Angiographic and surgical therapies are the standards of care for persistent diverticular bleeding.
Currently, colonoscopic intervention - using epinephrine injection, multipolar electrocautery, and Endoclip placement - does not have widespread acceptance. This is due to concerns about complications, as well as the management of severe lower GI bleeding by surgeons and interventional radiologists.
In this study, doctors from Massachusetts, United States, evaluated colonoscopic band ligation for control of diverticular bleeding.
|Active bleeding was controlled in all 4 patients.|
The team performed endoscopic band ligation on diverticula specimens, as well as in 4 patients with actively bleeding colonic diverticula.
The doctors were able to completely control active bleeding in all 4 patients using endoscopic band ligation.
In 2 of the cases a visible vessel was seen on the everted and banded diverticulum.
Overall, the team found that the procedure time ranged between 45 and 140 min.
The lentght of hospital stay ranged between 2 and 35 days. However, hospital stays greater than 7 days were associated with non-gastrointestinal co-morbidity.
The team did not identify any acute complications of band ligation. No rebleeding or need for surgery occurred during a 12-month follow-up.
In the ex-vivo study, the team everted and banded 11 diverticula in 5 of the 9 surgical specimens. Mucosa was identified in all of the "banded" segments.
They identified evidence of blood vessels or submucosal tissue in 10 of the 11 ligated diverticula. In addition, subserosal fat was suggested in 3 of the 11 "banded" segments.
The team did not identify any evidence of perforation.
Dr Farrell's team concluded, "Both in-vivo and ex-vivo data suggest that endoscopic band ligation may be a safe and effective therapy for actively bleeding colonic diverticula".