title: High-dose barium impaction therapy for the recurrence of colonic diverticular bleeding: a randomized controlled trial.
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.
authors.affiliation: *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.
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Ryota
authors.initials: R
authors.lastname: Niikura
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishizuka
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamano
authors.forename: Kyoko
authors.initials: K
authors.lastname: Mizuguchi
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Mikio
authors.initials: M
authors.lastname: Yanase
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate / Q000627:therapeutic use*; D003108:Colonic Diseases / Q000209:etiology / Q000517:prevention & control*; D004241:Diverticulum, Colon / Q000150:complications*; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D001466:Barium Sulfate