Urgent contrast-enhanced computed tomography before early colonoscopy in the management of colonic diverticular bleeding: A multicenter randomized controlled trial

• Published in: Digestion p. 1
• Main Authors: Hirai, Yuichiro, Uraoka, Toshio, Wada, Michiko, Mori, Hideki, Fujimoto, Ai, Sakakibara, Yuko, Toyokawa, Tatsuya, Kagaya, Takashi, Sasaki, Yoshihiro, Mannami, Tomohiko, Kuwai, Toshio, Watanabe, Noriko, Hamada, Hiroshige, Esaka, Naoki, Kimura, Toshihisa, Fujii, Hiroyuki, Hosoda, Yasuo, Shimada, Masaaki, Miyabayashi, Hideharu, Somada, Shinichi, Mabe, Katsuhiro, Inoue, Shuji, Saito, Hiroki, Furuya, Kensuke, Kawamura, Norio, Kudo, Tomohiro, Hori, Keisuke, Sakamoto, Naoto, Kato, Mototsugu, Higuchi, Nobuya, Harada, Naohiko
• Format: Journal Article
• Language: English
• Published: Switzerland 15.10.2024
• ISSN: 1421-9867
• DOI: 10.1159/000541942

Contrast-enhanced computed tomography (CE-CT) has been gaining attention as an initial investigation in the management of colonic diverticular bleeding (CDB), yet the role of CE-CT other than its diagnostic yield, has not been adequately clarified. We aimed to determine whether the use of urgent CE-CT improves identification of stigmata of recent hemorrhage (SRH) in subsequently performed early colonoscopy (≤24 hours of arrival) or other clinical outcomes of CDB. We conducted a randomized, open-label, controlled trial at 23 institutions in Japan. Outpatients with suspected CDB were randomly assigned to undergo either urgent CE-CT followed by early colonoscopy (urgent-CE-CT + early-colonoscopy group) or early colonoscopy alone (early-colonoscopy group). The primary outcome was SRH identification. Secondary outcomes included successful endoscopic hemostasis, early (<30 days) and late (<1 year) rebleeding, length of hospital stay and transfusion requirements. In total, 240 patients, mostly in a hemodynamically stable condition, were randomized. A contrast extravasation on CE-CT was observed in 20 of 115 patients (17.4%) in the urgent-CE-CT + early-colonoscopy group. SRH was identified in 23 of 115 patients (20.0%) in the urgent-CE-CT + early-colonoscopy group and 21 of 118 patients (17.8%) in the early-colonoscopy group (difference, 2.2; 95% confidence interval [CI], -7.9 to 12.3; P=0.739). Successful endoscopic hemostasis was achieved in 21 patients in each group (18.3% and 17.8%, respectively) (difference, 0.5; 95% CI, -9.4 to 10.4; P=1.000). There were also no significant differences between groups in early and late rebleeding, length of hospital stay and transfusion requirements. The use of urgent CE-CT before early colonoscopy did not improve SRH identification or other clinical outcomes in patients with suspected CDB in a hemodynamically stable condition. The routine use of urgent CE-CT as an initial investigation is not recommended in this population, also considering the low rate of extravasation-positive cases (UMIN Registry number, UMIN000026865).