Commentary

Endoscopic retrieval of fecaliths has recently been described for selected patients with diverticular abscesses, in order to reduce the risk of recurrence despite antibiotic therapy [1] [2]. It is not a first-line treatment, but rather offers a less invasive option with quicker recovery time.

In this video, Cai et al. report a novel endoscopic direct diverticulitis therapy (EDDT), using a digital single-operator cholangioscope (DSOC) over a swollen cecal diverticulum with purulent exudate. The DSOC provided a direct view of fecaliths in the diverticular cavity; this enabled their safe removal with no septal incision required as in prior case reports. A pancreatic stent was placed to maintain drainage [3].

In conclusion, EDDT for septic diverticulitis is a new and evolving approach to treat specific cases, but the long-term effectiveness of this method is currently unknown.

Publication History

Article published online:
27 September 2024

• References

• 1 Zhang HB, Duan BS, Shi JN. et al. Novel endoscopic management for acute diverticulitis with localized abscess. Endoscopy 2024; 56 (Suppl. 01) E484-E485 DOI: 10.1055/a-2325-2694.
• 2 Mao L, Zhang Q. Endoscopic diverticular ridge myotomy to treat acute colonic diverticulitis caused by impacted fecalith. Clin Gastroenterol Hepatol 2024; 22: A11-A12 DOI: 10.1016/j.cgh.2023.11.037. (PMID: 38065371)
• 3 Cai J, Huang S, Lu Y. et al. First report of the use of a digital single-operator cholangioscope for endoscopic direct diverticulitis therapy. Endoscopy 2024; 56 (Suppl. 01) E466-E467 DOI: 10.1055/a-2316-1111. (PMID: 38843823)