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High-Dose Barium Impaction Therapy for the Recurrence of Colonic Diverticular Bleeding: A Randomized Controlled Trial

Nagata, Naoyoshi MD*; Niikura, Ryota MD*; Shimbo, Takuro PhD; Ishizuka, Naoki PhD; Yamano, Kazuyoshi MT; Mizuguchi, Kyoko MSN§; Akiyama, Junichi MD*; Yanase, Mikio MD*; Mizokami, Masashi PhD; Uemura, Naomi PhD

Erratum

In the February 2015 (261.2) issue of Annals of Surgery in the article by Nagata et al., “High-dose Barium Impaction Therapy for the Recurrence of Colonic Diverticular Bleeding: A Randomized Controlled Trial,” the sentence of exclusion criteria in the Method section should read, “Spontaneous cessation of bleeding was not achieved within 4 days of hospitalization.” Also, the Figure 3 legend should read, “Probability of rebleeding was significantly higher in the conservative group than in the barium group (P = 0.04). The corrections are not felt to affect the results.

Annals of Surgery. 263(3):e58, March 2016.

Annals of Surgery:
doi: 10.1097/SLA.0000000000000658
Randomized Controlled Trials
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.

In Brief

Patients with both definitive and presumptive diverticular bleeding are at high risk of recurrence. High-dose barium impaction therapy is effective in the long-term prevention of rebleeding, and also decreases the rehospitalization, repeated blood transfusion, and reexamination. Barium therapy appears safe and well tolerated by patients.

Author Information

*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.

Reprints: Naoyoshi Nagata, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail: nnagata_ncgm@yahoo.co.jp.

Supported by a grant-in-aid from the Ministry of Health Labor and Welfare of Japan and a grant-in-aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (271000) and the Grant of National Center for Global Health and Medicine (22–302). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Disclosure: The authors declare no conflicts of interest.

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