Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study

Kobayashi, Katsumasa; Nagata, Naoyoshi; Furumoto, Yohei; Yamauchi, Atsushi; Yamada, Atsuo; Omori, Jun; Ikeya, Takashi; Aoyama, Taiki; Tominaga, Naoyuki; Sato, Yoshinori; Kishino, Takaaki; Ishii, Naoki; Sawada, Tsunaki; Murata, Masaki; Takao, Akinari; Mizukami, Kazuhiro; Kinjo, Ken; Fujimori, Shunji; Uotani, Takahiro; Fujita, Minoru; Sato, Hiroki; Suzuki, Sho; Narasaka, Toshiaki; Hayasaka, Junnosuke; Kaise, Mitsuru

doi:10.1055/a-1705-0921

Cited by 27 publications

(26 citation statements)

References 30 publications

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“…The guidelines recommend endoscopic clipping for CDB because it is the most common treatment and typically poses a lower risk of tissue injury 1,23 . However, endoscopic band ligation has been shown to be ultimately superior to endoscopic clipping regarding short‐term and long‐term rebleeding rates and the need for IVR/surgery in CDB cases 34,35 . We performed endoscopic band ligation in 83% (124/149) of patients with definitive CDB (Table S1), which contributed to the risk reduction of 30‐day rebleeding in the recent bleeding group (Table S2).…”

Section: Discussionmentioning

confidence: 99%

“…1,23 However, endoscopic band ligation has been shown to be ultimately superior to endoscopic clipping regarding short-term and long-term rebleeding rates and the need for IVR/surgery in CDB cases. 34,35 We performed endoscopic band Candidates for early colonoscopy ligation in 83% (124/149) of patients with definitive CDB (Table S1), which contributed to the risk reduction of 30-day rebleeding in the recent bleeding group (Table S2). However, the impact of clipping accompanied by early colonoscopy should be investigated by accumulating a larger number of cases in future studies.…”

Section: Discussionmentioning

confidence: 99%

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Optimal candidates for early colonoscopy in the management of acute lower gastrointestinal bleeding

Saino

Aoyama

Yamane

et al. 2022

J of Gastro and Hepatol

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Background and Aim Early colonoscopy has not shown any advantages over elective colonoscopy in reducing the risk of early rebleeding (≤ 30 days) after acute lower gastrointestinal bleeding (ALGIB). Considering the heterogeneity among patients with ALGIB, we sought to evaluate appropriate candidates for early colonoscopy. Methods A total of 592 patients with ALGIB were enrolled, and the clinical outcomes of early colonoscopy were investigated. Thereafter, the participants were divided into two groups: the recent bleeding group (n = 445), with hematochezia 0–6 h before hospital arrival, and non‐recent bleeding group (n = 147). The clinical outcomes yielded by early colonoscopy were assessed in each group. Results The multivariate analysis including the entire population revealed that early colonoscopy (< 24 h) did not reduce the risk of early rebleeding (adjusted odds ratio [AOR], 0.88; 95% confidence interval [CI], 0.55–1.39). However, in the subgroup analysis, early colonoscopy independently reduced the risk of early rebleeding in the recent bleeding group (AOR, 0.56; 95% CI, 0.33–0.94). Moreover, a reduction in the need for radiological or surgical intervention (AOR, 0.34), transfusion (AOR, 0.62), and prolonged hospitalization (AOR, 0.42), as well as improvement in diagnostic yield (AOR, 1.78) and endoscopic treatment rates (AOR, 1.66), were observed. Early colonoscopy did not improve the outcomes of the non‐recent bleeding group. Conclusions Early colonoscopy is not required for all patients with ALGIB. However, it may be suitable for those with hematochezia 0–6 h before hospital arrival, as it reduces early rebleeding and improves clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Optimal candidates for early colonoscopy in the management of acute lower gastrointestinal bleeding

Saino

Aoyama

Yamane

et al. 2022

J of Gastro and Hepatol

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“…Giri and Sundaram for their interest in our study and for their comments. In this study, we reviewed data for 1679 patients with colonic diverticular hemorrhage (CDH) who were treated with endoscopic band ligation (EBL) or clipping at 49 hospitals across Japan (CODE BLUE-J study), and the association between endoscopic treatment and clinical outcomes was analyzed using logistic regression models [1]. The treatment strategy was chosen at the discretion of each hospital and endoscopist.…”

Section: Reply To Drs Giri and Sundarammentioning

confidence: 99%

Reply to Drs. Giri and Sundaram

Kobayashi

Nagata

2022

Endoscopy

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In their recent article, Kobayashi et al [1] analyzed the retrospective multicenter data from the CODE BLUE-J trial and reported higher efficacy of endoscopic band ligation (EBL) in colonic diverticular hemorrhage (CDH) compared with endoscopic clipping. EBL was associated with significantly lower early and late rebleeding rates, ultimately reducing the need for interventional radiology.

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confidence: 99%

Band ligation or clipping for diverticular bleeding: quite the quandary

Giri

Sundaram

2022

Endoscopy

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In their recent article, Kobayashi et al. [1] analyzed the retrospective multicenter data from the CODE BLUE-J trial and reported higher efficacy of endoscopic band ligation (EBL) in colonic diverticular hemorrhage (CDH) compared with endoscopic clipping. EBL was associated with significantly lower early and late rebleeding rates, ultimately reducing the need for interventional radiology. While the present study adds to the limited literature on the use of EBL for CDH, a few issues need to be addressed. The study, being a retrospective analysis, has a risk of selection and attrition bias. It is unclear how patients were selected for EBL versus clipping. Also, there was a significant difference in the characteristics between the patients who underwent EBL and clipping. A higher proportion of the patients in the clipping group had a systolic blood pressure ≤ 100 mmHg and hemoglobin (Hb) < 12 g/dL. The use of antiplatelet agents and corticosteroids was also higher in the clipping group. Previous studies have shown the presence of hypotension [2, 3], low Hb (≤ 11 g/dL) at admission [2], and the use of antiplatelet drugs [4] to be independent predictors of rebleeding after CDH. The significantly higher proportion of these factors in the clipping group therefore makes them susceptible to a higher risk of rebleeding. In addition, patients in the clipping group seem to have had a greater severity of bleeding, which would have contributed to their prolonged hospital stay. The use of a propensity score-matched analysis would have helped in better estimating the effects of these treatments on outcomes. Overall, we would like to congratulate the authors for conducting this multicenter study with a large sample size. EBL seems to be a promising alternative therapy for the management of CDH, mostly in hemodynamically stable patients. Further randomized studies are needed before recommending EBL over clipping for CDH.

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Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study

Cited by 27 publications

References 30 publications

Optimal candidates for early colonoscopy in the management of acute lower gastrointestinal bleeding

Optimal candidates for early colonoscopy in the management of acute lower gastrointestinal bleeding

Reply to Drs. Giri and Sundaram

Band ligation or clipping for diverticular bleeding: quite the quandary

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