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Ann Surg. 2015 Feb;261(2):269-75. doi: 10.1097/SLA.0000000000000658.

High-dose barium impaction therapy for the recurrence of colonic diverticular bleeding: a randomized controlled trial.

Author information

1
*Department of Gastroenterology and Hepatology †Clinical Research and Informatics, International Clinical Research Center Research Institute ‡Department of Radiology §Department of Nursing, National Center for Global Health and Medicine, Tokyo, Japan; and ‖Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.

Erratum in

  • Ann Surg. 2016 Mar;263(3):e58.

Abstract

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.

PMID:
25569028
DOI:
10.1097/SLA.0000000000000658
[Indexed for MEDLINE]

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