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Colonic diverticular bleeding: An update on pathogenesis and management
Sneha Annie Sebastian1, Edzel Lorraine Co2, Venkatesh Panthangi3
1Azeezia Medical College, Kollam, Kerala, India.
Insights
Colonic diverticular bleeding, a common cause of lower GI bleeding, is increasing in older adults. The over-the-scope clip (OTSC) method shows promise for severe cases, especially rebleeding.
Area of Science:
- Gastroenterology
- Endoscopy
- Hemorrhage Management
Background:
- Colonic diverticular bleeding is a prevalent, potentially life-threatening condition, particularly in aging populations.
- Increased use of anticoagulants/antiplatelets contributes to a higher incidence of acute diverticular bleeding.
- Severe bleeding often necessitates transfusions or emergency surgery, highlighting the need for effective interventions.
Approach:
- This review summarizes the pathophysiology of colonic diverticulosis and diverticular bleeding.
- It examines recent evidence on management strategies and preventive measures.
- The efficacy and outcomes of the over-the-scope clip (OTSC) technique are discussed.
Key Points:
- The over-the-scope clip (OTSC) method is an effective endoscopic hemostatic technique for severe diverticular bleeding.
- OTSC is particularly valuable in managing rebleeding after conventional endoscopic procedures.
- Understanding pathophysiology and exploring preventive strategies are crucial for controlling diverticular bleeding.
Conclusions:
- The OTSC method offers a promising solution for challenging cases of colonic diverticular bleeding.
- Further research into preventive strategies may reduce the incidence and severity of this condition.
- Effective endoscopic management, including OTSC, is vital for improving patient outcomes.
Abstract:
Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years, the prevalence of diverticulosis has increased in developed countries, with a documented incidence of 50% in patients older than 60 years. Based on the evidence, the use of anticoagulants and/or antiplatelets in the elderly population has resulted in an increased incidence of acute diverticular bleeding. According to the literature, about 50% of patients with diverticular bleeding require a blood transfusion, and 18% - 53% need emergency surgery. Although endoscopic identification of the culprit diverticula and appropriate intervention is a challenge, the newer treatment modality, over-the-scope clip method (OTSC) has been demonstrated to be an effective endoscopic hemostatic method in severe diverticular bleeding, especially in cases of rebleeding after first-line conventional endoscopic procedures. In this review, we summarize the pathophysiology of colonic diverticulosis and diverticular bleeding, recent evidence in its management, and existing theories on various preventive strategies to control diverticular bleeding. We also discuss the efficacy and treatment outcome of the OTSC technique in controlling diverticular bleeding.
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