worldwide.The management of acute diverticulitis without perforation and peri...Diverticular disease(DD) of the colon is very common in developed countries and is ranked the fifth most important gastrointestinal disease worldwide.The management of acute diverticulitis without perforation and peritonitis is still debated.Health related quality of life(HRQL),subjectively perceived by patients,is becoming a major issue in the evaluation of any therapeutic intervention,mainly in patients with chronic disease.To date only a few published studies can be found on Medline examining HRQL in patients with DD.The aim of this study was to review the impact of surgery for DD on HRQL.All Medline articles regarding HRQL after surgery for colonic DD,particularly those comparing different surgical approaches,were reviewed.DD has a negative impact on HRQL with lower scores in bowel function and systemic symptoms.Both surgery-related complications and disease activity have a significant impact on patients' HRQL.While no signif icant differences in HRQL between different operations for DD in non-randomized studies were revealed,the only prospective double-blind randomized study that compared laparoscopic and open colectomy found that patients undergoing laparoscopic colectomy had signif icantly reduced major postoperative complication rates and subsequently had better HRQL scores.Formal assessment of HRQL could be a good instrument in the selection of appropriate patients for elective surgery as well as in the assessment of surgical outcome.展开更多
文摘BACKGROUND Current guidelines recommend colonoscopy within 24 h for acute lower gastrointestinal bleeding;however,the evidence in support for colonic diverticular hemorrhage(CDH)indications remains insufficient.AIM To investigate the effectiveness of early colonoscopy on the length of hospital stay for CDH patients.METHODS We conducted a single-center retrospective cohort study.Patients who underwent colonoscopy within 24 h of presentation(early group)were compared with those who underwent colonoscopy beyond 24 h of presentation(elective group).The primary outcome was the length of hospital stay,and secondary outcomes were the identification of stigmata of recent hemorrhage(SRH),rebleeding,red blood cell transfusion more than 4 units,and interventional radiology and abdominal surgery after colonoscopy.RESULTS We identified 574 CDH cases.Patients were divided into the early(n=328)and elective(n=226)groups.After propensity score matching,191 pairs were generated.The length of hospital stay did not significantly differ between the two groups(early group vs elective group;median,7 vs 8 d;P=0.10).The early group had a significantly high identification of SRH(risk difference,11.6%;95%CI:2.7 to 20.3;P=0.02).No significant differences were found in the rebleeding(risk difference,4.7%;95%CI:-4.1 to 13.5;P=0.35),red blood cell transfusion more than 4 units(risk difference,1.6%;95%CI:-7.5 to 10.6;P=0.82),and interventional radiology and abdominal surgery rate after colonoscopy(risk difference,0.5%;95%CI:-2.2 to 3.2;P=1.00).CONCLUSION Early colonoscopy within 24 h,on arrival for CDH,could not improve the length of hospital stay.
文摘BACKGROUND Diverticular disease of the intestine is a major gastrointestinal cause of mortality in the United States and the world.It is one of the most common gastrointestinal conditions responsible for hospital admissions.AIM To identify mortality trends of diverticular disease among adults in the United States,examining regional and demographic variations,as these have not been previously studied.These trends are highly beneficial to studying disease burden and vulnerable populations.METHODS Diverticular disease-related mortality data were extracted as age-adjusted mortality rates(AAMRs)from death certificate data of the CDC WONDER database using International Statistical Classification of Diseases and Related Health Problems-10th Revision codes K57.0 to K57.9 from 1999 to 2020 in adults≥45 years of age per 100000 population.These AAMRs were stratified by gender,ethnicity,and demographics and analyzed using Joinpoint regression to determine annual percent changes(APCs)and assess trend changes.RESULTS Between 1999 and 2020,a total of 114044 diverticular disease-related deaths were reported among adults≥45 years of age.Our analysis reports progressive decline in mortality with AAMR decreasing from 6.7 in 1999 to 6.1 in 2003[APC:-2.60;95%confidence interval(CI):-3.79 to-0.33],after which it further declined to 3.6 in 2013(APC:-5.16;95%CI:-7.26 to-4.74),with a minimal decrease to 3.5 in 2020(APC:-0.65;95%CI:-1.87 to 1.51).Women had a higher AAMR(4.8)than men(3.8)throughout the study period.The racial analysis reported the highest overall AAMR in non-Hispanic(NH)Whites(4.7),followed by NH Black or African American(3.9),Hispanic or Latino(3.1),and Asian or Pacific Islander(1.5),with unreliable data for the American Indian or Alaska Native population.States in the top 90th percentile,such as Wyoming and Vermont,had approximately double the AAMRs compared to states in the bottom 10th percentile.The mortality rate also exhibited regional disparities,with an overall AAMR higher in the Midwest and West regions(4.7)compared to the Northeast and South regions(4.2),and higher in nonmetropolitan areas(5.4)compared to metropolitan areas(4.2).CONCLUSION Although the annual mortality of diverticular disease has decreased since 1999,there are certain demographic and regional disparities,with mortality rates higher in women,NH White and NH Black adults,Western regions,and nonmetropolitan areas.Further research is needed to identify factors responsible for these disparities and plan appropriate interventions.
文摘BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used for hemostasis in patients with CDB.Endoscopic detachable snare ligation(EDSL)has also become an increasingly common treatment option.The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.AIM To study the effectiveness and complications of endoscopic clipping,EBL,and EDSL for CDB.METHODS We conducted a systematic search of PubMed/MEDLINE,Scopus,Web of Science,Embase,Google Scholar,and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping,EBL,or EDSL as treatment methods.The pooled estimates of initial hemostasis,early and late rebleeding,and the need for transarterial embolization or surgery between these groups were calculated.RESULTS We analyzed 28 studies with 5224 patients.Of these,4526 had active CDB and required one of the three endoscopic interventions.The pooled prevalence of early rebleeding was 23.5%,10.7%,and 10.6%in the endoscopic clipping,EBL,and EDSL groups,respectively.Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL[odds ratio(OR)=3.76(95%CI:2.13-6.63)]and EDSL(OR=3.30,95%CI:1.28-8.53).There was no difference in the initial hemostasis between the three groups.The pooled prevalence of late rebleeding was 27.2%in the clipping,followed by 13.8%in the EBL and 2.7%in the EDSL group.Compared to 2.6%in the EBL group,4.0%of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization.These results were consistent in the network meta-analysis.Based on the ranking of the indirect comparison of modalities,the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.CONCLUSION The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.
文摘BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying the stigmata of a recent hemorrhage(SRH)during colonoscopy enables targeted hemostasis and reduces rebleeding.However,no benchmark exists for an appropriate observation duration,resulting in operator-dependent variation.Short observation periods may lead to missed SRH,whereas unnecessarily prolonged procedures,particularly in older patients,can increase patient burden and limit endoscopy unit availability.METHODS We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital.The Observation time was measured from scope insertion to SRH detection(excluding therapeutic time)or withdrawal.The primary outcome,the“5%plateau time”,was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%.Computed tomography(CT)-based stratified analyses were performed by endoscopists who conducted≥10%of procedures.RESULTS Of the 1039 patients who underwent colonoscopy,845(mean age 77±11 years;64.5%male)were included.Nine board-certified endoscopists performed the procedures.SRH was detected in 286 patients(33.8%),with a median detection time of 19 minutes(interquartile range,12-28 minutes).The overall 5%plateau time was 40 minutes and varied according to the CT findings:40,35,and 30 minutes for no extravasation,right-sided extravasation,and left-sided extravasation,respectively.This time point corresponded to when 80%-90%of SRH cases were detected.De-spite variations in SRH detection rates and observation durations among endoscopists,the 5%plateau time was consistently approximately 40 minutes.CONCLUSION Although it varied according to the CT findings,the overall 5%plateau time was 40 minutes.This offers a practical benchmark for the minimum observation time without SRH detection.
基金Supported by the Department of Science and Technology of Liaoning Province,No.2024JH2/102600288.
文摘Esophageal diverticulum can be broadly classified into three main types:Phar-yngoesophageal diverticulum located near the upper esophageal sphincter(including Zenker’s diverticulum,Killian-Jamieson diverticulum,and Laimer’s diverticulum);Mid-esophageal diverticulum,and epiphrenic diverticulum loca-ted just above the lower esophageal sphincter.Most asymptomatic esophageal diverticulum are incidentally detected during routine imaging studies,such as barium swallow,computed tomography scans,or esophagogastroduodenoscopy.For these patients,regular follow-up is typically sufficient.However,a small subset may experience persistent symptoms such as dysphagia and acid reflux.Patients with symptomatic diverticulum should be assessed for the potential need for surgical intervention to prevent serious complications,including aspiration pneumonia and malnutrition.The treatment options for symptomatic esophageal diverticulum encompass both endoscopic and surgical approaches.Due to the technical complexity and significant risks associated with surgical intervention,endoscopic treatment has gained increasing preference,achieving remarkable results with the advancements in endoscopic instruments and techniques.Given the anatomical location and pathophysiological differences among esophageal diverticulum,a personalized endoscopic strategy is essential to achieve optimal results.This review provides an overview of the characteristics of esophageal diverticulum and offers a comprehensive discussion of diverticular peroral endoscopic myotomy and its related variations as the primary endoscopic treat-ment strategy.
文摘AIM: To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex. RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7). CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.
基金Supported by The study was in part supported by Bracco Spa(Milan,Italy)
文摘AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive out- patients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A （n = 24 patients） received 1 symbiotic sachet Flortec~ （Lactobacillus paracasei B21060） once daily plus high-fibre diet for 6 mo. Treatment B （n = 21 patients） received high-fibre diet alone for 6 rno. The primary endpoint was regres- sion of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. RESULTS： In group A, the proportion of patients with abdominal pain 〈 24 h decreased from 100% at base- line to 35% and 25% after 3 and 6 mo, respectively （P 〈 0.001）. In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively （P = 0.001）. Symptom improvement became statistically sig- nificant at 3 and 6 mo in group A and B, respectively. The proportion of patients with abdominal pain 〉24 h decreased from 60% to 20% then 5% after 3 and 6 too, respectively in group A （P 〈 0.001） and from 33.3% to 9.5% at both 3 and 6 mo in group B （P = 0.03）. In group A the proportion of patients with ab- dominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable （65%） at 6-mo follow-up （P = 0.005） while in group B, no significant changes in abdominal bloating was observed （P = 0.11）. After 6 mo of treatment, the mean visual analogic scale （VAS） values of both short-lasting abdominal pain （VAS, mean ± SD, group A： 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B： 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03） and abdom- inal bloating （VAS, mean ± SD, group A： 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B： 5.3 ±3.2 vs 2.3 ± 1.9, P = 0.006） decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec group, but remained unchanged in the high-fibre diet group （VAS, mean ± SD, group A： 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B： 4.5 ± 3.8 vs 5.5 ± 3.5）. CONCLUSION： A high-fibre diet is effective in relievingabdominal symptoms in symptomatic uncomplicated di- verticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec~.
基金Supported by Department of Gastroenterology and Hepatology,Chang Gung Memorial Hospital
文摘AIM:To evaluate the efficacy of endoscopic diagnosis and therapy for jejunal diverticular bleeding.METHODS:From January 2004 to September 2009,154 patients underwent double-balloon enteroscopy (DBE) for obscure gastrointestinal bleeding.Ten consecutive patients with jejunal diverticula (5 males and 5 females) at the age of 68.7 ± 2.1 years (range 1995 years) at Chang Gung Memorial Hospital,Academic Tertiary Referral Center,were enrolled in this study.RESULTS:Of the 10 patients,5 had melena,2 had hematochezia,2 had both melena and hematochezia,1 had anemia and dizziness.DBE revealed ulcers with stigmata of recent hemorrhage in 6 patients treated by injection of epinephrine diluted at 1:10 000,Dieulafoylike lesions in 4 patients treated by deploying hemoclips on the vessels,colonic diverticula in 2 patients,and duodenal diverticula in 3 patients,respectively.Of the 2patients who underwent surgical intervention,1 had a large diverticulum and was referred by the surgeon for DBE,1 received endoscopic therapy but failed due to massive bleeding.One patient had a second DBE for recurrent hemorrhage 7 mo later,which was successfully treated with a repeat endoscopy.The mean follow-up time of patients was 14.7 ± 7.8 mo.CONCLUSION:DBE is a safe and effective treatment modality for jejunal diverticular bleeding.
基金Supported by Food Standards Agency, N12105Northumbria Colorectal Research Funds
文摘Diverticular disease(DD) is an age-related disorder of the large bowel which may affect half of the population over the age of 65 in the UK.This high prevalence ranks it as one of the most common bowel disorders in western nations.The majority of patients remain asymptomatic but there are associated life-threatening co-morbidities, which, given the large numbers of people with DD, translates into a considerable number of deaths per annum.Despite this public health burden, relatively little seems to be known about either the mechanisms of development or causality.In the 1970s, a model of DD formulated the concept that diverticula occur as a consequence of pressureinduced damage to the colon wall amongst those with a low intake of dietary fiber.In this review, we have examined the evidence regarding the influence of ageing, diet, inflammation and genetics on DD development.We argue that the evidence supporting the barotrauma hypothesis is largely anecdotal.We have also identified several gaps in the knowledge base which need to be filled before we can complete a model for the etiology of diverticular disease.
文摘AIM:To compare the outcome of the surgical management of left-sided and right-sided diverticular disease.METHODS:The medical records of 77 patients who were surgically treated for diverticular disease between 1999 and 2010 in a tertiary referral hospital were retrospectively reviewed.The study population was limited to cases wherein the surgical specimen was confirmed as diverticulosis by pathology.Rightsided diverticula were classified as those arising from the cecum,ascending colon,and transverse colon,and those from the descending colon,sigmoid colon,and rectum were classified as left-sided diverticulosis.To assess the changing trend of occurrence of diverticulosis,data were compared with two previous studies of 51 patients.RESULTS:The proportion of left-sided disease cases was significantly increased compared to the results of our previous studies in 1994 and 2001,(27.5%vs48.1%,P<0.05).Moreover,no differences in gender,body mass index,multiplicity of the diverticula,fever,or leukocytosis were noted between patients with rightsided and left-sided disease.However,patients with right-sided disease were significantly younger(50.9year vs 64.0 year,P<0.01).Furthermore,left-sided disease was significantly associated with a higher incidence of complicated diverticulitis(89.2%vs 57.5%,P<0.01),combined resection due to extensive inflammation(21.6%vs 5.0%,P<0.05),operative complications(51.4%vs 27.5%,P<0.05),and in-hospital mortality(10.8%vs 0%,P<0.05),along with longer post-operative hospitalization duration(21.3±10.2 d vs 10.6±8.1 d,P<0.05).CONCLUSION:Compared with right-sided diverticular disease,the incidence of left-sided disease in Korea has increased since 2001 and is associated with worse surgical outcomes.
文摘AIM:To investigate associations between ethnicity,age and sex and the risk,colon distribution and density scores of diverticular disease(DD).METHODS:Barium enemas were examined in 1000 patients:410 male,590 female;760 whites,62 Asians,44 black africans(BAs),and 134 other blacks(OBs).Risks and diverticula density of left-sided DD(LSDD)and rightsided-component DD(RSCDD=right-sided DD+right and left DD+Pan-DD)were compared using logistic regression.RESULTS:Four hundred and forty-seven patients had DD(322 LSDD and 125 RSCDD).Adjusted risks:(1)LSDD:each year increase in age increased the odds by 6%(95%CI:5-8,SE:0.8%,P<0.001);Asians:odds ratio(OR):0.23(95%CI:0.10-0.53,SE:0.1,P≤0.001)and OBs:OR:0.25(95%CI:0.14-0.43,SE:0.07,P≤0.001)appeared protected vs Whites;(2)RSCDD:each year increase in age increased the odds by 4%(95%CI:2-6,SE:1%,P<0.001);females were 0.60 times(95%CI:0.40-0.90,SE:0.12,P=0.01)less likely than males to have RSCDD;BAs were 3.51 times(95%CI:1.70-7.24,SE:1.30,P<0.001)more likely than Whites to have RSCDD;and(3)DD density scores:each year increase in age increased the odds of highdensity scores by 4%(95%CI:1-6,SE:1%,P<0.001);RSCDD was 2.77 times(95%CI:1.39-3.32,SE:0.67,P<0.001)more likely to be of high density than LSDD.No further signif icant differences were found in the adjusted models.CONCLUSION:Right colonic DD might be more common and has higher diverticula density in the west than previously reported.BAs appear predisposed to DD,whereas other ethnic differences appear conserved following migration.
基金Supported by Research funding,Abbott Japan Co.,LTD
文摘AIM:To evaluate the effectiveness of barium impaction therapy for patients with colonic diverticular bleeding.METHODS:We reviewed the clinical charts of patients in whom therapeutic barium enema was performed for the control of diverticular bleeding between August2010 and March 2012 at Yokohama Rosai Hospital.Twenty patients were included in the review,consisting of 14 men and 6 women.The median age of the patients was 73.5 years.The duration of the followup period ranged from 1 to 19 mo(median:9.8 mo).Among the 20 patients were 11 patients who required the procedure for re-bleeding during hospitalization,6patients who required it for re-bleeding that developed after the patient left the hospital,and 3 patients who required the procedure for the prevention of rebleeding.Barium(concentration:150 w%/v%)was administered per the rectum,and the leading edge of the contrast medium was followed up to the cecum by fluoroscopy.After confirmation that the ascending colon and cecum were filled with barium,the enema tube was withdrawn,and the patient’s position was changed every 20 min for 3 h.RESULTS:Twelve patients remained free of rebleeding during the follow-up period(range:1-19mo)after the therapeutic barium enema,including 9men and 3 women with a median age of 72.0 years.Re-bleeding occurred in 8 patients including 5 men and 3 women with a median age of 68.5 years:4developed early re-bleeding,defined as re-bleeding that occurs within one week after the procedure,and the remaining 4 developed late re-bleeding.The DFI(disease-free interval)decreased 0.4 for 12 mo.Only one patient developed a complication from therapeutic barium enema(colonic perforation).CONCLUSION:Therapeutic barium enema is effective for the control of diverticular hemorrhage in cases where the active bleeding site cannot be identified by colonoscopy.
文摘We herein report the rare complication of sepsis caused by endoscopic clipping for colonic diverticular bleeding. A 78-year-old man with a 12-h history of near syncope and painless hematochezia was admitted to our hospital. Following the transfusion of 4 U of blood and continued hematochezia, a colonoscopy was performed. Active bleeding was seen as continuous arterial spurting from a single diverticulum located in the middle ascending colon. This diverticulum was seamed by four endoclips. The next day, the patient became febrile with a temperature of 39.2℃. Laboratory data included a white blood cell count of 18 100/mm3 and a C-reactive protein level of 3.4 mg/dL. He was diagnosed with sepsis since Escherichia coli was detected in the blood culture. Antibiotics were started. Four days later his fever had improved and laboratory data improved 9 d later.
文摘AIM: To classify changes over time in causes of lower gastrointestinal bleeding(LGIB) and to identify factors associated with changes in the incidence and characteristics of diverticular hemorrhage(DH).METHODS: A total of 1803 patients underwent colonoscopy for overt LGIB at our hospital from 1995 to 2013. Patients were divided into an early group(EG, 1995-2006, n = 828) and a late group(LG, 2007-2013, n = 975), and specific diseases were compared between groups. In addition, antithrombotic drug(ATD) use and nonsteroidal anti-inflammatory drug(NSAID) use were comparedbetween patients with and without DH. RESULTS: Older patients(≥ 70 years old) and those with colonic DH were more frequent in LG than in EG(P < 0.01). Patients using ATDs as well as NSAIDs, male sex, obesity(body mass index ≥ 25 kg/m2), smoking, alcohol drinking, and arteriosclerotic diseases were more frequent in patients with DH than in those without. CONCLUSION: Incidence of colonic DH seems to increase with aging of the population, and factors involved include use of ATDs and NSAIDs, male sex, obesity, smoking, alcohol drinking, and arteriosclerotic disease. These factors are of value in handling DH patients.
基金Supported by Development Foundation of Region Skane(BO),No.F2014/354
文摘AIM To compare gut bacterial diversity and amount of Enterobacteriaceae in colonic mucosa between patients with and without diverticular disease(DD).METHODS Patients in a stable clinical condition with planned elective colonoscopy were included. Blood samples and colon mucosa biopsies were collected at the colonoscopy. Study questionnaires including questions about gastrointestinal symptoms were completed by the patients and physicians. DNA from mucosa samples was isolated and the amount of Enterobacteriaceae was estimated using PCR assay. Terminal restriction frag mentlength polymorphism was applied to assess microbial diversity. Diversity was estimated by calculations of richness(number of terminal restriction fragments) and Shannon-Wiener and Simpson's indices. RESULTS A total of 51 patients were included, 16 patients with DD [68(62-76) years] and 35 controls [62(40-74) years] without any diverticula. Patients with DD had significantly higher levels of Enterobacteriaceae than those without DD(P = 0.043), and there was an inverse relationship between the amount of Enterobacteriaceae and the Simpson's index(rs =-0.361, P = 0.033) and the Shannon-Wiener index(rs =-0.299, P = 0.081). The Simpson's index(P = 0.383), Shannon-Wiener index(P = 0.401) or number of restrictions fragments(P = 0.776) did not differ between DD and controls. The majority of patients experienced gastrointestinal symptoms, and 22 patients(43.1%) fulfilled the criteria for irritable bowel syndrome, with no difference between the groups(P = 0.212). Demography, socioeconomic status, lifestyle habits, inflammatory biomarkers, or symptoms were not related to the amount of Enterobacteriaceae or bacterial diversity. CONCLUSION Patients with DD had higher amount of Enterobacteriaceae in the colon mucosa compared to patients without diverticula.
文摘I read with interest the review on the pathogenesis of diverticular disease by Commane et al in World J Gastroenterol 2009;15(20):2479-2488.However,I would like to discuss several important errors that the authors made whilst citing information from previously published work on the neuromuscular dysfunction in the disease.
文摘Numerous drugs,largely used in the wards or at home,have a significant influence on patients with untreated diverticular disease.The consequences can be disastrous,may require an emergency operation,postoperative intensive care,and overall influence the patient’s length of stay and the final outcomes.Bearing these considerations in mind the routine or chronic administration of pain-killers,steroids and non-steroidal anti-inflammatory should be balanced in patients with known diverticular disease as it normally happens with other conditions potentially affected by these drugs(i.e.,peptic ulcer disease or chronic obstructive pulmonary disease).This is even more important in the old and frail patient where an eventual surgical treatment may not always be possible.
文摘Diverticula are the most common incidental finding during routine colonoscopy,and their prevalence increases with patient age.The term“diverticular disease”encompasses the range of clinical manifestations and complications that can occur with colonic diverticula,including diverticular bleeding,diverticulitisassociated strictures,and acute diverticulitis.Colonoscopy is a vital tool in the diagnosis and management of diverticular disease and can be useful in a variety of regards.In this editorial,we concisely delineate the current approach to and practices in colonoscopic management of diverticular disease.In particular,we discuss treatment options for diverticular bleeding,propose consideration of colonic stenting as a bridge to surgery in patients with diverticulitis-associated strictures,and the need for diagnostic colonoscopy following an episode of acute diverticulitis in order to rule out underlying conditions such as colonic malignancy or inflammatory bowel disease.In addition,we offer practical tips for performing safe and successful colonoscopy in patients with dense diverticulosis coli.
基金Supported by Reinier de Graaf Gasthuis, VU University Medical Center and Deventer Ziekenhuis
文摘AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized data base. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the other undergoing acute surgery (acute group). RESULTS: Two hundred and ninety-nine patients were admitted between 2000 and 2007. One hundred and seventy-eight patients underwent acute surgery and 121 patients received elective operations. The median age of the 121 patients was 69 years (range: 28-94 years), significantly higher in acute patients (P = 0.010). Laparoscopic resection was performed in 31% of elective patients. In the acute setting, 61% underwent a Hartmann procedure. The overall morbidity and mortality were 51% and 10%, and 60% and 16% in the acute group, which were significantly higher than in the elective group (36% and 1%). Only 35% of the temporary ostomies were restored. CONCLUSION: This study gives a picture of current surgical practice for DD in the Netherlands. New developments are implemented in daily practice, resulting in acceptable morbidity and mortality rates.
文摘Diverticular disease(DD) of the colon is very common in developed countries and is ranked the fifth most important gastrointestinal disease worldwide.The management of acute diverticulitis without perforation and peritonitis is still debated.Health related quality of life(HRQL),subjectively perceived by patients,is becoming a major issue in the evaluation of any therapeutic intervention,mainly in patients with chronic disease.To date only a few published studies can be found on Medline examining HRQL in patients with DD.The aim of this study was to review the impact of surgery for DD on HRQL.All Medline articles regarding HRQL after surgery for colonic DD,particularly those comparing different surgical approaches,were reviewed.DD has a negative impact on HRQL with lower scores in bowel function and systemic symptoms.Both surgery-related complications and disease activity have a significant impact on patients' HRQL.While no signif icant differences in HRQL between different operations for DD in non-randomized studies were revealed,the only prospective double-blind randomized study that compared laparoscopic and open colectomy found that patients undergoing laparoscopic colectomy had signif icantly reduced major postoperative complication rates and subsequently had better HRQL scores.Formal assessment of HRQL could be a good instrument in the selection of appropriate patients for elective surgery as well as in the assessment of surgical outcome.
