Endoscopic Hemostasis of a Bleeding Diverticulum of the Sigma with Fibrin Sealant

Andreß, H.-J.; Mewes, André; Lange, Volker

doi:10.1055/s-2007-1010286

Cited by 36 publications

(11 citation statements)

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“…Several studies involving small series of patients have reported successful endoscopic therapies for diverticular hemorrhage, including epinephrine injection, contact thermal therapy, band ligation, and endoclips [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Critics of urgent colonoscopic evaluation may comment on the difficulty of adequate visualization in the setting of retained feces and clots.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic Treatment of Acute Diverticular Hemorrhage Using Endoclips

et al. 2007

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Although colonoscopy is used in the diagnostic evaluation of patients with diverticular hemorrhage, data on colonoscopic treatment outcomes are limited. We reviewed records of inpatients undergoing colonoscopy to identify patients that were colonoscopically diagnosed and treated for acute diverticular hemorrhage. Eleven patients with acute diverticular hemorrhage had active bleeding (n = 7) or non-bleeding visible vessel (n = 4) at colonoscopy. Endoclip treatment (preceded by epinephrine injection in 64%) achieved hemostasis in all patients without procedural complications. Patients were discharged within three days without evidence of early rebleeding. During a median follow-up of 15 months, late recurrent bleeding occurred in two patients (18.2%). Colonoscopic treatment of patients with acute diverticular hemorrhage using endoclips appears to be effective and safe, with high rates of immediate and long-term success. Colonoscopy should be considered in patients with suspected acute diverticular hemorrhage, as it may enable definitive therapy without the need for more invasive treatment.

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Section: Discussionmentioning

confidence: 99%

Colonoscopic Treatment of Acute Diverticular Hemorrhage Using Endoclips

et al. 2007

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“…Endoscopic treatment of bleeding secondary to diverticulosis includes contact coagulation [8,27,65], epinephrine injection [8,66], hemoclip application [33], fibrin sealant [4], and a combination of the above. Epinephrine injection is the best endoscopic option for treatment.…”

Section: Diverticulosismentioning

confidence: 99%

Lower gastrointestinal bleeding: a review

Edelman

Sugawa

2007

Surg Endosc

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Lower gastrointestinal bleeding (LGIB) continues to be a problem for physicians. Acute LGIB is defined as bleeding that emanates from a source distal to the ligament of Treitz. Although 80% of all LGIB will stop spontaneously, the identification of the bleeding source remains challenging and rebleeding can occur in 25% of cases. Some patients with severe hematochezia require urgent attention to minimize further bleeding and complications. This article reviews the causes, diagnostic methods, and endoscopic treatment of LGIB.

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“…A case report in 1985 first described cessation of haemorrhage from an actively bleeding diverticulum by local irrigation with 1:1,000 epinephrine [58]. Later reports have demonstrated the haemostatic abilities of the heater probe, bicap probe, injection therapies, and fibrin sealant in patients with bleeding diverticula [59,60,61,62,63]. Recently, an endoscopic description of diverticular ‘stigmata’ thought to have prognostic values, similar to those associated with peptic ulcers, in patients with acute lower gastrointestinal bleeding ‘unequivocally’ due to diverticula, has been reported [64, 65].…”

Section: Complicated Diverticulitismentioning

confidence: 99%

Management of Colonic Diverticular Disease

Frieri¹,

Pimpo²,

Scarpignato³

2006

Digestion

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Diverticular disease of the colon is a complex syndrome that includes several clinical conditions, each needing different therapeutic strategies. In patients with asymptomatic diverticulosis, only a fiber-rich diet can be recommended in an attempt to reduce intraluminal pressure and slow down the worsening of the disease. Fiber supplementation is also indicated in symptomatic diverticulosis in order to get symptom relief and prevent acute diverticulitis. In this regard, the best results have been obtained by combination of soluble fiber, like glucomannan, and poorly absorbed antibiotics, like rifaximin, given 7–10 days every month. For uncomplicated diverticulitis the standard therapy is liquid diet and oral antimicrobials, usually ciprofloxacin and metronidazole. Hospitalization, bowel rest, and intravenous antibacterial agents are mandatory for complicated diverticulitis. Haemorrhage is usually a self-limited event but may require endoscopic or surgical treatment. Once in remission, continuous fiber intake and intermittent course of rifaximin may improve symptoms and reduce diverticulitis recurrence. These preventive strategies will likely improve patients’ quality of life and reduce management costs. A surgical approach in diverticular disease is needed in 15–30% of cases and consists of removing the intestinal segment affected by diverticula. It is indicated in diffuse peritonitis, abscesses, fistulas, stenosis and after the second to fourth attack of uncomplicated diverticulitis. Young people and immunocompromised patients are more likely to be operated.

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Endoscopic Hemostasis of a Bleeding Diverticulum of the Sigma with Fibrin Sealant

Cited by 36 publications

References 0 publications

Colonoscopic Treatment of Acute Diverticular Hemorrhage Using Endoclips

Colonoscopic Treatment of Acute Diverticular Hemorrhage Using Endoclips

Lower gastrointestinal bleeding: a review

Management of Colonic Diverticular Disease

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