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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a24711016
DOI: 10.1055/a-2471-1016
Original article

Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to endoscopic findings (with video)

Authors

  • Takaaki Kishino

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)

  • Yoko Kitamura

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)

  • Takashi Okuda

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)

  • Naoki Okamoto

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)

  • Takayuki Sawa

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)

  • Maiko Yamakawa

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)

  • Kazuyuki Kanemasa

    1   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan (Ringgold ID: RIN53356)
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Erratum zu diesem Artikel:

Correction: Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to endoscopic findings (with video)Endosc Int Open 2025; 13(CP):
DOI: 10.1055/a-2569-9279

Abstract

Background and study aims

Direct or indirect clipping and endoscopic band ligation (EBL) are widely used for hemostasis in patients with colonic diverticular bleeding (CDB). However, no treatment selection strategy has been established. This report describes our approach and its outcomes.

Patients and methods

We select direct clipping if the bleeding point is visible and clips could be inserted into the diverticulum. When direct clipping is not feasible, we select EBL as the second choice and indirect clipping as the third. We reviewed data from 192 patients treated with clipping or EBL for definitive CDB with stigmata of recent hemorrhage (SRH) at our hospital between March 2016 and February 2023.

Results

The hemostatic method was clipping in 84 patients (direct, n=78; indirect, n=6) and EBL in 108. The rate of SRH with active bleeding was significantly higher in the EBL group (33.3% vs. 60.2%, p <0.001). Median hemostasis time was significantly shorter in the clipping group (9 min vs. 22 min, P <0.001). There was no significant difference in the 30-day rebleeding rate between clipping and EBL (15.5% vs. 13.0%; P=0.619). There was one case of delayed perforation post-EBL. There were no complications after clipping.

Conclusions

Direct clipping when placement of clips at the bleeding point is feasible and EBL when direct clipping is not feasible is a reasonable strategy in terms of effectiveness, efficiency, and safety. Selection of hemostatic method according to the visual field of SRH and maneuverability of the endoscope allows the advantages of both methods to be realized.

Keywords

Endoscopy Lower GI Tract - Lower GI bleeding - GI surgery - Quality and logistical aspects - Quality management

Supplementary Material



Publikationsverlauf

Eingereicht: 24. Juni 2024

Angenommen nach Revision: 14. November 2024

Accepted Manuscript online:
21. November 2024

Artikel online veröffentlicht:
07. Januar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Takaaki Kishino, Yoko Kitamura, Takashi Okuda, Naoki Okamoto, Takayuki Sawa, Maiko Yamakawa, Kazuyuki Kanemasa. Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to endoscopic findings (with video). Endosc Int Open 2025; 13: a24711016.
DOI: 10.1055/a-2471-1016
 

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