Megan Lipcsey, MD1, Matthew Moore, MD1, Daniel J. Stein, MD, MPH1, Joseph Feuerstein, MD2
1Beth Israel Deaconess Medical Center, Boston, MA; 2Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
Introduction: Diverticular hemorrhage is the most common cause of lower gastrointestinal hemorrhage. Determining the source of bleeding is difficult and therapeutic intervention rates are variable. Many centers perform angiography for patients with more severe bleeding since it does not require bowel preparation and can be rapidly performed; however it has never been directly compared to colonoscopy and may not be available. Using the national inpatient sample, we compared outcomes for patients with diverticular bleeding undergoing angiography to colonoscopy.
Methods: This national inpatient sample (NIS) from 2016 was queried for cases of diverticular hemorrhage based on ICD-10. Outcomes were compared for colonoscopy alone to angiography including mortality and rate of post-procedure transfusion. Angiography use was compared by hospital type to deduce if there was an availability bias in usage pattern. Survey-adjusted logistic regression was used to examine mortality and predictors of angiography use. Adjustment was made for the Elixhauser mortality score (a validated measure of comorbidities) and other confounders as below.
Results: 63,620 patients were admitted for diverticular hemorrhage in 2016. 2,795 (4.4%) underwent angiography and 40,380 (63.5%) underwent colonoscopy. 62.3% of angiography patients had a colonoscopy (98.6% prior to the angiogram). Angiography was more common in patients at academic (5.1%) and urban non-teaching (4.0%) compared with rural (0.5%) hospitals. Mortality was 2.3% in patients undergoing angiography versus 0.8% in patients undergoing colonoscopy alone. In the multivariable regression, requiring angiography was associated with a 3.2 times the odds of mortality (95% CI 1.7-6.0) adjusting for age, transfusion requirement and Elixhauser. Adjusting for age, Elixhauser and transfer status, freedom from transfusion (OR=0.34, 95% CI 0.28-0.40) and rural hospital location (OR=0.13, 95% CI 0.06-0.28 compared to urban teaching) were strongly associated with angiography.
Discussion: In a national cohort of patients managed for diverticular bleeding, angiography was performed in under 5% compared with nearly 64% who had colonoscopy. However, it was associated with a higher rate of mortality though not transfusion. This persisted after controlling for confounders. Far fewer patients underwent angiography at small community hospitals, raising concern about the availability of this resource in the community setting.
Citation: Megan Lipcsey, MD; Matthew Moore, MD; Daniel J. Stein, MD, MPH; Joseph Feuerstein, MD. P1307 - ANGIOGRAPHY VERSUS COLONOSCOPY IN DIVERTICULAR HEMORRHAGE. Program No. P1307. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.