Related Experiment Video
Updated: May 25, 2025
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to
Takaaki Kishino1, Yoko Kitamura1, Takashi Okuda1
1Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan.
Insights
Direct clipping is preferred for colonic diverticular bleeding (CDB) when feasible, followed by endoscopic band ligation (EBL). This strategy offers effective, efficient, and safe hemostasis for CDB patients.
Area of Science:
- Gastroenterology
- Endoscopic interventions
- Colorectal surgery
Background:
- Colonic diverticular bleeding (CDB) is a common condition requiring hemostasis.
- Direct or indirect clipping and endoscopic band ligation (EBL) are established treatments for CDB.
- A clear treatment selection strategy for CDB hemostasis is lacking.
Purpose of the Study:
- To describe a treatment selection strategy for colonic diverticular bleeding.
- To evaluate the outcomes of clipping versus EBL for CDB hemostasis.
- To compare the effectiveness, efficiency, and safety of different hemostatic methods for CDB.
Main Methods:
- A retrospective review of 192 patients with CDB and stigmata of recent hemorrhage (SRH) treated between March 2016 and February 2023.
- Treatment selection prioritized direct clipping, followed by EBL, then indirect clipping.
- Data on hemostasis time, rebleeding rates, and complications were analyzed.
Main Results:
- Clipping was used in 84 patients (78 direct, 6 indirect) and EBL in 108.
- Active bleeding (SRH) was more frequent in the EBL group (60.2% vs. 33.3%).
- Median hemostasis time was shorter with clipping (9 min vs. 22 min). No significant difference in 30-day rebleeding rates (15.5% vs. 13.0%). One delayed perforation post-EBL; no complications with clipping.
Conclusions:
- A strategy prioritizing direct clipping when feasible, followed by EBL, is effective, efficient, and safe for CDB.
- Tailoring the hemostatic method to the visual field of SRH and endoscope maneuverability optimizes outcomes.
- This approach effectively utilizes the advantages of both clipping and EBL for managing colonic diverticular bleeding.
Background And Study Aims:
Direct or indirect clipping and endoscopic band ligation (EBL) are widely used for hemostasis in patients with colonic diverticular bleeding (CDB). However, no treatment selection strategy has been established. This report describes our approach and its outcomes.
Patients And Methods:
We select direct clipping if the bleeding point is visible and clips could be inserted into the diverticulum. When direct clipping is not feasible, we select EBL as the second choice and indirect clipping as the third. We reviewed data from 192 patients treated with clipping or EBL for definitive CDB with stigmata of recent hemorrhage (SRH) at our hospital between March 2016 and February 2023.
Results:
The hemostatic method was clipping in 84 patients (direct, n=78; indirect, n=6) and EBL in 108. The rate of SRH with active bleeding was significantly higher in the EBL group (33.3% vs. 60.2%, p <0.001). Median hemostasis time was significantly shorter in the clipping group (9 min vs. 22 min, P <0.001). There was no significant difference in the 30-day rebleeding rate between clipping and EBL (15.5% vs. 13.0%; P =0.619). There was one case of delayed perforation post-EBL. There were no complications after clipping.
Conclusions:
Direct clipping when placement of clips at the bleeding point is feasible and EBL when direct clipping is not feasible is a reasonable strategy in terms of effectiveness, efficiency, and safety. Selection of hemostatic method according to the visual field of SRH and maneuverability of the endoscope allows the advantages of both methods to be realized.
More Related Videos
04:00Laparoscopic Splenectomy with Pericardial Devascularization for Hypersplenism and Esophageal Variceal Hemorrhage Due to Portal Hypertension
Published on: November 15, 2024
15:49Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System
Published on: October 16, 2013
Related Concept Videos
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:25Endoscopic Procedures II: Colonoscopy
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:26Peptic Ulcer Disease IV: Management
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current...