Colon to Rectum

Endoscopy. 2022;54(8):735–44

Kobayashi K, Nagata N, Furumoto Y, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Kaise M; CODE BLUE-J study collaborators

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

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, the authors investigated which was the more effective and safe treatment in a multicenter long-term cohort study.
Methods: They 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 2 treatments.
Results: In multivariate analysis, EBL was independently associated with reduced risk of early rebleeding (adjusted odds ratio [aOR] = 0.46; p < 0.001) and late rebleeding (aOR = 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 (aOR = 0.37; p = 0.006) and prolonged length of hospital stay (aOR = 0.35; p < 0.001), but not need for surgery. Diverticulitis developed in 1 patient (0.16 %) following EBL and 2 patients (0.19 %) following clipping. Perforation occurred in 2 patients (0.31 %) following EBL and none following clipping.

Conclusions: Analysis of a large endoscopy dataset suggests that endoscopic band ligation is an effective and safe endoscopic therapy for colonic diverticular hemorrhage, offering the advantages of lower early and late rebleeding rates, reduced need for interventional radiology, and shorter length of hospital stay.

Prof. Dr. Dr. N. Nagata, Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan,
E-Mail: nnagata_ncgm@yahoo.co.jp

DOI: 10.1055/a-1705-0921

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