Annals of Surgery

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

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

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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.

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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. Identifier, UMIN 000002832.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


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