CC BY-NC-ND 4.0 · Endoscopy 2022; 54(08): 735-744
DOI: 10.1055/a-1705-0921
Original article

Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study

 1   Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
Naoyoshi Nagata
 2   Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
 3   Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
Yohei Furumoto
 1   Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
 4   Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
Atsuo Yamada
 5   Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Jun Omori
 6   Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
Takashi Ikeya
 7   Department of Gastroenterology, St. Luke's International University, Tokyo, Japan
Taiki Aoyama
 8   Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
Naoyuki Tominaga
 9   Department of Gastroenterology, Saga Medical Center Koseikan, Saga, Japan
Yoshinori Sato
10   Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
Takaaki Kishino
11   Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
Naoki Ishii
12   Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
Tsunaki Sawada
13   Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
Masaki Murata
14   Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
Akinari Takao
15   Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Kazuhiro Mizukami
16   Department of Gastroenterology, Oita University, Oita, Japan
Ken Kinjo
17   Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
Shunji Fujimori
18   Department of Gastroenterology, Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan
Takahiro Uotani
19   Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
Minoru Fujita
20   Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
21   Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
Sho Suzuki
22   Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan
Toshiaki Narasaka
23   Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
24   Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki Japan
Junnosuke Hayasaka
25   Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
Mitsuru Kaise
 6   Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
CODE BLUE-J study collaborators
› Author Affiliations
Supported by: JSPS KAKENHI Grant 20K08366
Supported by: Smoking Research Foundation, Takeda Science Foundation, Grants-in-Aid for Research from the National Center for Global Health and Medicine 19A-2015
Supported by: the Ministry of Health, Labour and Welfare 19HB1003


Background Prior studies have shown the effectiveness of both endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Therefore, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study.

Methods We reviewed data for 1679 patients with CDH who were treated with EBL (n = 638) or clipping (n = 1041) between January 2010 and December 2019 at 49 hospitals across Japan (CODE BLUE-J study). Logistic regression analysis was used to compare outcomes between the two treatments.

Results In multivariate analysis, EBL was independently associated with reduced risk of early rebleeding (adjusted odds ratio [OR] 0.46; P < 0.001) and late rebleeding (adjusted OR 0.62; P < 0.001) compared with clipping. These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant differences were found between the treatments in the rates of initial hemostasis or mortality. Compared with clipping, EBL independently reduced the risk of needing interventional radiology (adjusted OR 0.37; P = 0.006) and prolonged length of hospital stay (adjusted OR 0.35; P < 0.001), but not need for surgery. Diverticulitis developed in one patient (0.16 %) following EBL and two patients (0.19 %) following clipping. Perforation occurred in two patients (0.31 %) following EBL and none following clipping.

Conclusions Analysis of our large endoscopy dataset suggests that EBL is an effective and safe endoscopic therapy for CDH, offering the advantages of lower early and late rebleeding rates, reduced need for interventional radiology, and shorter length of hospital stay.

Tables 1 s, 2 s, Fig, 1 s

Publication History

Received: 25 May 2021

Accepted: 01 December 2021

Accepted Manuscript online:
24 November 2021

Article published online:
11 February 2022

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