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Endoscopic band ligation alone and combined with clipping for colonic diverticular bleeding: Retrospective

Noritaka Ozawa1, Kenji Yamazaki1, Nae Hasebe1

  • 1Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.

Endoscopy International Open
|March 20, 2025
PubMed

Insights

Combining endoscopic band ligation (EBL) with clipping (EBL-C) shows promise for treating colonic diverticular bleeding (CDB). This novel method may reduce rebleeding rates compared to EBL alone, with neck formation being key to success.

Area of Science:

  • Gastroenterology and Endoscopy
  • Digestive System Diseases
  • Minimally Invasive Surgery

Background:

  • Colonic diverticular bleeding (CDB) is a significant clinical challenge.
  • Current endoscopic hemostasis methods include clipping alone or endoscopic band ligation (EBL) alone.
  • There is a need for improved hemostatic techniques to reduce rebleeding rates.

Purpose of the Study:

  • To evaluate the usefulness of a novel combined endoscopic band ligation and clipping (EBL-C) method for hemostasis of CDB.
  • To compare the efficacy of EBL-C versus EBL alone in preventing early rebleeding from colonic diverticula.
  • To identify risk factors for early rebleeding in patients treated with EBL-C.

Main Methods:

  • Retrospective study of 138 patients with CDB treated endoscopically from March 2019 to July 2024.
  • Comparison of two groups: EBL (n=24) and combined EBL-C (n=56).
  • Analysis of risk factors for early rebleeding (within 30 days) in the EBL-C group.

Main Results:

  • The EBL-C group showed a lower rate of early rebleeding (8.9%) compared to the EBL group (25.0%), though not statistically significant (P=0.0776).
  • Failure of neck formation was the sole independent risk factor for rebleeding (aOR 0.076, P=0.0023).
  • Successful neck formation was significantly higher in the EBL-C group (89.3%) versus the EBL group (66.7%) (P=0.0235), with EBL-C being an independent factor for successful neck formation (aOR 7.01, P=0.0095).

Conclusions:

  • The combined EBL-C method may be more effective than EBL alone in preventing rebleeding from colonic diverticula by facilitating better ligation.
  • Successful neck formation is crucial for preventing early rebleeding.
  • Difficult-to-manage diverticula remain a challenge for endoscopic hemostasis.

Keywords:
Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...)Endoscopy Lower GI TractLower GI bleedingPolyps / adenomas / ...

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