Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to endoscopic findings (with video).

IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY
Endoscopy International Open Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI:10.1055/a-2471-1016
Takaaki Kishino, Yoko Kitamura, Takashi Okuda, Naoki Okamoto, Takayuki Sawa, Maiko Yamakawa, Kazuyuki Kanemasa
{"title":"Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to endoscopic findings (with video).","authors":"Takaaki Kishino, Yoko Kitamura, Takashi Okuda, Naoki Okamoto, Takayuki Sawa, Maiko Yamakawa, Kazuyuki Kanemasa","doi":"10.1055/a-2471-1016","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and study aims: </strong>Direct or indirect clipping and endoscopic band ligation (EBL) are widely used for hemostasis in patients with colonic diverticular bleeding (CDB). However, no treatment selection strategy has been established. This report describes our approach and its outcomes.</p><p><strong>Patients and methods: </strong>We select direct clipping if the bleeding point is visible and clips could be inserted into the diverticulum. When direct clipping is not feasible, we select EBL as the second choice and indirect clipping as the third. We reviewed data from 192 patients treated with clipping or EBL for definitive CDB with stigmata of recent hemorrhage (SRH) at our hospital between March 2016 and February 2023.</p><p><strong>Results: </strong>The hemostatic method was clipping in 84 patients (direct, n=78; indirect, n=6) 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, <i>P</i> <0.001). There was no significant difference in the 30-day rebleeding rate between clipping and EBL (15.5% vs. 13.0%; <i>P</i> =0.619). There was one case of delayed perforation post-EBL. There were no complications after clipping.</p><p><strong>Conclusions: </strong>Direct clipping when placement of clips at the bleeding point is feasible and EBL when direct clipping is not feasible is a reasonable strategy in terms of effectiveness, efficiency, and safety. Selection of hemostatic method according to the visual field of SRH and maneuverability of the endoscope allows the advantages of both methods to be realized.</p>","PeriodicalId":11671,"journal":{"name":"Endoscopy International Open","volume":"13 ","pages":"a24711016"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863548/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Endoscopy International Open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/a-2471-1016","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background and study aims: Direct or indirect clipping and endoscopic band ligation (EBL) are widely used for hemostasis in patients with colonic diverticular bleeding (CDB). However, no treatment selection strategy has been established. This report describes our approach and its outcomes.

Patients and methods: We select direct clipping if the bleeding point is visible and clips could be inserted into the diverticulum. When direct clipping is not feasible, we select EBL as the second choice and indirect clipping as the third. We reviewed data from 192 patients treated with clipping or EBL for definitive CDB with stigmata of recent hemorrhage (SRH) at our hospital between March 2016 and February 2023.

Results: The hemostatic method was clipping in 84 patients (direct, n=78; indirect, n=6) 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). There was no significant difference in the 30-day rebleeding rate between clipping and EBL (15.5% vs. 13.0%; P =0.619). There was one case of delayed perforation post-EBL. There were no complications after clipping.

Conclusions: Direct clipping when placement of clips at the bleeding point is feasible and EBL when direct clipping is not feasible is a reasonable strategy in terms of effectiveness, efficiency, and safety. Selection of hemostatic method according to the visual field of SRH and maneuverability of the endoscope allows the advantages of both methods to be realized.

根据内窥镜检查结果选择内镜下结肠憩室出血止血的有效治疗策略(附视频)。
背景与研究目的:直接或间接夹持和内镜下结扎术(EBL)广泛应用于结肠憩室出血(CDB)患者的止血。然而,目前尚未建立治疗选择策略。本报告描述了我们的方法及其成果。患者和方法:如果出血点可见,我们选择直接夹夹,夹夹可以插入憩室。当直接裁剪不可行时,我们选择EBL作为第二选择,间接裁剪作为第三选择。我们回顾了2016年3月至2023年2月在我院接受剪切术或EBL治疗伴有近期出血(SRH)的明确CDB患者的数据。结果:84例患者采用夹持止血方法(直接止血,78例;间接,n=6), EBL为108例。EBL组SRH合并活动性出血的发生率明显高于对照组(33.3% vs. 60.2%, p p p =0.619)。ebl后延迟穿孔1例。夹闭后无并发症。结论:在出血点放置夹子可行时直接夹取,在不能直接夹取时EBL是一种有效、高效、安全的合理策略。根据SRH的视野和内窥镜的可操作性选择止血方法,使两种方法的优点得以发挥。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Endoscopy International Open
Endoscopy International Open GASTROENTEROLOGY & HEPATOLOGY-
自引率
3.80%
发文量
270
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信