Commentary

Endoscopists need a large toolbox and the ability to improvise depending on the patient’s therapeutic needs. Active diverticular bleeding has been managed with injection, cautery, clipping, and banding. High quality evidence to tell us which technique is best is lacking, but guidelines suggest the use of clipping or banding if feasible [1]. However, the attachments needed for banding or cap-mounted clips compromise visibility and maneuverability of the endoscope, and delayed perforation and early rebleeding have been reported.

Kawano and colleagues provide us with an additional tool to consider when encountering diverticular bleeding. They used marking clips, followed by a cap-mounted clip deployed around the bleeding diverticulum, followed by placement of a detachable loop around the resulting pseudopolyp. The authors speculate that this combination therapy will reduce the risk of perforation and rebleeding.

While it is not immediately clear how a detachable loop, placed on the luminal side of the circular clip, will result in the postulated risk reduction when the clip falls off, larger case series will be necessary to confirm the benefits of such a more complex and costly approach. In the meantime, add this option to your toolbox and consider using it depending on specific circumstances.

Publikationsverlauf

Artikel online veröffentlicht:
27. Januar 2022

• References

• 1 Triantafyllou K, Gkolfakis P, Gralnek I. et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53: 850-868