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Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band

Naoyoshi Nagata1, Naoki Ishii2, Mitsuru Kaise3

  • 1Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.

Gastrointestinal Endoscopy
|July 24, 2018
PubMed

Insights

Endoscopic band ligation shows a lower 1-year recurrent bleeding risk for colonic diverticular bleeding (CDB) compared to clipping. This suggests band ligation offers better long-term outcomes for managing CDB.

Area of Science:

  • Gastroenterology
  • Endoscopic interventions
  • Gastrointestinal bleeding

Background:

  • Limited prospective studies evaluate long-term outcomes of endoscopic therapy for colonic diverticular bleeding (CDB).
  • Recurrent bleeding risk after endoscopic treatment for CDB requires further elucidation.

Purpose of the Study:

  • To compare the 1-year recurrent bleeding risk of endoscopic band ligation versus clipping for definitive CDB.
  • To evaluate long-term outcomes of endoscopic therapies for CDB based on stigmata of recent hemorrhage (SRH).

Main Methods:

  • Prospective enrollment of patients hospitalized for acute lower GI bleeding.
  • High-resolution colonoscopy with water-jet visualization for SRH.
  • First-line treatment using endoscopic band ligation or clipping, followed by prospective follow-up.

Main Results:

  • 1-year recurrent bleeding probability was significantly lower with band ligation (11.5%) versus clipping (37.0%).
  • No statistical difference in baseline characteristics or follow-up duration between groups.
  • Left colon location was an independent predictor for recurrent bleeding in the ligation group.

Conclusions:

  • Endoscopic band ligation demonstrates superior long-term outcomes compared to clipping for definitive CDB treatment.
  • Band ligation may be more effective due to complete diverticulum elimination, reducing recurrence.
  • CDB recurrence can occur at the same diverticulum short-term or different diverticula long-term.
Abstract

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