title: Predictors for identification of stigmata of recent hemorrhage on colonic diverticula in lower gastrointestinal bleeding.
abstract: OBJECTIVE
  The aim of this study was to identify predictors for the identification of stigmata of recent hemorrhage (SRH) on colonic diverticula.
  
  
  BACKGROUND
  Several factors influence the identification of SRH in the diagnosis of colonic diverticular bleeding.
  
  
  METHODS
  A total of 396 patients hospitalized for lower gastrointestinal bleeding were analyzed. Comorbidities, medications, timing of colonoscopy [<24 h (h); urgent, 24 to 48 h, >48 h], preparation, expert colonoscopist, use of a cap, use of a water-jet scope, total colonoscopy, and procedure time (over 60 min) were assessed. A multivariable logistic regression model was used to estimate odds ratio (OR) and 95% confidence interval (CI).
  
  
  RESULTS
  Two hundred fifteen patients were diagnosed with colonic diverticular bleeding and 37 (17%) were identified with SRH. Urgent colonoscopy (OR, 8.4; 95% CI, 2.3-30; P<0.01), expert colonoscopist (OR, 3.0; 95% CI, 1.2-7.3; P=0.02), use of a cap (OR, 3.4; 95% CI, 1.4-8.0; P=0.01), and use of water-jet scope (OR, 5.8; 95% CI, 2.3-15; P<0.01) were found to be independent predictive factors for SRH. The accuracy of these factors in combination was 0.90 (95% CI, 0.85-0.96) as measured by area under the receiver operating characteristic curve (ROC-AUC). SRH identification rate was higher in the urgent (22%) than in the 24 to 48 hours (2.9%, P<0.01) and >48 hours groups (1.0%, P<0.01), showing a tendency to decrease with time (P<0.01 for trend).
  
  
  CONCLUSIONS
  Factors of urgent colonoscopy, expert colonoscopist, use of a cap, and use of water-jet scope are useful for identifying SRH diverticula.
authors.affiliation: Departments of *Gastroenterology and Hepatology †Clinical Research and Informatics, International Clinical Research Center Research Institute, National Center for Global Health and Medicine (NCGM), Tokyo ‡The Research Center for Hepatitis and Immunology §Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Tomonori
authors.initials: T
authors.lastname: Aoki
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Shohei
authors.initials: S
authors.lastname: Tanaka
authors.forename: Katsunori
authors.initials: K
authors.lastname: Sekine
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kishida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Chizu
authors.initials: C
authors.lastname: Yokoi
authors.forename: Mikio
authors.initials: M
authors.lastname: Yanase
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D019540:Area Under Curve; D001803:Blood Transfusion; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003106:Colon / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy / Q000379:methods*; D004241:Diverticulum, Colon / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000473:pathology* / Q000628:therapy; D006487:Hemostasis; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome