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

Nagata, Naoyoshi; Ishii, Naoki; Kaise, Mitsuru; Shimbo, Takuro; Sakurai, Toshiyuki; Akiyama, Junichi; Uemura, Naomi

doi:10.1016/j.gie.2018.07.018

Cited by 41 publications

(97 citation statements)

References 36 publications

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“…Across the two papers, early rebleeding rates were 7% (2/27) with a direct method and 22% (19/85) with an indirect method. Direct clipping could therefore be superior to the indirect method in terms of early rebleeding; however, late bleeding rates were comparable between the methods; 42.9% and 36.4% for direct and indirect clipping, respectively . Furthermore, the feasibility rate of the direct method was limited at 24% (27/112) of endoscopic clipping.…”

Section: Recent Advances In the Management Of Cdb: Ligation Therapy Hmentioning

confidence: 94%

“…Two papers clearly classified clipping techniques into direct or indirect methods and compared the data between the methods . Across the two papers, early rebleeding rates were 7% (2/27) with a direct method and 22% (19/85) with an indirect method.…”

Section: Recent Advances In the Management Of Cdb: Ligation Therapy Hmentioning

confidence: 99%

“…Five reports with EBL and three with EDSL, were selected (Table ). The first clinical data on EBL for CDB were reported in 2003 by Farrell et al .…”

Section: Recent Advances In the Management Of Cdb: Ligation Therapy Hmentioning

confidence: 99%

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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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Section: Recent Advances In the Management Of Cdb: Ligation Therapy Hmentioning

confidence: 94%

Section: Recent Advances In the Management Of Cdb: Ligation Therapy Hmentioning

confidence: 99%

See 1 more Smart Citation

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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“…In particular, the number of reports of colonic diverticular bleeding from Japan has been increasing in the past 2 or 3 years [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Colonic diverticular bleeding and diverticulitis are both acute illnesses, but because they tend to recur and necessitate colectomy when severe, their clinical significance is increasing.…”

Section: Introductionmentioning

confidence: 99%

“…Colonic diverticular bleeding and diverticulitis are both acute illnesses, but because they tend to recur and necessitate colectomy when severe, their clinical significance is increasing. Novel treatment methods such as endoscopic band ligation (EBL) have been introduced as hemostatic modalities for colonic diverticular bleeding, and the knowledge and skills required for the diagnosis and treatment of colonic diverticular disease have steadily accumulated [3,14]. However, challenges remain, including a low rate of identifying bleeding sites [22] and a relatively high rate of rebleeding after achieving hemostasis [14,17,23].…”

Section: Introductionmentioning

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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Rare complication of endoscopic band ligation for colonic diverticular bleeding

2020

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A 79‐year‐old female patient receiving maintenance hemodialysis was referred to our hospital because of massive hematochezia. Abdominal enhanced computed tomography (CT) demonstrated extravasation of contrast medium in the descending colon. We then performed urgent colonoscopy, and successful endoscopic hemostasis was achieved using endoscopic band ligation (EBL) for a bleeding colonic diverticulum. However, the patient unexpectedly complained of severe abdominal pain and fever 5 days after EBL, and abdominal CT revealed free air and mesenteric panniculitis. Emergency surgery was performed, and delayed colonic perforation at the EBL site was confirmed. Although rare, delayed perforation after EBL for colonic diverticular bleeding should be considered.

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

Cited by 41 publications

References 36 publications

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

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

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

Rare complication of endoscopic band ligation for colonic diverticular bleeding

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