Endoscopic band ligation for colonic diverticular hemorrhage lowers early and late rebleeding rates: Study
Japan: A recent study suggests that endoscopic band ligation (EBL) versus clipping lowers both early and late rebleeding rates following endoscopic treatment for colonic diverticular hemorrhage (CDH). This reduces the need for interventional radiology (IVR) and results in a shorter length of hospital stay (LOS).
The findings of the analysis of a large endoscopy dataset published in the journal Endoscopy suggest that EBL is an effective and safe endoscopic therapy for CDH.
Diverticular hemorrhage is the most common cause of severe colon bleeding and requires hospitalization after presentation with hematochezia. Previous studies have shown the effectiveness of EBL and clipping for CDH but were small and conducted at single centers. Katsumasa Kobayashi, Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan, and colleagues, therefore, aimed to investigate that which among the two treatments is more effective and safe in a multicenter long-term cohort study.
For this purpose, the researchers reviewed data for 1,679 patients with CDH who were treated with EBL (n=638) or clipping (n=1,041) at 49 hospitals across Japan (CODE BLUE-J Study) between January 2010 and December 2019. The outcomes were two treatments were compared using logistic regression analysis.
The study revealed the following findings:
- In multivariate analysis, EBL compared with clipping was independently associated with reduced risk of early rebleeding (adjusted odds ratio [AOR] 0.46) and late rebleeding (AOR 0.62).
- These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy.
- No significant difference was found between the treatments in the rate of initial hemostasis or mortality.
- EBL compared with clipping independently reduced the risk of the need for interventional radiology (IVR) (AOR 0.37) and prolonged length of hospital stay (LOS) (AOR 0.35), but no 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.
"Our findings suggest that EBL is an effective and safe endoscopic therapy for CDH offering the advantages of lower early and late rebleeding rates, reduced need for IVR, and shorter LOS," wrote the authors.
Reference:
The study titled, "Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: A large-scale multicenter cohort study," was published in the Thieme journal Endoscopy.
DOI: 10.1055/a-1705-0921
