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Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band
Naoyoshi Nagata1,2, Ryota Niikura3, Naoki Ishii4
1Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan.
Insights
Band ligation is more effective than clipping for treating colonic diverticular bleeding (CDB), significantly reducing both short-term and long-term rebleeding rates. This systematic review highlights band ligation as a superior endoscopic therapy for CDB recurrence.
Area of Science:
- Gastroenterology
- Endoscopic interventions
- Hemorrhage control
Background:
- Colonic diverticular bleeding (CDB) is a common condition often treated with endoscopic methods like clipping or band ligation.
- Rebleeding is a significant concern following endoscopic treatment for CDB, necessitating a comparison of available techniques.
- Current evidence lacks a comprehensive comparison of short-term and long-term rebleeding rates between clipping and band ligation for CDB.
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing the efficacy of endoscopic band ligation versus clipping in reducing rebleeding after colonic diverticular bleeding (CDB).
- To evaluate and compare early and late rebleeding rates associated with band ligation and clipping for CDB.
- To assess secondary outcomes including initial hemostasis and the need for further interventions such as transcatheter arterial embolization or surgery.
Main Methods:
- A systematic literature search was performed across PubMed/MEDLINE and Embase databases up to December 2019.
- Included studies focused on endoscopic treatment for colonic diverticular bleeding (CDB), comparing clipping and band ligation.
- Main outcomes analyzed were early (within 30 days) and late (within 1 year) rebleeding rates, alongside initial hemostasis and need for embolization or surgery.
Main Results:
- Sixteen studies involving 790 participants were analyzed.
- Band ligation demonstrated significantly lower pooled prevalence for both early (0.08 vs. 0.19) and late (0.09 vs. 0.29) rebleeding compared to clipping.
- The need for transcatheter arterial embolization or surgery was also significantly lower with band ligation (0.01 vs. 0.02), though two cases of colonic diverticulitis were noted with band ligation.
Conclusions:
- Endoscopic band ligation is more effective than clipping for reducing recurrence of colonic diverticular hemorrhage.
- Band ligation offers superior short-term and long-term outcomes in managing colonic diverticular bleeding (CDB).
- While effective, potential complications like colonic diverticulitis should be considered with band ligation.
Background And Aim:
Either clipping or band ligation will become the most common endoscopic treatment for colonic diverticular bleeding (CDB). Rebleeding is a significant clinical outcome of CDB, but there is no cumulative evidence comparing reduction of short-term and long-term rebleeding between them. Thus, we conducted a systematic review and meta-analysis to determine which endoscopic treatment is more effective to reduce recurrence of CDB.
Methods:
A comprehensive search of the databases PubMed/MEDLINE and Embase was performed through December 2019. Main outcomes were early and late rebleeding rates, defined as bleeding within 30 days and 1 year of endoscopic therapy for CDB. Initial hemostasis, need for transcatheter arterial embolization, or surgery were also assessed. Overall pooled estimates were calculated.
Results:
Sixteen studies fulfilled the eligibility criteria, and a total of 790 participants were included. The pooled prevalence of early rebleeding was significantly lower for band ligation than clipping (0.08 vs 0.19; heterogeneity test, P = 0.012). The pooled prevalence of late rebleeding was significantly lower for band ligation than clipping (0.09 vs 0.29; heterogeneity test, P = 0.024). No significant difference of initial hemostasis rate was noted between the two groups. Pooled prevalence of need for transcatheter arterial embolization or surgery was significantly lower for band ligation than clipping (0.01 vs 0.02; heterogeneity test, P = 0.031). There were two cases with colonic diverticulitis due to band ligation but none in clipping.
Conclusion:
Band ligation therapy was more effective compared with clipping to reduce recurrence of colonic diverticular hemorrhage over short-term and long-term durations.
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