Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band ligation versus clipping.

Authors:
Naoyoshi Nagata
Naoyoshi Nagata
National Center for Global Health and Medicine
Shinjuku | Japan
Naoki Ishii
Naoki Ishii
St. Luke's International Hospital
Japan
Mitsuru Kaise
Mitsuru Kaise
The Jikei University School of Medicine
Japan
Takuro Shimbo
Takuro Shimbo
Ohta Nishinouchi Hospital
Koriyama | Japan
Toshiyuki Sakurai
Toshiyuki Sakurai
Kohnodai Hospital
Japan
Junichi Akiyama
Junichi Akiyama
National Center for Global Health and Medicine
Shinjuku | Japan
Naomi Uemura
Naomi Uemura
National Center for Global Health and Medicine
Shinjuku | Japan

Gastrointest Endosc 2018 11 20;88(5):841-853.e4. Epub 2018 Jul 20.

Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan.

Background And Aims: Very few prospective studies with over 100 samples have evaluated the long-term outcomes of endoscopic therapy for colonic diverticular bleeding (CDB). This study sought to elucidate the recurrent bleeding risk of endoscopic band ligation versus clipping for definitive CDB based on stigmata of recent hemorrhage (SRH).

Methods: Patients emergently hospitalized for acute lower GI bleeding and examined by high-resolution colonoscopy were enrolled. Better visualization of SRH from a diverticulum was obtained using a water-jet device. Endoscopic band ligation or clipping was performed as first-line treatment, and patients were prospectively followed after discharge.

Results: No statistical difference was found between the ligation (n = 61) and clipping (n = 47) groups in baseline characteristics or follow-up period. The probability of 1-year recurrent bleeding was 11.5% in the ligation group versus 37.0% in the clipping group (P = .018). No patients required surgery or experienced perforation. One patient in the ligation group experienced diverticulitis the next day. In patients with recurrent bleeding within 7 days, the recurrent bleeding site was the same diverticulum, and ulceration was found in the ligation group on repeat colonoscopy. In patients with recurrent bleeding after 2 months, repeat colonoscopy identified that the recurrent bleeding site was different, and scar formation was seen in the ligation group. The left side of the colon was an independent predictor for recurrent bleeding in the ligation group but not in the clipping group.

Conclusions: Band ligation for definitive CDB has better outcomes than clipping during long-term follow-up after endoscopic therapy, probably because of complete elimination of the diverticulum. CDB can recur at the same diverticulum in the short term but at a different diverticulum in the long term.

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http://dx.doi.org/10.1016/j.gie.2018.07.018DOI Listing

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November 2018
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