| International Session（Panel Discussion）2(JGES・JSGE・JSGS) |
| Sat. November 2nd 14:00 - 17:00 Room 9: Portopia Hotel Main Building Kairaku 3 |
| Our treatment selection strategy for endoscopic hemostasis in definitive colonic diverticular bleeding | |||
| Takaaki Kishino1, Yoko Kitamura1, Kazuyuki Kanemasa1 | |||
| 1Center for Digestive and Liver Diseases, Nara City Hospital | |||
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| Background and aims: Clipping (direct or indirect) and endoscopic band ligation (EBL) are commonly used hemostatic methods for colonic diverticular bleeding (CDB). However, no treatment selection strategy has been established for them. Here we present our approach and evaluate the outcomes. Methods: We select direct clipping as the first choice if the bleeding point is visible and clip insertion into the diverticulum is possible. When direct clipping is not feasible, we select EBL as the second choice and indirect clipping as the third. We reviewed data of 192 patients treated with clipping or EBL for definitive CDB with stigmata of recent hemorrhage (SRH) between March 2016 and February 2023 in our hospital. Results: The hemostatic method was clipping in 84 patients (78: direct; 6: indirect) and EBL in 108. The rate of SRH with active bleeding was significantly higher in the EBL group (33.3% vs. 60.2%, p<0.001). Median hemostasis time was significantly shorter in the clipping group (9 min vs. 22 min, p<0.001). Rebleeding rate within 30 days showed no significant different between clipping (15.5%) and EBL (13.0%) (p=0.619). Delayed perforation occurred in 1 patient following EBL and there were no post-treatment complications following clipping. Conclusion: Our strategy suggests the possibility of utilizing the advantages of both clipping and EBL by selecting the hemostatic method according to the visual field of SRH and the manipulability of the endoscope. |
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Index Term 1: colonic diverticular bleeding Index Term 2: clipping |
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