S1419 Conservative Management Versus Repeat Colonoscopy in Stable Patients With Diverticular Bleeding After a Recent Unremarkable Colonoscopy: A Propensity-Matched Retrospective Cohort Study

Introduction: Lower gastrointestinal bleeding (LGIB) is one of the most common causes of emergency department (ED) visits and hospital admissions with diverticular bleeding being the leading cause of LGIB. Treatment for LGIB includes colonoscopy to identify the source and control the bleeding. However, in hemodynamically stable patients with diverticular bleeding, conservative management frequently achieves spontaneous hemostasis without colonoscopy. This study aims to compare 30-day outcomes between conservative management and repeat colonoscopy in stable patients with LGIB with a known history of diverticular disease and a recent colonoscopy that showed no other causes of LGIB. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. We identified adults aged 18 years or older who are hospitalized for LGIB due to diverticular disease within 6 months of a colonoscopy that was negative for polyps, neoplasia, IBD, hemorrhoids of fissures. Two cohorts were established: conservative management who had no repeat colonoscopy (n = 1,049) and intervention who had a repeat colonoscopy (n = 1,049) after propensity score matching. Outcomes were 30-day all-cause mortality, rebleeding, colectomy, and packed red blood cell (PRBC) transfusion. Results: No significant differences were observed in outcomes between the 2 groups. Rebleeding occurred in 357 and 361 in the conservative and intervention group, respectively with RR of 1.063 (95% CI 0.54-2.092) and P-value of 0.854. Mortality occurred in 17 patients in conservative group and 16 in the intervention group (P -value 0.861), colectomy in 10 patients in both groups (P-value 1), and transfusion rates were zero in both groups. Kaplan-Meier analysis confirmed no survival or rebleeding-free survival benefit with repeat colonoscopy. Conclusion: Conservative management in patients with stable diverticular bleeding who had a recent colonoscopy that showed no other GI problem demonstrates equivalent clinical outcomes to repeat colonoscopy, suggesting that conservative management may be sufficient for management and this will reduce unnecessary endoscopic interventions and therefore potential adverse events related to sedation and colonoscopy.