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[Classification of the bleeding pattern in colonic diverticulum is useful to predict the risk of bleeding or

Yoko Kominami1, Hirotoki Ohe, Sayo Kobayashi

  • 1Department of Gastroenterology and Metabolism Graduate School of Biomedical Sciences, Hiroshima University Hospital, Japan.

Nihon Shokakibyo Gakkai Zasshi = the Japanese Journal of Gastro-Enterology
|March 9, 2012
PubMed

Insights

Re-bleeding after endoscopic hemostasis for acute lower gastrointestinal hemorrhage from colonic diverticula is higher in active bleeding (Type 1) than in non-bleeding (Type 2) cases. The direct clipping method may reduce re-bleeding in Type 2 patients.

Area of Science:

  • Gastroenterology
  • Endoscopic Surgery

Context:

  • Acute lower gastrointestinal hemorrhage (LGIB) from colonic diverticula is a common clinical challenge.
  • Endoscopic hemostasis is a primary treatment modality for diverticular bleeding.
  • Differentiating bleeding patterns is crucial for predicting treatment outcomes.

Purpose:

  • To evaluate the re-bleeding rate after endoscopic hemostasis based on bleeding patterns in patients with colonic diverticular hemorrhage.
  • To compare the efficacy of the direct clipping method versus the reefing method for endoscopic hemostasis.
  • To identify optimal endoscopic strategies for preventing re-bleeding in different bleeding types.

Summary:

  • A study involving 83 patients with colonic diverticular hemorrhage (34 active bleeding - Type 1, 49 non-active bleeding - Type 2) assessed re-bleeding rates after endoscopic hemostasis.
  • Re-bleeding occurred significantly more often in Type 1 patients (all treated with the reefing method) than in Type 2 patients.
  • In Type 2 patients, the direct clipping method (used in 14 cases) resulted in no re-bleeding, whereas the reefing method (used in 35 cases) had a re-bleeding rate of 14.3% (5 cases).

Impact:

  • Findings suggest that the direct endoscopic clipping method may be more effective in preventing re-bleeding for Type 2 diverticular hemorrhage.
  • Further research into optimized endoscopic techniques is warranted, particularly for Type 1 active bleeding diverticular hemorrhage, to reduce early re-bleeding rates.

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