Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping

Ishii, Naoki; Hirata, Nobuto; Omata, Fumio; Itoh, Toshiyuki; Uemura, Masayo; Matsuda, Michitaka; Suzuki, Shinichi; Iizuka, Yusuke; Fukuda, Katsuyuki; Fujita, Yoshiyuki

doi:10.1016/j.gie.2012.07.040

Cited by 68 publications

(89 citation statements)

References 30 publications

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“…In the present study, approximately 70% of bleeding diverticula were present in the right-side of the colon. These data are in agreement with the previous report that 71% of bleeding points were located in the right colon in colonic diverticular bleeding (21). Our findings did not demonstrate the efficacy of PEG ingestion for detecting bleeding diverticula, although Obana et al (16) previously reported that urgent colonoscopy should be performed after bowel preparation using PEG ingestion to detect bleeding diverticula.…”

Section: Discussionsupporting

confidence: 91%

“…When colonoscopy revealed active bleeding from a diverticulum, endoscopic hemostasis with a hemoclip was performed directly on the vessel if possible. When direct clipping was not possible because of dome location, massive hemorrhage, or a small diverticular orifice, indirect clipping was selected, and bleeding diverticula were closed with multiple hemoclips in a zipper fashion (21). Monotherapy with clipping was performed, and injection of epinephrine solution was not performed.…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

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Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

et al. 2015

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Objective Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding, and its incidence has recently increased. However, the treatment strategy of diverticular bleeding has not yet been established. The aim of the study was to investigate the efficacy of contrast-enhanced computed tomography (CECT) to determine the indication for urgent colonoscopy to achieve hemostasis. Methods A total of 124 patients diagnosed with diverticular bleeding between 2012 and 2013 in our hospital were analyzed. The clinical behavior, factors related to detecting bleeding diverticula, and risk factors for early rebleeding of diverticular bleeding were evaluated. Results Clinical behavior: Bleeding diverticula were identified in 23 of 124 (19%) patients and most of them (16/23; 70%) were located in the ascending colon. Hemostasis was achieved in all 23 cases, however, six (26%) developed early rebleeding. Factors for detecting bleeding diverticula: In patients in whom extravasation was detected using CECT, the endoscopic detection rate of bleeding diverticula was 60% (12/20), while bleeding diverticula were detected in only 31% (11/35) of patients in whom extravasation was not detected using CECT (p<0.05). The interval between the first hematochezia and colonoscopy in which the bleeding point was detected by colonoscopy (median 23.5 hours) was shorter than that in which bleeding diverticula were not detected (median 43.6 hours) (p<0.01). Risk factors for short term rebleeding: Using a univariate analysis, atherosclerotic comorbidity, anti-inflammatory drugs including low-dose aspirin, antithrombotic agents, vital signs on admission, hemoglobin level on hospitalization, and extravasation on CECT were not found to be significant risk factors. Conclusion The finding of extravasation on CECT is the most important factor for identifying and treating bleeding diverticula by colonoscopy. In such cases, urgent colonoscopy is recommended.

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Section: Discussionsupporting

confidence: 91%

Section: Endoscopic Proceduresmentioning

confidence: 99%

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

et al. 2015

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“…Colonic diverticular bleeding is the leading cause of acute LGIB [62,68,80]. In patients with colonic diverticular bleeding, diverticula with SRH (see CQ13) are often detected on the right side of the colon [80], and although rare, hemorrhagic lesions are observed in the terminal ileum from time to time [81]. Therefore, we recommend total colonoscopy encompassing the terminal ileum.…”

Section: Cq12: Is Total Colonoscopy Effective For Acute Lgib and Colomentioning

confidence: 99%

“…Therefore, we recommend total colonoscopy encompassing the terminal ileum. Acute rectal ulcer, ischemic enteritis, and tumors are also included in clinical cases of acute LGIB [62,68,80]. But these do not necessarily require total colonoscopy in emergency situations.…”

Section: Cq12: Is Total Colonoscopy Effective For Acute Lgib and Colomentioning

confidence: 99%

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

et al. 2019

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Colonic diverticular disease has been increasing in prevalence in Japan due to the rapidly aging population. Colonic diverticular bleeding can result in hemorrhagic shock requiring blood transfusion, and it carries a high risk of recurrence within 1 year. Colonic diverticulitis can cause abscess, fistula formation, and perforation of the colon that may require surgery, and it often recurs. As a result, patients with colonic diverticular disease are often bothered by required frequent examinations, re-hospitalization, and a consequent decrease in quality of life. However, the management of diverticular disease differs between Japan and Western countries. For example, computed tomography (CT) is readily accessible at Japanese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular disease. Endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding. Administration of antibiotics and complete bowel rest may be considered as first-line therapy for colonic diverticulitis. In addition, diverticula occur mainly in the sigmoid colon in Western countries, whereas the right side or bilateral of the colon is more commonly involved in Japan. As such, diverticular disease in the right-side colon is more prevalent in Japan than in Western countries. Against this background, concern is growing about the management of colonic diverticular disease in Japan and there is currently no practice guideline available. To address this situation, the Japanese Gastroenterological Association decided to create a clinical guideline for colonic diverticular bleeding and colonic diverticulitis in collaboration with the Japanese Society of Gastroenterology, Japan Gastroenterological Endoscopy Society, and Japanese Society of Interventional Radiology. The steps taken to establish this guideline involved incorporating the concept of the GRADE system for rating clinical guidelines, developing clinical questions (CQs), accumulating evidence through a literature search and review, and developing the Statement and Explanation sections. This guideline includes 2CQs for colonic diverticulosis, 24 CQs for colonic diverticular bleeding, and 17 CQs for diverticulitis.

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“…The usefulness of endoscopic band ligation (EBL) for hemostasis in cases of hemorrhage from a colonic diverticulum has been reported [2,3], and the "resect and discard strategy" has been used for adenomatous polyps [4]. Therefore, we hypothesized that EBL could be used to entrap an adenomatous lesion spreading into a diverticulum.…”

mentioning

confidence: 99%

Complete removal of a colonic neoplasm extending into a diverticulum with hybrid endoscopic submucosal dissection–mucosal resection and endoscopic band ligation

et al. 2015

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Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping

Cited by 68 publications

References 30 publications

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

Complete removal of a colonic neoplasm extending into a diverticulum with hybrid endoscopic submucosal dissection–mucosal resection and endoscopic band ligation

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