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Step-clipping method can improve the detectability of the target lesion in colonic diverticular bleeding
Taiki Aoyama1, Hiroki Takemoto1, Yukari Takeuchi1
1Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan.
Insights
The step-clipping method significantly improves colonoscopy's ability to detect the bleeding source in colonic diverticular bleeding (CDB). This technique reduces search time, lowers re-bleeding rates, and allows for earlier patient discharge.
Area of Science:
- Gastroenterology
- Medical Imaging
- Surgical Techniques
Background:
- Colonic diverticular bleeding (CDB) diagnosis is challenging due to poor correlation between contrast-enhanced computed tomography (CECT) and colonoscopy findings.
- The
- step-clipping
- method offers a strategic approach to mark and identify the bleeding diverticulum.
Purpose of the Study:
- To evaluate the clinical effectiveness of the step-clipping method in identifying the bleeding source during colonoscopy for patients with CDB.
Main Methods:
- A retrospective study included 87 patients with CDB and CECT-confirmed extravasation.
- Patients were categorized into a traditional colonoscopy group (n=54) and a step-clipping group (n=33).
Main Results:
- The step-clipping group demonstrated a significantly higher detection rate of the responsible diverticulum (94% vs. 63%, P=.0013).
- Colonoscopy search time was reduced (9.6 vs. 40.5 minutes, P<.0001), and re-bleeding rates decreased (6% vs. 26%, P=.02) in the step-clipping group.
- The step-clipping group experienced earlier hospital discharge (5.4 vs. 6.8 days, P=.027).
Conclusions:
- The step-clipping method enhances the detectability of target lesions in CDB during colonoscopy.
- This technique leads to improved efficiency, reduced re-bleeding, and shorter hospital stays.
Abstract:
Background and study aims Despite the information regarding extravasation from contrast-enhanced computed tomography (CECT), the detectability of the target diverticulum by colonoscopy remains unsatisfactory in colonic diverticular bleeding (CDB). The lack of common signs recognizable on CT and endoscopic images makes it difficult to set a region of interest; however, this can be overcome with the "step-clipping" method, a strategic marking technique for revealing the target. We aimed to investigate the clinical performance of the step-clipping method in patients with CDB. Patients and methods Eighty-seven patients diagnosed with CDB with extravasation using CECT who underwent colonoscopy between August 2007 and February 2020 were included. Patients were divided into two categories: the traditional group (those who underwent colonoscopy from August 2007 to May 2017, n = 54) and the step-clipping group (those who underwent colonoscopy from June 2017 to February 2020, n = 33). Results The detection rate for the responsible diverticulum was significantly higher in the step-clipping group than in the traditional group (94 % vs 63 %; P = .0013). The step-clipping group had a shorter average search time during colonoscopy (9.6 vs 40.5 minutes; P < .0001) and lower re-bleeding rate after the initial colonoscopy (6 % vs 26 %; P = .02) than the traditional group, which facilitated earlier hospital discharge (5.4 vs 6.8 days; P = .027). Conclusions Colonoscopy using the step-clipping method can improve the detectability of the target lesion within a shorter time, thus leading to lower re-bleeding rates and earlier hospital discharge.
