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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)

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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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
 

  • References

  • 1 Sengupta N, Feuerstein JD, Jairath V. et al. Management of patients with acute lower gastrointestinal bleeding: An updated ACG guideline. Am J Gastroenterol 2023; 118: 208-231
    Suche in Google Scholar
  • 2 Nagata N, Kobayashi K, Yamauchi A. et al. Identifying bleeding etiologies by endoscopy affected outcomes in 10,342 cases with hematochezia: CODE BLUE-J Study. Am J Gastroenterol 2021; 116: 2222-2234
    Suche in Google Scholar
  • 3 Jensen DM, Ohning GV, Kovacs TOG. et al. Natural history of definitive diverticular hemorrhage based on stigmata of recent hemorrhage and colonoscopic Doppler blood flow monitoring for risk stratification and definitive hemostasis. Gastrointest Endosc 2016; 83: 416-423
    Suche in Google Scholar
  • 4 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
    Suche in Google Scholar
  • 5 Gobinet-Suguro M, Nagata N, Kobayashi K. et al. Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study. Gastrointest Endosc 2022; 95: 1210-1222.e12
    Suche in Google Scholar
  • 6 Kumar A, Artifon E, Chu A. et al. Effectiveness of endoclips for the treatment of stigmata of recent hemorrhage in the colon of patients with acute lower gastrointestinal tract bleeding. Dig Dis Sci 2011; 56: 2978-2986
    Suche in Google Scholar
  • 7 Kaltenbach T, Watson R, Shah J. et al. Colonoscopy with clipping is useful in the diagnosis and treatment of diverticular bleeding. Clin Gastroenterol Hepatol 2012; 10: 131-137
    Suche in Google Scholar
  • 8 Nagata N, Niikura R, Ishii N. et al. Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: Systematic review and meta-analysis. J Gastroenterol Hepatol 2021; 36: 1738-1743
    Suche in Google Scholar
  • 9 Strate LL, Gralnek IM. ACG Clinical Guideline: Management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol 2016; 111: 459-474
    Suche in Google Scholar
  • 10 Yen EF, Ladabaum U, Muthusamy VR. et al. Colonoscopic treatment of acute diverticular hemorrhage using endoclips. Dig Dis Sci 2008; 53: 2480-2485
    Suche in Google Scholar
  • 11 Xavier AT, Campos JF, Robinson L. et al. Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications. Ann Gastroenterol Hepatol 2020; 33: 563-570
    Suche in Google Scholar
  • 12 Nagata N, Ishii N, Kaise M. et al. Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band ligation versus clipping. Gastrointest Endosc 2018; 88: 841-853.e4
    Suche in Google Scholar
  • 13 Kishino T, Kanemasa K, Kitamura Y. et al. Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos). Endosc Int Open 2020; 8: E377-E385
    Suche in Google Scholar
  • 14 Kishino T, Nagata N, Kobayashi K. et al. Endoscopic direct clipping versus indirect clipping for colonic diverticular bleeding: A large multicenter cohort study. United European Gastroenterol J 2022; 10: 93-103
    Suche in Google Scholar
  • 15 Setoyama T, Ishii N, Fujita Y. Enodoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage. Surg Endosc 2011; 25: 3574-3578
    Suche in Google Scholar
  • 16 Kobayashi K, Nagata N, Furumoto Y. et al. Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study. Endoscopy 2022; 54: 735-744
    Suche in Google Scholar
  • 17 Sato Y, Yasuda H, Fukuoka A. et al. Delayed perforation after endoscopic band ligation for colonic diverticular hemorrhage. Clin J Gastroenterol 2020; 13: 6-10
    Suche in Google Scholar
  • 18 Tominaga N, Ogata S, Esaki M. Rare complication of endoscopic band ligation for colonic diverticular bleeding. JGH Open 2020; 4: 1244-1245
    Suche in Google Scholar
  • 19 Takahashi S, Inaba T, Tanaka N. Delayed perforation after endoscopic band ligation for treatment of colonic diverticular bleeding. Dig Endosc 2016; 28: 484
    Suche in Google Scholar
  • 20 Kishino T, Kitaichi T, Kanemasa K. Usefulness of water immersion observations to identify the stigmata of hemorrhage in colonic diverticular bleeding. Dig Endosc 2018; 30: 121-122
    Suche in Google Scholar
  • 21 Ishii N, Setoyama T, Deshpande GA. et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc 2012; 75: 382-387
    Suche in Google Scholar
  • 22 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
    Suche in Google Scholar
  • 23 Nagata N, Ishii N, Manabe N. et al. Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association. Digestion 2019; 99: 1-26
    Suche in Google Scholar
  • 24 Ishii N, Hirata N, Omata F. et al. Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping. Gastrointest Endosc 2012; 76: 1175-1181
    Suche in Google Scholar
  • 25 Saito M, Sudo G, Takai S. et al. Direct clipping using underwater inversion method for colonic diverticular bleeding. VideoGIE 2022; 7: 187-189
    Suche in Google Scholar
  • 26 Takada J, Arao M, Kojima K. et al. Usefulness of water pressure observation in detection and direct clipping of source of colonic diverticular bleeding. Endoscopy 2023; 55: E753-E754
    Suche in Google Scholar
  • 27 Kawanishi K, Kato J, Kakimoto T. et al. Risk of colonic diverticular rebleeding according to endoscopic appearance. Endosc Int Open 2018; 6: E36-E42
    Suche in Google Scholar
  • 28 Suzuki S, Esaki M, Ichijima R. Direct clipping method with a repositioning endoscopic clip for colonic diverticular bleeding. Dig Endosc 2020; 32: e67-e68
    Suche in Google Scholar
  • 29 Aoki T, Sadashima E, Kobayashi K. et al. High risk stigmata and treatment strategy for acute lower gastrointestinal bleeding: a nationwide study in Japan. Endoscopy 2024; 56: 291-301
    Suche in Google Scholar
  • 30 Sadahiro S, Ohmura T, Yamada Y. et al. Analysis of length and surface area of each segment of the large intestine according to age, sex and physique. Surg Radiol Anat 1992; 14: 251-257
    Suche in Google Scholar
  • 31 Niikura R, Nagata N, Shimbo T. et al. Colonoscopy can miss diverticula of the left colon identified by barium enema. World J Gastroenterol 2013; 19: 2362-2367
    Suche in Google Scholar
  • 32 Strangfeld A, Richter A, Siegmund B. et al. Risk for lower intestinal perforations in patients with rheumatoid arthritis treated with tocilizumab in comparison to treatment with other biologic or conventional synthetic DMARDs. Ann Rheum Dis 2017; 76: 504-510
    Suche in Google Scholar
  • 33 Gout T, Ostör AJK, Nisar MK. Lower gastrointestinal perforation in rheumatoid arthritis patients treated with conventional DMARDs or tocilizumab: a systematic literature review. Clin Rheumatol 2011; 30: 1471-1474
    Suche in Google Scholar
  • 34 Murakami T, Kamba E, Haga K. et al. Emergency endoscopic hemostasis for gastrointestinal bleeding using a self-assembling peptide: A case series. Medicina 2023; 59
    Suche in Google Scholar
  • 35 Kume K, Yamasaki M, Yoshikawa I. Sepsis caused by endoscopic clipping for colonic diverticular bleeding: a rare complication. World J Gastroenterol 2009; 15: 3817-3818
    Suche in Google Scholar