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A scoping review on the efficacy of barium enema for use in patients with acute diverticular bleeding
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Talk Descripción

Institución: The Royal Melbourne Hospital - Victoria, Australia

Background: Acute diverticular bleeding largely affects elderly patients and is associated with significant morbidity and mortality. Barium enemas are not routinely utilised for management of lower gastrointestinal bleeds but potentially offer a non-invasive strategy for control of diverticular bleeding. This scoping review aims to assess the effectiveness of barium enema use in management of diverticular bleeding. Methods: A comprehensive computer assisted literature search was performed on Medline, Embase, Emcare, Evidence-Based Medicine (EBM). Papers evaluating the use of barium enema as an intervention for adults with acute diverticular bleeding were included in this scoping review. Primary outcomes included rebleeding, time to rebleeding, success of intervention, need for additional interventions and mortality. Results: 15 unique studies, compromising of retrospective cohort and randomized controlled studies, case series and case reports were included. All studies showed clinical success rate of over 80% following therapeutic barium intervention. 15.2% of patients experienced rebleeding following barium enema or impaction therapy (n= 21/138) compared to 32.3% following conservative management (n=32/99) (p < 0.05). There is a lower probability of rebleeding in a 1-year period following barium impaction (14.8%, 95% CI 5.83 - 34.8%) compared to conservative management (42.5%, 95%CI 26.1 - 63.7%), hazard ratio 0.34 (95% CI, 0.12 – 0.97). The need for colonic resection following barium enema ranged from 2.08 – 9.52% across 3 studies. Only 2 cases of perforation were reported. 2 studies reported shorter length of hospital stay compared to conservative management. Conclusion: Therapeutic barium interventions for active diverticular bleeding seemingly show a high clinical success rate, with lower rates of rebleeding and low rates of reported serious complications.However, the evidence-base to support its safety and efficacy remains limited.
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Dr Khang Duy Ricky Le - , Dr Shasha Haycock - , Mr Kelvin Le - , Dr Annie Jiao Wang - , Dr Hasanga Jayasekera -

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