title: New Trends in Acute Management of Colonic Diverticular Bleeding: A Systematic Review.
abstract: Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding.The aim of this systematic review is to define the best treatment for colonic diverticular bleeding.A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology.The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding.Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments.Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former.
authors.affiliation: From the Department of Digestive Surgery and Liver Unit, St Maria Hospital, Terni, Italy (RC, VG); Surgical Oncology, Forlì Hospital, Forlì, Italy (DC); Department of General and Oncologic Surgery, University of Perugia, St Maria Hospital, Perugia, Italy (CR); Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland (RT); Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy (GP); Department of Endocrine Surgery, University of Perugia, Perugia, Italy (SA); Department of Digestive Surgery, ULB-Hopital Erasme, Brussels, Belgium (EF); Department of Surgical Sciences, University of Torino, Torino, Italy (AA); Department of Surgery, Montichiari, Ospedali Civili Brescia, Italy (NV); Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy (VD); Department of Colorectal Surgery, Galliera Hospital, Genoa, Italy (GAB); and Surgical Research Unit, Medical University of Graz, Austria and First Department of Surgery, Hippokration Hospital, University of Athens Medical School, Athens, Greece (AF).
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Veronica
authors.initials: V
authors.lastname: Grassi
authors.forename: Davide
authors.initials: D
authors.lastname: Cavaliere
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.forename: Renata
authors.initials: R
authors.lastname: Tabola
authors.forename: Giulia
authors.initials: G
authors.lastname: Poli
authors.forename: Stefano
authors.initials: S
authors.lastname: Avenia
authors.forename: Eleonora
authors.initials: E
authors.lastname: Farinella
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.forename: Nereo
authors.initials: N
authors.lastname: Vettoretto
authors.forename: Vito
authors.initials: V
authors.lastname: D'Andrea
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Binda
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D019468:Disease Management; D004241:Diverticulum, Colon / Q000150:complications*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans