Arterial Blood Flow Detection and Clinical Outcomes of Patients with Flat Spots and Diverticular Hemorrhage

Colonoscopic hemostasis is recommended for diverticular (TIC) hemorrhage (TICH) with major stigmata of recent hemorrhage (SRH). Whether flat spots should be included as a major SRH is unknown. For TIC flat spots, our aims were 1) to report rates of blood flow detected underneath by Doppler endoscopic probe (DEP), 2) to compare rebleeding rates of medical vs. endoscopic treatment, and 3) to compare rates of arterial blood flow detection and rebleeding with non-bleeding visible vessels (NBVV). This is a retrospective study of prospectively collected data of patients at VA and UCLA Medical Centers from 1993 to 2023 for definitive TICH from either flat spots or NBVV. Arterial blood flow underneath SRH was monitored by DEP. Descriptive and comparative analyses were used. Of 24 patients with TIC flat spots, treatment in 83.3% was hemoclips vs. 16.7% medical. 17 of 19 patients with DEP monitoring had positive arterial blood flow and all had hemoclipping. Within 30 days, 25% of the medical group rebled, while 10% of the endoscopic group rebled. After 30 days, 35 % of the endoscopic group rebled vs. none of the medical group. Rates of positive DEP were the same for flat spots and NBVV. Flat spot patients had a significantly lower rate of colonoscopic hemostasis and a higher rebleeding rate. TIC flat spots should be considered as a major SRH and treated due to high rates of arterial blood flow underneath and rebleeding. Improvements in TICH spot hemostasis are warranted.