Effectiveness of therapeutic standard concentration barium enema for colonic diverticular bleeding: Preliminary results

Abstract

Purpose: To evaluate the effectiveness of a therapeutic barium enema as a treatment for colonic diverticulum bleeding, by using a standard concentration as a diagnostic examination.

Methods: We retrospectively analyzed 68 cases of the patients admitted to our hospital with colonic diverticular bleeding between October 2012 and September 2017. We evaluated the following items: (1) the presence/absence of a previous history of diverticular bleeding, (2) the use of medications (anticoagulants, nonsteroidal anti-inflammatory drugs, and antiplatelet drugs), (3) the location of bleeding, (4) the presence/absence of previous treatment and the result, (5) the time between bleeding and the beginning of the barium enema, (6) procedural success, (7) the clinical success of the initial hemostasis, (8) the clinical success of preventing recurrence, and (9) complications such as perforation and diverticulitis associated with this procedure.

Results: Four patients (three men and one woman; age range 60-85 years; median age 76 years) who underwent therapeutic barium enema with a concentration equivalent for diagnostic purpose (78 w/v%) were included. The follow-up period ranged from 11 to 12 months (median 12 months). All three patients who received a barium enema for initial hemostasis were successfully treated. All four patients remained free from recurrence during the follow-up period. There was no complication due to barium in this series.

Conclusion: Although we had no statistical evidence, a therapeutic barium enema with a standard concentration as a diagnostic examination may be effective for both the initial hemostasis and preventing the recurrence of colonic diverticular bleeding without complications.

Keywords: Barium enema; Bleeding; Diverticulum; GI, gastrointestinal tract; Gastrointestinal tract; MDCT, multi-detector row computed tomography; TAE, transarterial embolization; w/v%, weight/volume percent.

Fig. 1

Flow chart of the management of colonic diverticular bleeding. Flow chart of the management of colonic diverticular bleeding. A total of 101 episodes were analyzed. Among the 65 patients initially treated with conservative treatment, 17 cases failed during hospitalization. Three of these cases failed again, and one was treated with barium as the third treatment. Among the 25 patients initially treated with endoscopy, nine cases failed during hospitalization, and one received barium therapy as the second treatment. Among the 10 patients initially treated with TAE, one case failed during hospitalization. Hemostasis succeeded in one patient initially treated with barium. Four patients received a barium enema for the purpose of preventing recurrence after initial hemostasis by other treatments, and three of them were excluded because of the use of a high concentration barium or the concentration was not recorded. A final total of four patients received a therapeutic barium enema was included in this study. Note: TAE, transarterial embolization

Fig. 2

An 80-year-old woman with diverticular bleeding (case 1). a. Hemorrhages from the diverticula of the ascending colon was suspected, and endoscopic treatment (local injection therapy with hypertonic saline epinephrine solution) was performed. However, bleeding continued (arrow) and a barium enema was administered. b. X-ray image at 3 days after the barium administration revealed diverticula filled with barium. c. X-ray image at 6 days after the barium administration revealed diverticula filled with barium with less amount of the barium in the colon compared with those at 3 days prior.