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Updated: Dec 31, 2025

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The 'step-clipping' method: a guide for identifying a previously bleeding colonic diverticulum.

Hirosato Tamari1, Taiki Aoyama1, Kenjiro Shigita1

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The step-clipping method effectively guides colonoscopy to previously bleeding diverticula, even after bleeding stops. This technique significantly improves lesion detection and treatment success rates in patients with colonic diverticular bleeding.

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Area of Science:

  • Gastroenterology
  • Endoscopy
  • Medical Imaging

Background:

  • Colonic diverticular bleeding poses diagnostic challenges due to difficulties in precisely locating the bleeding source during colonoscopy.
  • Contrast-enhanced computed tomography (CECT) can show extravasation but may not pinpoint the exact diverticulum for endoscopic intervention.

Purpose of the Study:

  • To evaluate the efficacy of the step-clipping method in improving the detectability and treatment of previously bleeding diverticula.
  • To assess the step-clipping method's utility in guiding endoscopic interventions when active bleeding is not evident during colonoscopy.

Main Methods:

  • The step-clipping technique was applied to patients with a history of colonic diverticular bleeding and CECT-confirmed extravasation, but without active bleeding during colonoscopy.
  • Computed tomography images were compared pre- and post-step clipping to establish the spatial relationship between clips and the target diverticulum.
  • Endoscopic identification and treatment of the target diverticulum were performed using guidance from the step-clipping markers.

Main Results:

  • The step-clipping method successfully identified the target diverticulum in 95% (20 out of 21) of cases.
  • Endoscopic identification and treatment were achieved rapidly, with a median time of 5 minutes.
  • No adverse events were associated with the step-clipping procedure.

Conclusions:

  • Step-clipping offers a reliable and efficient method for guiding endoscopic treatment of colonic diverticular bleeding, even in the absence of active bleeding.
  • This technique overcomes the limitations of conventional colonoscopy in precisely locating bleeding diverticula after initial imaging.
  • The step-clipping method facilitates timely and safe intervention for a significant majority of patients with challenging diverticular bleeding.