Endoscopic therapies for colonic diverticular bleeding: a systematic review and meta-analysis

Colonic diverticular bleeding (CDB) is a common cause of acute lower gastrointestinal bleeding. Several endoscopic modalities are used for treating CDB, including through-the-scope (TTS) clip, endoscopic band ligation (EBL), endoscopic detachable snare ligation (EDSL), and over-the-scope-clip (OTSC). This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of endoscopic treatment options for CDB.

We searched PubMed, Embase, and Cochrane Library databases. The proportion meta-analysis calculated the pooled estimates with 95% confidence intervals (CIs) with subgroup analyses based on endoscopic treatment modalities. A P-value < 0.10 was considered statistically significant for subgroup differences.

We included 21 observational studies (3,161 participants). The pooled rate of successful hemostasis using endoscopic treatment was 98.90% (95% CI 97.66-99.75%), with no significant subgroup differences (P = 0.64). However, significant treatment interactions were observed for early rebleeding, late rebleeding, procedure time, and need for transcatheter arterial embolization or surgery, with TTS clip consistently associated with worse outcomes. The EDSL subgroup had the highest rate of overall adverse events (2.15%; 95% CI 0.02-6.27%). There were no significant differences among the treatment modalities regarding length of hospital stay or mortality.

Endoscopic treatment for CDB achieved high rates of immediate hemostasis across all modalities. While TTS clips were associated with worse outcomes across several effectiveness measures, there were no significant differences among the endoscopic treatment modalities regarding length of hospital stay or mortality. Adverse events were more frequently reported with EDSL.