Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study

Katsumasa Kobayashi; Naoyoshi Nagata; Yohei Furumoto; Atsushi Yamauchi; Atsuo Yamada; Jun Omori; Takashi Ikeya; Taiki Aoyama; Naoyuki Tominaga; Yoshinori Sato; Takaaki Kishino; Naoki Ishii; Tsunaki Sawada; Masaki Murata; Akinari Takao; Kazuhiro Mizukami; Ken Kinjo; Shunji Fujimori; Takahiro Uotani; Minoru Fujita; Hiroki Sato; Sho Suzuki; Toshiaki Narasaka; Junnosuke Hayasaka; Mitsuru Kaise; CODE BLUE-J study collaborators

doi:10.1055/a-1705-0921

Endoscopy, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endoscopy 2022; 54(08): 735-744
DOI: 10.1055/a-1705-0921

Original article

Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study

Katsumasa Kobayashi

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Naoyoshi Nagata

²Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan

³Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan

,

Yohei Furumoto

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Atsushi Yamauchi

⁴Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan

,

Atsuo Yamada

⁵Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Jun Omori

⁶Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

,

Takashi Ikeya

⁷Department of Gastroenterology, St. Luke's International University, Tokyo, Japan

,

Taiki Aoyama

⁸Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

,

Naoyuki Tominaga

⁹Department of Gastroenterology, Saga Medical Center Koseikan, Saga, Japan

,

Yoshinori Sato

¹⁰Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan

,

Takaaki Kishino

¹¹Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan

,

Naoki Ishii

¹²Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan

,

Tsunaki Sawada

¹³Department of Endoscopy, Nagoya University Hospital, Aichi, Japan

,

Masaki Murata

¹⁴Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

,

Akinari Takao

¹⁵Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

,

Kazuhiro Mizukami

¹⁶Department of Gastroenterology, Oita University, Oita, Japan

,

Ken Kinjo

¹⁷Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan

,

Shunji Fujimori

¹⁸Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan

,

Takahiro Uotani

¹⁹Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan

,

Minoru Fujita

²⁰Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan

,

Hiroki Sato

²¹Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

,

Sho Suzuki

²²Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan

,

Toshiaki Narasaka

²³Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan

²⁴Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki Japan

,

Junnosuke Hayasaka

²⁵Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

,

Mitsuru Kaise

⁶Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan

,

CODE BLUE-J study collaborators

(

Tomohiro Funabiki

²⁶Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan

²⁷Emergency and Critical Care Center, Saiseikai Yokohama Tobu Hospital, Kanagawa, Japan

,

Yuzuru Kinjo

²⁸Department of Gastroenterology, Naha City Hospital, Okinawa, Japan

,

Akira Mizuki

²⁹Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan

,

Shu Kiyotoki

³⁰Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan

,

Tatsuya Mikami

³¹Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan

,

Ryosuke Gushima

³²Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

,

Hiroyuki Fujii

³³Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan

,

Yuta Fuyuno

³⁴Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

,

Naohiko Gunji

³⁵Department of Gastroenterology, Fukushima Medical University, Fukushima, Japan

,

Yosuke Toya

³⁶Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan

,

Kazuyuki Narimatsu

³⁷Department of Internal Medicine, National Defense Medical College, Saitama, Japan

,

Noriaki Manabe

³⁸Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan

,

Koji Nagaike

³⁹Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan

,

Tetsu Kinjo

⁴⁰Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan

,

Yorinobu Sumida

⁴¹Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

,

Sadahiro Funakoshi

⁴²Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan

,

Kana Kawagishi

⁴³Department of Gastroenterology, Kitasato University, School of Medicine, Kanagawa, Japan

,

Tamotsu Matsuhashi

⁴⁴Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan

,

Yuga Komaki

⁴⁵Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

,

Kuniko Miki

²Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan

,

Kazuhiro Watanabe

³Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan

,

Naoki Kitano

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Shu Kato

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Shun Sakai

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Eri Oshina

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Tomohiro Mochida

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Yukito Okura

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Mana Matsuoka

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Takahito Nozaka

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Ayako Sato

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Masato Yauchi

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Taichi Matsumoto

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

,

Toru Asano

¹Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

)› Institutsangaben

Abstract

Background Prior studies have shown the effectiveness of both endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Therefore, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study.

Methods We reviewed data for 1679 patients with CDH who were treated with EBL (n = 638) or clipping (n = 1041) between January 2010 and December 2019 at 49 hospitals across Japan (CODE BLUE-J study). Logistic regression analysis was used to compare outcomes between the two treatments.

Results In multivariate analysis, EBL was independently associated with reduced risk of early rebleeding (adjusted odds ratio [OR] 0.46; P < 0.001) and late rebleeding (adjusted OR 0.62; P < 0.001) compared with clipping. These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant differences were found between the treatments in the rates of initial hemostasis or mortality. Compared with clipping, EBL independently reduced the risk of needing interventional radiology (adjusted OR 0.37; P = 0.006) and prolonged length of hospital stay (adjusted OR 0.35; P < 0.001), but not need for surgery. Diverticulitis developed in one patient (0.16 %) following EBL and two patients (0.19 %) following clipping. Perforation occurred in two patients (0.31 %) following EBL and none following clipping.

Conclusions Analysis of our large endoscopy dataset suggests that EBL is an effective and safe endoscopic therapy for CDH, offering the advantages of lower early and late rebleeding rates, reduced need for interventional radiology, and shorter length of hospital stay.

Volltext

Referenzen

References
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