Treatment of acute colonic diverticular bleeding in high risk patients, using an over-the-scope clip: a case series

Wedi, Edris; Renteln, Daniel von; Jung, Carlo; Tchoumak, Irina; Roth, Victor; Gonzales, Susana; Leroy, Joël; Hochberger, J.

doi:10.1055/s-0042-118168

Cited by 31 publications

(27 citation statements)

References 5 publications

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“…Recent studies have described an over‐the‐scope clip (OTSC) for the treatment of CDB . However, an OTSC may contribute to increased difficulty in the reinsertion of the colonoscope owing to the narrow endoscopic view and the increased diameter of the colonoscope tip.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have described an over-the-scope clip (OTSC) for the treatment of CDB. [31][32][33] However, an OTSC may contribute to increased difficulty in the reinsertion of the colonoscope owing to the narrow endoscopic view and the increased diameter of the colonoscope tip. Further studies regarding OTSC may be required to clarify its role in the treatment of AB cases as the existing studies have small sample sizes.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Honda

Ishii

Takasu

et al. 2019

J of Gastro and Hepatol

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Background and Aim The risk factors for early rebleeding following the management of colonic diverticular bleeding (CDB) are unclear. This study aimed to determine the risk factors for early rebleeding following initial colonoscopy. Methods Overall, 370 patients with CDB were divided as having presumptive (229) or definite CDB with stigmata of recent hemorrhage (141) on the basis of initial colonoscopy. Definite CDB cases were treated by either endoscopic clipping (EC) or endoscopic band ligation (EBL) as a first‐line treatment. Time‐to‐event analysis for early rebleeding was performed by Kaplan–Meier methods with log‐rank test between the three groups (presumptive, EC, and EBL). Multivariate Cox proportional hazards regression was used to identify risk factors for early rebleeding. Results There were 38 and 103 patients in the EC and EBL groups, respectively. Early rebleeding developed in 61 cases (16.5%). The cumulative incidence rates of early rebleeding at 1, 5, and 30 days were 7.7%, 16.4%, and 17.9% in the presumptive group; 1.9%, 7.0%, and 9.5% in the EBL group; and 2.6%, 34.9%, and 37.7% in the EC group, respectively (log‐rank test, P = 0.00059). Moreover, 90.2% of early rebleeding occurred within 5 days. Adjusted hazard ratio (HR) was marginally lower in the presumptive group (HR = 0.50; 95% confidence interval, 0.26–1.01; P = 0.052) and significantly lower in the EBL‐treated group than in the EC group (HR = 0.21; 95% confidence interval, 0.09–0.50; P = 0.0004). Conclusions Most early rebleeding occurred within 5 days after initial colonoscopy. EC was less effective than EBL in terms of early rebleeding.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Honda

Ishii

Takasu

et al. 2019

J of Gastro and Hepatol

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“…The over-the-scope clip system was also used to achieve endoscopic hemostasis in a recent study [98].…”

Section: Cq13: What Endoscopic Findings Of Colonic Diverticular Bleedmentioning

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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“…In 2011, Kirschniak and colleagues 16 described the successful use of OTS clips for primary hemostasis of colonic diverticular bleeding in 2 patients. Other groups have subsequently published case reports and series (ranging from 1-6 patients) on their experience using OTS clips for primary hemostasis in patients with diverticular bleeding, 17,18 for high-risk groups on anticoagulation therapy, [19][20][21] and for recurrent bleeding following failed primary therapy with TTS clips. 18,22,23 In the largest published series, 2 of the 6 patients treated with the C-OTS technique for diverticular bleeding experienced inhospital rebleeding (4 days and 13 days after C-OTS) and required additional endoscopic therapy; 1 patient was retreated with a second OTS clip and an additional 3 TTS clips, and 1 patient was retreated with fibrin glue.…”

Section: Use Of the Clipping Over The Scope Techniquementioning

confidence: 99%

“…18,22,23 In the largest published series, 2 of the 6 patients treated with the C-OTS technique for diverticular bleeding experienced inhospital rebleeding (4 days and 13 days after C-OTS) and required additional endoscopic therapy; 1 patient was retreated with a second OTS clip and an additional 3 TTS clips, and 1 patient was retreated with fibrin glue. 20…”

Section: Use Of the Clipping Over The Scope Techniquementioning

confidence: 99%

Use of the Endoscopic Clipping Over the Scope Technique to Treat Acute Severe Lower Gastrointestinal Bleeding in the Colon and Anal Transition Zone

Kaltenbach

Asokkumar

Kolb³

et al. 2020

Gastrointestinal Endoscopy Clinics of North America

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Treatment of acute colonic diverticular bleeding in high risk patients, using an over-the-scope clip: a case series

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Cited by 31 publications

References 5 publications

Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding

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

Use of the Endoscopic Clipping Over the Scope Technique to Treat Acute Severe Lower Gastrointestinal Bleeding in the Colon and Anal Transition Zone

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