Background and Aims

Very few prospective studies with over 100 samples have evaluated the long-term outcomes of endoscopic therapy for colonic diverticular bleeding (CDB). This study sought to elucidate the recurrent bleeding risk of endoscopic band ligation versus clipping for definitive CDB based on stigmata of recent hemorrhage (SRH).

Methods

Patients emergently hospitalized for acute lower GI bleeding and examined by high-resolution colonoscopy were enrolled. Better visualization of SRH from a diverticulum was obtained using a water-jet device. Endoscopic band ligation or clipping was performed as first-line treatment, and patients were prospectively followed after discharge.

Results

No statistical difference was found between the ligation (n = 61) and clipping (n = 47) groups in baseline characteristics or follow-up period. The probability of 1-year recurrent bleeding was 11.5% in the ligation group versus 37.0% in the clipping group (P = .018). No patients required surgery or experienced perforation. One patient in the ligation group experienced diverticulitis the next day. In patients with recurrent bleeding within 7 days, the recurrent bleeding site was the same diverticulum, and ulceration was found in the ligation group on repeat colonoscopy. In patients with recurrent bleeding after 2 months, repeat colonoscopy identified that the recurrent bleeding site was different, and scar formation was seen in the ligation group. The left side of the colon was an independent predictor for recurrent bleeding in the ligation group but not in the clipping group.

Conclusions

Band ligation for definitive CDB has better outcomes than clipping during long-term follow-up after endoscopic therapy, probably because of complete elimination of the diverticulum. CDB can recur at the same diverticulum in the short term but at a different diverticulum in the long term.

中文翻译：

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内镜治疗后确定性结肠憩室出血的长期复发性出血风险：带结扎与截断

背景和目标

很少有100多个样本的前瞻性研究评估内镜治疗结肠憩室出血（CDB）的长期结果。这项研究试图阐明基于最近出血（SRH）的耻辱而确定的CDB内镜带结扎术与截断术再发出血的风险。

方法

纳入急诊住院的急性下消化道出血并通过高分辨率结肠镜检查的患者。使用喷水装置可以更好地观察憩室中的SRH。内镜下结扎或钳扎作为一线治疗，出院后对患者进行前瞻性随访。

结果

在基线特征或随访期间，结扎组（n = 61）和剪接组（n = 47）之间未发现统计学差异。结扎组1年复发性出血的可能性为11.5％，而截断组为37.0％（P = .018）。没有患者需要手术或有经验的穿孔。结扎组的一名患者第二天发生憩室炎。在7天内出现复发性出血的患者中，复发性出血部位是相同的憩室，并且在重复结肠镜检查的结扎组中发现溃疡。2个月后复发性出血的患者，重复结肠镜检查发现复发性出血部位不同，结扎组可见瘢痕形成。在结扎组中结肠左侧是复发性出血的独立预测因子，而在截断组中则不是。

结论

内镜治疗后的长期随访中，确定性CDB的带扎结扎比截留效果更好，这可能是因为憩室已完全消除。CDB短期内可复发于同一憩室，而长期内可复发于另一憩室。