8 research outputs found
ATTIVITA’ IN VITRO DI ANIDULAFUNGINA, CASPOFUNGINA, VORICONAZOLO, ITRACONAZOLO E FLUCONAZOLO NEI CONFRONTI DI ISOLATI CLINICI DI CANDIDA SPP.
New Trends in Acute Management of Colonic Diverticular Bleeding
Colonic diverticular disease is the most common cause of
lower gastrointestinal bleeding. In the past, this condition was usually
managed with urgent colectomy. Recently, the development of endoscopy
and interventional radiology has led to a change in the management
of colonic diverticular bleeding.
The aim of this systematic review is to define the best treatment for
colonic diverticular bleeding.
A systematic bibliographic research was performed on the online
databases for studies (randomized controlled trials [RCTs], observational
trials, case series, and case reports) published between 2005 and
2014, concerning patients admitted with a diagnosis of diverticular
bleeding according to the PRISMA methodology.
The outcomes of interest were: diagnosis of diverticulosis as source
of bleeding; incidence of self-limiting diverticular bleeding; management
of non self-limiting bleeding (endoscopy, angiography, surgery);
and recurrent diverticular bleeding.
Fourteen studies were retrieved for analysis. No RCTs were found.
Eleven non-randomized clinical controlled trials (NRCCTs) were
included in this systematic review. In all studies, the definitive diagnosis
of diverticular bleeding was always made by urgent colonoscopy. The
colonic diverticular bleeding stopped spontaneously in over 80% of the
patients, but a re-bleeding was not rare. Recently, interventional endoscopy
and angiography became the first-line approach, thus relegating
emergency colectomy to patients presenting with hemodynamic
instability or as a second-line treatment after failure or complications
of hemostasis with less invasive treatments.
Colonoscopy is effective to diagnose diverticular bleeding. Nowadays,
interventional endoscopy and angiographic treatment have gained
a leading role and colectomy should only be entertained in case of
failure of the forme