Related Experiment Video
Updated: Sep 10, 2025
Underwater Endoscopic Injection Sclerotherapy for Gastroesophageal Varices
Published on: August 1, 2025
Endoscopic treatment modalities for colonic diverticular bleeding: A systematic review with direct and network
Zahid Ijaz Tarar1, Mustafa Gandhi1, Faisal Inayat2
1Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States.
Insights
Endoscopic detachable snare ligation (EDSL) shows superiority over endoscopic clipping and endoscopic band ligation (EBL) for colonic diverticular bleeding (CDB). EDSL achieves better initial hemostasis and significantly reduces late rebleeding rates in CDB patients.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Hemorrhage Management
Background:
- Colonic diverticular bleeding (CDB) is a major cause of lower gastrointestinal hemorrhage with high recurrence.
- Endoscopic clipping, endoscopic band ligation (EBL), and endoscopic detachable snare ligation (EDSL) are common hemostasis methods for CDB.
- Comparative efficacy data for these endoscopic therapies remain inconsistent.
Purpose of the Study:
- To compare the effectiveness and complication rates of endoscopic clipping, EBL, and EDSL for managing CDB.
- To evaluate initial hemostasis, and early and late rebleeding rates across the three endoscopic interventions.
Main Methods:
- Systematic literature search of major databases (PubMed/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, Cochrane).
- Inclusion of clinical trials reporting on CDB and endoscopic clipping, EBL, or EDSL.
- Calculation of pooled estimates for initial hemostasis, early/late rebleeding, and need for surgery/embolization.
Main Results:
- Analysis of 28 studies involving 4526 patients with active CDB requiring endoscopic intervention.
- Endoscopic clipping showed significantly higher early rebleeding rates (23.5%) compared to EBL (10.7%) and EDSL (10.6%).
- EDSL demonstrated superior outcomes with lower late rebleeding rates (2.7%) compared to clipping (27.2%) and EBL (13.8%).
Conclusions:
- Endoscopic detachable snare ligation (EDSL) is more effective than endoscopic clipping and EBL for initial hemostasis in CDB.
- EDSL significantly reduces the rate of late rebleeding in patients with colonic diverticular bleeding.
- The snare technique offers improved outcomes for managing CDB compared to clipping and ligation.
Background:
Colonic diverticular bleeding (CDB) is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence. The endoscopic clipping and endoscopic band ligation (EBL) methods are widely used for hemostasis in patients with CDB. Endoscopic detachable snare ligation (EDSL) has also become an increasingly common treatment option. The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.
Aim:
To study the effectiveness and complications of endoscopic clipping, EBL, and EDSL for CDB.
Methods:
We conducted a systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping, EBL, or EDSL as treatment methods. The pooled estimates of initial hemostasis, early and late rebleeding, and the need for transarterial embolization or surgery between these groups were calculated.
Results:
We analyzed 28 studies with 5224 patients. Of these, 4526 had active CDB and required one of the three endoscopic interventions. The pooled prevalence of early rebleeding was 23.5%, 10.7%, and 10.6% in the endoscopic clipping, EBL, and EDSL groups, respectively. Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL [odds ratio (OR) = 3.76 (95%CI: 2.13-6.63)] and EDSL (OR = 3.30, 95%CI: 1.28-8.53). There was no difference in the initial hemostasis between the three groups. The pooled prevalence of late rebleeding was 27.2% in the clipping, followed by 13.8% in the EBL and 2.7% in the EDSL group. Compared to 2.6% in the EBL group, 4.0% of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization. These results were consistent in the network meta-analysis. Based on the ranking of the indirect comparison of modalities, the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.
Conclusion:
The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.
More Related Videos
04:09Endoscopic Injection Sclerotherapy Assisted by Cyanoacrylate and Clips for Gastroesophageal Varices
Published on: June 13, 2025
05:43The Role of Anatomical Dissection in Defining Colic and Small Bowel Artery Lymphovascular Bundles in the D3 Volume of Small and Large Bowel Mesentery
Published on: August 1, 2025
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
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Pharmacologic...
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...
01:24Esophageal Varices-I: Introduction