Colonic diverticular hemorrhage: the hood method for detecting responsible diverticula and endoscopic band ligation for hemostasis
submitted 18. November 2012
accepted after revision20. August 2013
11.November 2013 (eFirst)
Background and study aims: Although colonic diverticular hemorrhage is a common cause of lower gastrointestinal bleeding, the low rate of detection of the diverticula responsible for bleeding, together with inadequate evaluation of endoscopic hemostasis, remain unsatisfactory.
Patients and methods: Over 3 years, we employed the hood method to diagnose diverticular hemorrhage in 53 patients and applied endoscopic band ligation (EBL) for hemostasis in 27 patients with responsible diverticula.
Results: The hood method revealed active bleeding in 13 patients (24.5 %), nonbleeding visible vessels in 14 patients (26.4 %), and presumptive diverticular hemorrhage in 26 patients (49.1 %). The nonbleeding visible vessels were located in the diverticular dome in 13 patients and at the diverticular orifice in one patient. EBL was performed in 27 patients, and a hemostasis rate of 96.3 % was achieved. In 9 of 12 patients treated with EBL, follow-up colonoscopy revealed resolution of the responsible diverticula.
Conclusions: The hood method improves the detection rate of diverticula responsible for bleeding by revealing potential nonbleeding visible vessels in the diverticular dome. EBL may become an effective procedure for hemostasis of colonic diverticular hemorrhage.
- 1 Jensen DM, Machicado GA, Jutabha R et al. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000; 342: 78-82
- 2 Smoot RL, Gostout CJ, Rajan E et al. Is early colonoscopy after admission for acute diverticular bleeding needed?. Am J Gastroenterol 2003; 98: 1996-1999
- 3 Yen EF, Ladabaum U, Muthusamy VR et al. Colonoscopic treatment of acute diverticular hemorrhage using endoclip. Dig Dis Sci 2008; 53: 2480-2485
- 4 Sugiyama H. Endoscopic diagnosis and treatment for diverticular bleeding of the colon [in Japanese with English abstract]. Nihon Fukubu Kyukyu Igakkai Zasshi (Japanese Journal of Abdominal Emergency Medicine) 2000; 20: 667-673
- 5 Setoyama T, Ishii N, Fujita Y. Endoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage. Surg Endosc 2011; 25: 3574-3578
- 6 Sos TA, Lee JG, Wixson D et al. Intermittent bleeding from minute to minute gastrointestinal hemorrhage: arteriographic demonstration. Am J Roentgenol 1978; 131: 1015-1017
- 7 Simpson PW, Nguyen MH, Lim JK et al. Use of endoclips in the treatment of massive colonic diverticular bleeding. Gastrointest Endosc 2004; 59: 433-437
- 8 Farrell JJ, Graeme-Cook F, Kelsey PB. Treatment of bleeding colonic diverticula by endoscopic band ligation: an in-vivo and ex-vivo pilot study. Endoscopy 2003; 35: 823-829
- 9 Ishii N, Sotoyama T, Deshpande GA et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc 2012; 75: 382-387