Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

Couto-Worner, Ignacio; González-Conde, Benito; Estévez-Prieto, Emilio; Alonso-Aguirre, Pedro

doi:10.4321/s1130-01082013000800010

Cited by 17 publications

(18 citation statements)

References 17 publications

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“…This is lower than the rates reported in a previous systematic review and meta-analysis [25], with rates of 19 % for clipping and 21 % for thermal contact, which were similar to that for EBL (9 %). The early rebleeding rates of patients treated with endoclips were previously reported to be between 0 % and 50 %, which is a wide range [13,17,18,[26][27][28][29][30][31][32]. We speculate that these differences in early rebleeding rates following endoclips depend on whether endoclips are placed directly on vessels.…”

Section: Discussionmentioning

confidence: 81%

Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos)

et al. 2020

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Background and study aims The efficacy of endoclips for colonic diverticular hemorrhage remains unclear. The aim of the current study was to evaluate the safety and efficacy of endoclips versus endoscopic band ligation (EBL) for the treatment of colonic diverticular hemorrhage. Patients and methods At Nara City Hospital, 93 patients with colonic diverticular hemorrhage with stigmata of recent hemorrhage (SRH) were treated using endoclips or EBL between January 2013 and December 2018. We classified the patients treated by endoclips into the direct clipping group and indirect clipping group. Endoclips were placed directly onto the vessel if technically feasible (direct clipping). When direct placement of endoclips onto the vessel was not possible, the diverticulum was closed in a zipper fashion (indirect clipping). Patient demographics, rate of early rebleeding within 30 days after initial treatment, and complications were retrospectively evaluated. Results Of the 93 patients, 34, 28, and 31 were in the direct clipping group, indirect clipping group, and EBL group, respectively. Rates of early rebleeding in the direct clipping, indirect clipping, and EBL groups were 5.9 % (2/34), 35.7 % (10/28), and 6.5 % (2/31), respectively (P = 0.006: direct clipping vs indirect clipping, P = 1: direct clipping vs EBL). No complications occurred in any groups. All patients who had early rebleeding in the direct clipping group underwent EBL, and no further bleeding occurred after repeat therapy. Conclusions Direct clip placement is acceptable as the first treatment choice for colonic diverticular hemorrhage. When direct placement of endoclips is not possible, EBL should be performed instead of indirect clipping.

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Section: Discussionmentioning

confidence: 81%

Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos)

et al. 2020

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“…Finally, the risk of bowel infarction after TAE has been reported 13% to 33% of patients. 11 Heianna et al 10 proposed a colonoscopy-guided superselective arterial embolization for patients in whom endoscopic treatment was not effective. In these cases, some radiopaque clips were placed at the bleeding site during colonoscopy to mark the embolization site for the subsequent angiography.…”

Section: Discussionmentioning

confidence: 99%

New Trends in Acute Management of Colonic Diverticular Bleeding

et al. 2015

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Colonic diverticular disease is the most common cause of lower gastrointestinal bleeding. In the past, this condition was usually managed with urgent colectomy. Recently, the development of endoscopy and interventional radiology has led to a change in the management of colonic diverticular bleeding.The aim of this systematic review is to define the best treatment for colonic diverticular bleeding.A systematic bibliographic research was performed on the online databases for studies (randomized controlled trials [RCTs], observational trials, case series, and case reports) published between 2005 and 2014, concerning patients admitted with a diagnosis of diverticular bleeding according to the PRISMA methodology.The outcomes of interest were: diagnosis of diverticulosis as source of bleeding; incidence of self-limiting diverticular bleeding; management of non self-limiting bleeding (endoscopy, angiography, surgery); and recurrent diverticular bleeding.Fourteen studies were retrieved for analysis. No RCTs were found. Eleven non-randomized clinical controlled trials (NRCCTs) were included in this systematic review. In all studies, the definitive diagnosis of diverticular bleeding was always made by urgent colonoscopy. The colonic diverticular bleeding stopped spontaneously in over 80% of the patients, but a re-bleeding was not rare. Recently, interventional endoscopy and angiography became the first-line approach, thus relegating emergency colectomy to patients presenting with hemodynamic instability or as a second-line treatment after failure or complications of hemostasis with less invasive treatments.Colonoscopy is effective to diagnose diverticular bleeding. Nowadays, interventional endoscopy and angiographic treatment have gained a leading role and colectomy should only be entertained in case of failure of the former.

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“…In the present review, 10 reports were selected [26][27][28][29][30][31][32][33][34][35] to avoid overlapping cases among papers published from the same hospitals (Table 2). Primary hemostasis was achieved in 83-100% of cases, with an average of 97% in 383 cases treated by endoscopic clipping.…”

Section: Endoscopic Clippingmentioning

confidence: 99%

Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

Kaise

Nagata²,

Ishii

et al. 2019

Digestive Endoscopy

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There is the East-West paradox in prevalence and phenotype of colonic diverticula, but colonic diverticular bleeding (CDB) is the most common cause of acute lower gastrointestinal bleeding worldwide. Death from CDB can occur in elderly patients with multiple comorbidities, thus the management of CDB is clinically pivotal amid the aging populations in the East and West. Colonoscopy is the key modality for managing the condition appropriately; however, conventional endoscopic hemostasis by thermal coagulation and clipping cannot achieve the expected results of preventing early rebleeding and conversion to intensive intervention by surgery or transcatheter arterial embolization. Ligation therapy by endoscopic band ligation or endoscopic detachable snare ligation has emerged recently to enable more effective hemostasis for CDB, with an early rebleeding rate of approximately 10% and very rare conversion to intensive intervention. Ligation therapy might in turn reduce long-term rebleeding rates by eliminating the target diverticulum itself. Adverse events have been reported with ligation therapy including diverticulitis of the ascending colon in less than 1% of cases and perforation of the sigmoid colon in a few cases, thus more data are necessary to verify the safety of ligation therapy. Endoscopic hemostasis is indicated only for diverticulum with stigmata of recent hemorrhage (SRH), but the detection rates of SRH are relatively low. Therefore, efforts to increase detection are also key for improving CDB management. Urgent colonoscopy and triage by early contrastenhanced computed tomography may be candidates to increase detection but further data are necessary in order to make a conclusion. Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 241 Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 247 Digestive Endoscopy 2020; 32: 240-250 Control of colonic diverticular bleeding 249

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Colonic diverticular bleeding: urgent colonoscopy without purging and endoscopic treatment with epinephrine and hemoclips

Cited by 17 publications

References 17 publications

Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos)

Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos)

New Trends in Acute Management of Colonic Diverticular Bleeding

Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding

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