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Clinical outcomes of incomplete diverticular inversion after endoscopic band ligation for colonic diverticular
Chikamasa Ichita1, Takashi Nishino2, Tetsuya Hattori3
1Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; Department of Health Data Science, Yokohama City University, 22-2, Seto, Kanazawa-ku, Yokohama, Kanagawa 236-0027, Japan; Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanagawa 247-8533, Japan.
Background And Aims:
Endoscopic band ligation (EBL) is an established treatment for colonic diverticular bleeding (CDB), but the significance of incomplete diverticular inversion is unclear. We evaluated whether incomplete inversion after EBL was associated with 30-day rebleeding and postprocedural adverse events. Indirect clipping was an exploratory comparator because it may be considered when complete inversion with EBL is difficult.
Methods:
This single-center retrospective cohort included hospitalizations with definite CDB treated with EBL or indirect clipping alone during 2017-2025. Post-EBL inversion status was classified as complete or incomplete. Hospitalization was the unit of analysis. The primary outcome was 30-day rebleeding; postprocedural adverse events were secondary outcomes. After multiple imputation, propensity score-adjusted models with patient-level cluster-robust standard errors compared incomplete with complete inversion and, exploratorily, with indirect clipping.
Results:
Of 1,140 screened hospitalizations, 443 were analyzed: 303 EBL-treated hospitalizations (258 with complete and 45 with incomplete inversion) and 140 indirect-clipping hospitalizations. Thirty-day rebleeding was more frequent after incomplete than complete inversion (37.8% vs 10.9%; adjusted odds ratio [OR], 4.25; patient-clustered 95% confidence interval [CI], 2.07-8.73). In the exploratory comparison, 30-day rebleeding rates were 37.8% after incomplete inversion and 44.3% after indirect clipping (adjusted OR, 0.72; patient-clustered 95% CI, 0.37-1.41). Adjusted CIs for evaluable adverse events included the null; diverticulitis was too rare for adjustment.
Conclusions:
Incomplete inversion after EBL was associated with higher odds of 30-day rebleeding than complete inversion. Thirty-day rebleeding rates exceeded one-third in both the incomplete-inversion and indirect-clipping groups, but the exploratory comparison was inconclusive.
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