Endosc Int Open 2016; 04(02): E233-E237
DOI: 10.1055/s-0041-110954
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic band ligation for colonic diverticular bleeding: possibility of standardization

Yuto Shimamura
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Naoki Ishii
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Fumio Omata
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Noriatsu Imamura
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Takeshi Okamoto
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Mai Ego
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Kaoru Nakano
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Takashi Ikeya
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Kenji Nakamura
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Koichi Takagi
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Katsuyuki Fukuda
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
,
Yoshiyuki Fujita
Department of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan
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Weitere Informationen

Publikationsverlauf

submitted 08. Juni 2015

accepted after revision 30. November 2015

Publikationsdatum:
15. Januar 2016 (online)

Background and aims: Endoscopic band ligation (EBL) has been used to achieve hemostasis in patients with colonic diverticular bleeding. The safety and effectiveness of EBL when performed by non-expert endoscopists have not been sufficiently verified. This study aimed to elucidate the feasibility of the EBL technique when performed by non-expert endoscopists and of considering EBL as a standard treatment for colonic diverticular bleeding.

Patients and methods: A retrospective cohort study was conducted in a tertiary referral center in Tokyo, Japan, between June 2009 and October 2014. A total of 95 patients treated with EBL were included in the study and were divided into two groups according to whether they had been treated by expert or non-expert endoscopists. Comorbidities, medications, shock index, hemoglobin level on admission, location of the bleeding diverticula, rate of bowel preparation, procedure time, and EBL-associated adverse events were evaluated in each group. Multivariate linear regression analyses were used to investigate factors related to EBL procedure time, which is the time elapsed between marking the site of bleeding with hemoclips and completion of the band release.

Results: A total of 47 (49.5 %) procedures were performed by expert endoscopists. In a bivariate analysis, the median EBL procedure times in the expert and non-expert groups were 15 minutes (range 4 – 45) and 11 minutes (range 4 – 36), respectively (P = 0.03). When a multivariate linear regression model was used, EBL for right-sided diverticula was the factor most significantly affecting EBL procedure time. No adverse events were encountered.

Conclusion: EBL can be safely and effectively performed by non-expert endoscopists. A right-sided location of diverticula was the factor most significantly affecting EBL procedure time.

 
  • 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
  • 2 Chaudhry V, Hyser MJ, Gracias VH et al. Colonoscopy: the initial test for acute lower gastrointestinal bleeding. Am Surg 1998; 64: 723-728
  • 3 Newman J, Fitzgerald JE, Gupta S et al. Outcome predictors in acute surgical admissions for lower gastrointestinal bleeding. Colorectal Dis 2012; 14: 1020-1026
  • 4 McGuire Jr HH. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg 1994; 220: 653-656
  • 5 Poncet G, Heluwaert F, Voirin D et al. Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients. Aliment Pharmacol Ther 2010; 32: 466-471
  • 6 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
  • 7 Bloomfeld RS, Rockey DC, Shetzline MA. Endoscopic therapy of acute diverticular hemorrhage. Am J Gastroenterol 2001; 96: 2367-2372
  • 8 Hokama A, Uehara T, Nakayoshi T et al. Utility of endoscopic hemoclipping for colonic diverticular bleeding. Am J Gastroenterol 1997; 92: 543-546
  • 9 Simpson PW, Nguyen MH, Lim JK et al. Use of endoclips in the treatment of massive colonic diverticular bleeding. Gastrointest Endosc 2004; 59: 433-437
  • 10 Yen EF, Ladabaum U, Muthusamy VR et al. Colonoscopic treatment of acute diverticular hemorrhage using endoclips. Dig Dis Sci 2008; 53: 2480-2485
  • 11 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
  • 12 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
  • 13 Witte JT. Band ligation for colonic bleeding: modification of multiband ligating devices for use with a colonoscope. Gastrointest Endosc 2000; 52: 762-765
  • 14 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
  • 15 Ishii N, Itoh T, Uemura M et al. Endoscopic band ligation with a water-jet scope for the treatment of colonic diverticular hemorrhage. Dig Endosc 2010; 22: 232-235
  • 16 Ishii N, Uemura M, Itoh T et al. Endoscopic band ligation for the treatment of bleeding colonic and ileal diverticula. Endoscopy 2010; 42: 82-83
  • 17 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
  • 18 Ishii N, Setoyama T, Deshpande GA et al. Endoscopic band ligation (EBL) for colonic diverticular hemorrhage. Gastrointest Endosc 2012; 75: 382-387
  • 19 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
  • 20 Ikeya T, Ishii N, Nakano K et al. Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage. Endosc Int Open 2015; 3: E523-E528