Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline.

Outcomes and rebleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study.

Abstract In recent years, cases of diverticular bleeding have become more common. Although identifying the bleeding diverticulum is difficult, it is even more difficult to identify the exposed blood vessels in the bleeding diverticulum. We experienced a case in which we succeeded in directly observing the exposed blood vessels of a sigmoid colon diverticulum using the ultrathin endoscope. The patient was a 71‐year‐old man who experienced rebleeding after hemostasis in the sigmoid colon by endoscopic band ligation. In the case of diverticular bleeding in the sigmoid colon, we showed that identifying exposed blood vessels by observing the diverticulum under direct vision using the ultrathin endoscope may be useful for hemostasis. 

Direct observation of an exposed blood vessel in a colonic diverticulum using ultrathin endoscopy

There are few reports on bowel preparation for early colonoscopy in patients with suspected colonic diverticular bleeding (CDB). We aim to clarify in a retrospective, multicenter study.In a multicenter retrospective cohort study at 10 institutions, we analyzed clinical features of patients diagnosed with CDB, who underwent early colonoscopy within 24 h. We compared patients who were prepared with polyethylene glycol lavage (PEL) and those without PEL. We evaluated the effects of PEL for early colonoscopy in patients with suspected CDB.A total of 129 (53%) underwent under preparation with PEL and 113 patients without PEL. The PEL group was younger, had fewer comorbidities, and had better performance status. After adjusting for these variables with propensity score matching, the PEL group had a significantly shorter hospital stay (7.9 ± 4.7 vs. 10.1 ± 5.2 days; p = 0.001), and a higher cecal intubation rate (91.1% vs. 50.0%; p < 0.001). There were no significant differences in adverse event rates, identification of stigmata of recent hemorrhage, or frequency in endoscopic hemostatic treatment.PEL may be preferred for early colonoscopy in patients suspected of having CDB. 

Is bowel preparation necessary for early colonoscopy in patients with suspected colonic diverticular bleeding?: A multicenter retrospective study with propensity score matching analysis

Background and Aim Colonic diverticular bleeding is a common cause of acute lower gastrointestinal bleeding. Endoscopic hemostasis is generally selected as the first-line treatment; however, a considerable number of patients experience early rebleeding after endoscopic treatment. We investigated the risk factors for early rebleeding after endoscopic treatment. Methods We retrospectively evaluated the data of 142 consecutive patients who underwent endoscopic treatment (endoscopic clipping or endoscopic band ligation) for colonic diverticular bleeding with stigmata of recent hemorrhage between April 2012 and April 2020. Multivariate logistic regression analysis was conducted to evaluate the statistical relationship between patient characteristics and the incidence of early rebleeding occurring within 30 days after endoscopic treatment. Results Of 142 patients, early rebleeding was detected in 34 (23.9%) patients. According to univariate analysis, platelet count of <10 × 104/μL, bleeding from the left-sided colon, and endoscopic clipping usage were associated with early rebleeding (P < 0.05). The subsequent multivariate logistic regression analysis identified bleeding from the left-sided colon (odds ratio [OR], 4.16; 95% confidence interval [CI], 1.73-10.0; P = 0.001) and endoscopic clipping usage (OR, 2.92; 95% CI, 1.21-7.00; P = 0.017) as the independent risk factors for early rebleeding. Conclusions Bleeding from the left-sided colon and endoscopic clipping usage were the risk factors for early rebleeding after endoscopic treatment. Using endoscopic band ligation was associated with a decreased risk for early rebleeding compared with the use of endoscopic clipping, indicating that endoscopic band ligation was a preferable endoscopic modality to prevent early recurrent bleeding.

Risk factor analysis for early rebleeding after endoscopic treatment for colonic diverticular bleeding with stigmata of recent hemorrhage.

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Risk factor analysis for early rebleeding after endoscopic treatment for colonic diverticular bleeding with stigmata of recent hemorrhage.