Early Versus Late Bowel Preparation for Suspected Acute Diverticular Bleeding: A Retrospective Study

TL;DR

This study compares early and late bowel preparation in treating diverticular bleeding, finding fewer colonoscopies and shorter hospital stays with early preparation.

Contribution

The study introduces evidence that early bowel preparation may reduce colonoscopies and hospital stays without worsening outcomes in acute diverticular bleeding.

Findings

Early bowel preparation was associated with significantly fewer colonoscopies compared to late preparation.

Patients with early bowel preparation had shorter hospital stays and faster resolution times.

There was no significant difference in readmission rates or transfusion needs between groups.

Abstract

Introduction

Diverticular bleeding (DB) is a significant cause of inpatient gastrointestinal (GI) bleeding. We hypothesized that early bowel preparation (EBP) administration would reduce hospital resource utilization and improve outcomes compared to late administration.

Methods

We retrospectively identified patients admitted with acute DB from January 2019 to July 2023. EBP was given within 24 hours of admission, and late bowel preparation (LBP) was given after 24 hours. Variables examined included length of stay, readmissions for GI bleed, packed red blood cell (pRBC) transfusions, days to resolution, colonoscopy, tagged red blood cell (RBC) scan, and computed tomography (CT) angiographies, using chi-squared and T-tests for statistical analysis.

Results

One hundred and thirty-four patients were included: EBP (n=51), LBP (n=26), and no bowel preparation (NBP) (n=57). There were no statistically significant differences in baseline variables between groups that received bowel preparation and those who did not. EBP patients underwent fewer colonoscopies (56.86% vs. 84.62%, P=0.01). They had shorter hospital stays (mean 4.82 vs. 5.27 days), faster time to resolution (mean 2.94 vs. 3.58 days), and fewer CT angiograms (19.61% vs. 23.08%), although not statistically significant. EBP patients underwent more tagged RBC scans (37.25% vs. 30.77%, P=0.5727). Readmission rates, number of pRBC transfusions, hemostasis during colonoscopy, and total imaging showed no difference.

Conclusion

EBP compared to LBP was associated with significantly fewer colonoscopies and a trend toward shorter hospital stays and resolution times, without impacting clinical outcomes such as readmission rates or transfusion needs. The reduction in colonoscopies in the EBP group suggests that EBP may allow clinicians to identify resolved DB quicker and facilitate discharge without unnecessary colonoscopy.

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