Endoscopic Hemostasis in Acute Diverticular Bleeding

Introduction

Endoscopic hemostasis is the standard care in acute upper gastrointestinal bleeding [1] [2], and can be extended to bleeding angiodysplasia in the lower intestinal tract [3]. With the emerging role of urgent colonoscopy in acute lower intestinal bleeding [4] [5] [6], it is conceivable that actively bleeding diverticula will be identified with increasing frequency. Case reports suggest a limited role for endoscopic hemostasis of bleeding diverticula [7] [8], though techniques of localization and therapy are not well characterized. We describe our experience with endoscopic management of bleeding diverticula and review the literature pertinent to this procedure.

References

• 1 Steer M L, Silen W. Diagnostic procedures in gastrointestinal hemorrhage.  N Engl J Med. 1983;  309 646-650
• 2 Pertini J L. Endoscopic therapy for gastrointestinal bleeding.  Postgrad Med. 1988;  84 239-245
• 3 Jensen D M, Machicado G A. Diagnosis and treatment of severe hematochezia: the role of colonoscopy after purge.  Gastroenterology. 1988;  95 1569-1574
• 4 Zuccaro G. Management of the adult patient with acute lower gastrointestinal bleeding.  Am J Gastroenterol. 1998;  93 1202-1210
• 5 Zuckerman G R, Prakash C. Acute lower intestinal bleeding. Part I: clinical presentation and diagnosis.  Gastrointest Endosc. 1998;  48 606-616
• 6 Zuckerman G R, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy and outcomes.  Gastrointest Endosc. 1999;  49 228-238
• 7 Savides T, Jensen D M. Colonoscopic hemostasis of recent diverticular hemorrhage associated with a visible vessel: a report of three cases.  Gastrointest Endosc. 1994;  40 70-73
• 8 Richter J M, Christensen M R, Kaplan L M, Nishioka N S. Effectiveness of current technology in the diagnosis and management of lower gastrointestinal hemorrhage.  Gastrointest Endosc. 1995;  41 93-98
• 9 Meyers M A, Alonso D R, Gray G F, Baer J W. Pathogenesis of bleeding colonic diverticulosis.  Gastroenterology. 1976;  71 577-583
• 10 Akhrass R, Yaffe M B, Fischer C, et al. Small bowel diverticulosis: perceptions and reality.  J Am Coll Surg. 1997;  184 383-388
• 11 Hughes L E. Complications of diverticular disease: inflammation, obstruction and bleeding.  Clin Gastroenterol. 1975;  4 147-170
• 12 Reinus J F, Brandt L J. Vascular ectasias and diverticulosis. Common causes of lower intestinal bleeding.  Gastroenterol Clin N Am. 1994;  23 1-20
• 13 Longstreth G F. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study.  Am J Gastroenterol. 1997;  92 419-424
• 14 Geller A, Mayoral W, Balm R, et al. Colonoscopy in acute lower gastrointestinal bleeding (abstract).  Gastrointest Endosc. 1997;  45 AB107
• 15 McGuire H H. Bleeding colonic diverticula. A reappraisal of natural history and management.  Ann Surg. 1994;  220 653-656
• 16 Caos A, Benner K G, Manier J, et al. Colonoscopy after Go Lytely preparation in acute rectal bleeding.  J Clin Gastroenterol. 1986;  8 46-49
• 17 Rosen L, Bub D S, Reed J F. Hemorrhage following colonoscopic polypectomy.  Dis Colon Rectum. 1993;  36 1126-1131
• 18 Trudel J L, Fazio V W, Sivak M V. Colonoscopic diagnosis and treatment of arteriovenous malformations in chronic lower gastrointestinal bleeding.  Dis Colon Rectum. 1988;  31 107-110
• 19 Gupta N, Longo W E, Vernava A M. Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively.  Dis Colon Rectum. 1995;  38 979-982
• 20 Kim Y I, Marcon N E. Injection therapy for colonic diverticular disease.  J Clin Gastroenterol. 1993;  17 46-48
• 21 Bertoni G, Conigliaro R, Ricci E, et al. Endoscopic injection hemostasis of colonic diverticular bleeding: a case report.  Endoscopy. 1990;  22 154-155
• 22 Johnston J, Sones J. Endoscopic heater probe coagulation of the bleeding colonic diverticulum (abstract).  Gastrointest Endosc. 1986;  32 160
• 23 Damore L J 2nd, Rantis P C, Vernava A M, Longo W E. Colonoscopic perforations. Etiology, diagnosis, and management.  Dis Colon Rectum. 1996;  39 1308-1314
• 24 Johnston J H, Jensen D M, Auth D. Experimental comparison of endoscopic yttrium:aluminum-garnet laser, electrosurgery, and heater probe for canine gut arterial coagulation.  Gastroenterol. 1987;  92 1101-1108
• 25 Cappell M S. Gastrointestinal endoscopy in high-risk patients.  Dig Dis. 1996;  14 228-244
• 26 Cappell M S. Safety and clinical efficacy of flexible sigmoidoscopy and colonoscopy for gastrointestinal bleeding after myocardial infarction.  Dig Dis Sci . 1994;  39 473-480