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Endoscopy 2015; 47(11): 1039-1042
DOI: 10.1055/s-0034-1392204
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic detachable snare ligation: a new treatment method for colonic diverticular hemorrhage

Daisuke Akutsu
1   Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
,
Toshiaki Narasaka
2   Division of Endoscopy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
,
Mariko Wakayama
3   Department of Gastroenterology, Koyama Memorial Hospital, Kashima, Ibaraki, Japan
,
Masahiko Terasaki
1   Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
,
Tsuyoshi Kaneko
1   Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
,
Hirofumi Matsui
1   Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
,
Hideo Suzuki
2   Division of Endoscopy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
,
Ichinosuke Hyodo
1   Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan
,
Yuji Mizokami
2   Division of Endoscopy, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
› Author Affiliations
Further Information

Publication History

submitted: 08 December 2014

accepted after revision: 01 April 2015

Publication Date:
28 May 2015 (online)

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Background and study aims: Colonic diverticular hemorrhage is the most common cause of lower intestinal bleeding. We tried to develop a convenient and reliable hemostatic method, endoscopic detachable snare ligation (EDSL), to treat diverticular hemorrhage and retrospectively explored its safety and efficacy.

Patients and methods: The definitive bleeding diverticulum was ligated with a detachable snare, instead of a rubber band, in a procedure similar to endoscopic band ligation. Removal of the scope to attach a ligation device and reinsertion for treatment are not needed in this method.

Results: From November 2013 to September 2014, EDSL was used to treat 8 patients with colonic diverticular hemorrhage. The mean procedure time required for hemostasis after identification of the bleeding diverticulum was 5 ± 2 minutes. Sustained hemostasis was achieved in 7 patients (88 %), and early rebleeding occurred in 1 patient, in whom the applied suction seemed inadequate. No complications occurred in any patient.

Conclusions: EDSL may be a safe and effective treatment for colonic diverticular hemorrhage. However, additional studies are warranted to confirm these initial exploratory data.

 

  • References

  • 1 Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 1997; 92: 419-424
    PubMedSearch in Google Scholar
  • 2 Chaudhly V, Hyser MJ, Gracias VH et al. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg 1998; 64: 723-728
    PubMedSearch in Google Scholar
  • 3 Jensen DM, Machicado GA, Jutabha R et al. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342: 78-82
    CrossrefPubMedSearch in Google Scholar
  • 4 McGuire HH Jr. Bleeding colonic diverticula: a reappraisal of natural history and management. Ann Surg 1994; 220: 653-656
    CrossrefPubMedSearch in Google Scholar
  • 5 Aytac E, Stocchi L, Gorgun E et al. Risk of recurrence and long-term outcomes after colonic diverticular bleeding. Int J Colorectal Dis 2014; 29: 373-378
    CrossrefPubMedSearch in Google Scholar
  • 6 Setoyama T, Ishii N, Fujita Y. Endoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage. Surg Endosc 2011; 25: 3574-3578
    CrossrefPubMedSearch in Google Scholar
  • 7 Shibata S, Shigeno T, Fujimori K et al. Colonic diverticular hemorrhage: the hood method for detecting responsible diverticula and endoscopic band ligation for hemostasis. Endoscopy 2014; 46: 66-69
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Ishii N, Setoyama T, Deshpande GA et al. Endoscopic band for colonic diverticular hemorrhage. Gastrointest Endosc 2012; 75: 382-387
    CrossrefPubMedSearch in Google Scholar
  • 9 Kang JY, Melville D, Maxwell JD. Epidemiology and management of diverticular disease of colon. Drugs Aging 2004; 21: 211-228
    CrossrefPubMedSearch in Google Scholar
  • 10 Farrell JJ, Graeme-Cook F, Kelsey PB. Treatment of bleeding colonic diverticula by endoscopic band ligation. An in-vivo and ex-vivo pilot study. . Endoscopy 2003; 35: 823-829
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Akimaru K, Suzuki H, Tsuruta H et al. Eversion and ligation of a diverticulum: report of an inspirational case and subsequent animal study. J Nippon Med Sch 2008; 75: 157-161
    CrossrefPubMedSearch in Google Scholar