RSS-Feed abonnieren
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/a-1705-0921
Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
Gefördert durch: JSPS KAKENHI Grant 20K08366Gefördert durch: Smoking Research Foundation, Takeda Science Foundation, Grants-in-Aid for Research from the National Center for Global Health and Medicine 19A-2015
Gefördert durch: the Ministry of Health, Labour and Welfare 19HB1003
![](https://www.thieme-connect.de/media/endoscopy/202208/lookinside/thumbnails/20980_10-1055-a-1705-0921-1.jpg)
Abstract
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.
Publikationsverlauf
Eingereicht: 25. Mai 2021
Angenommen: 01. Dezember 2021
Accepted Manuscript online:
24. November 2021
Artikel online veröffentlicht:
11. Februar 2022
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Nagata N, Ishii N, Manabe N. et al. Guidelines for colonic diverticular bleeding and colonic diverticulitis: Japan Gastroenterological Association. Digestion 2019; 99 (Suppl. 01) 1-26
- 2 Jensen DM, Ohning GV, Kovacs TOG. et al. Natural history of definitive diverticular hemorrhage based on stigmata of recent hemorrhage and colonoscopic Doppler blood flow monitoring for risk stratification and definitive hemostasis. Gastrointest Endosc 2016; 83: 416-423
- 3 Kaise M, Nagata N, Ishii N. et al. Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding. Dig Endosc 2020; 32: 240-250
- 4 Nagata N, Ishii N, Kaise M. et al. Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band ligation versus clipping. Gastrointest Endosc 2018; 88: 841-853.e4
- 5 Okamoto N, Tominaga N, Sakata Y. et al. Lower rebleeding rate after endoscopic band ligation than endoscopic clipping of the same colonic diverticular hemorrhagic lesion: a historical multicenter trial in Saga, Japan. Intern Med 2019; 58: 633-638
- 6 Honda H, Ishii N, Takasu A. et al. Risk factors of early rebleeding in the endoscopic management of colonic diverticular bleeding. J Gastroenterol Hepatol 2019; 34: 1784-1792
- 7 Kobayashi K, Furumoto Y, Akutsu D. et al. Endoscopic detachable snare ligation improves the treatment for colonic diverticular hemorrhage. Digestion 2020; 101: 208-216
- 8 Kaltenbach T, Watson R, Shah J. et al. Colonoscopy with clipping is useful in the diagnosis and treatment of diverticular bleeding. Clin Gastroenterol Hepatol 2012; 10: 131-137
- 9 Kishino T, Kanemasa K, Kitamura Y. et al. Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos). Endosc Int Open 2020; 8: E377-E385
- 10 Nagata N, Niikura R, Ishii N. et al. Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: systematic review and meta-analysis. J Gastroenterol Hepatol 2020; DOI: 10.1111/jgh.15370.
- 11 Niikura R, Nagata N, Doyama H. et al. Current state of practice for colonic diverticular bleeding in 37 hospitals in Japan: A multicenter questionnaire study. World J Gastrointest Endosc 2016; 8: 785-794
- 12 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
- 13 Ikeya T, Ishii N, Nakano K. et al. Risk factors for early rebleeding after endoscopic band ligation for colonic diverticular hemorrhage. Endosc Int Open 2015; 3: E523-E528
- 14 Shibata S, Shigeno T, Fujimori K. et al. Colonic diverticular hemorrhage: the hood method for detecting responsible diverticula and endoscopic band ligation for hemostasis. Endoscopy 2014; 46: 66-69
- 15 Nagata N, Kobayashi K, Yamauchi A. et al. Nationwide large-scale data of acute lower gastrointestinal bleeding in Japan uncover detailed etiologies and relevant outcomes: CODE BLUE J-Study. medRxiv 2021; DOI: 10.1101/2021.01.18.21250035.
- 16 Nagata N, Kobayashi K, Yamauchi A. et al. Identifying bleeding etiologies by endoscopy affected outcomes in 10,342 cases with hematochezia: CODE BLUE-J Study. Am J Gastroenterol 2021; 116: 2222-2234
- 17 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
- 18 de’Angelis N, Di Saverio S, Chiara O. et al. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation. World J Emerg Surg 2018; 13: 5
- 19 van de Wall BJM, Draaisma WA, van der Kaaij RT. et al. The value of inflammation markers and body temperature in acute diverticulitis. Colorectal Dis 2013; 15: 621-626
- 20 Peduzzi P, Concato J, Kemper E. et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49: 1373-1379
- 21 Kenward MG, Carpenter J. Multiple imputation: current perspectives. Stat Methods Med Res 2007; 16: 199-218
- 22 van Buuren S. Multiple imputation of discrete and continuous data by fully conditional specification. Stat Methods Med Res 2007; 16: 219-242
- 23 Nakano K, Ishii N, Ikeya T. et al. Comparison of long-term outcomes between endoscopic band ligation and endoscopic clipping for colonic diverticular hemorrhage. Endosc Int Open 2015; 3: E529-E533
- 24 Kinjo K, Matsui T, Hisabe T. et al. Increase in colonic diverticular hemorrhage and confounding factors. World J Gastrointest Pharmacol Ther 2016; 7: 440-446
- 25 Ishii N, Fujita Y. Colonic diverticulitis after endoscopic band ligation performed for colonic diverticular hemorrhage. ACG Case Rep J 2015; 2: 218-220
- 26 Tominaga N, Ogata S, Esaki M. Rare complication of endoscopic band ligation for colonic diverticular bleeding. JGH Open 2020; 4: 1244-1245
- 27 Sato Y, Yasuda H, Fukuoka A. et al. Delayed perforation after endoscopic band ligation for colonic diverticular hemorrhage. Clin J Gastroenterol 2020; 13: 6-10
- 28 Takahashi S, Inaba T, Tanaka N. Delayed perforation after endoscopic band ligation for treatment of colonic diverticular bleeding. Dig Endosc 2016; 28: 484
- 29 Panteris V, Haringsma J, Kuipers EJ. Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 2009; 41: 941-951
- 30 Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol 2010; 105: 2636-2641 quiz 2642