Endoscopic band ligation for colonic diverticular hemorrhage

BackgroundThe number of sample cases of colonic diverticular hemorrhage treated with endoscopic band ligation (EBL) has been small to date.ObjectiveTo elucidate the safety and efficacy of EBL for colonic diverticular hemorrhage.DesignRetrospective study.SettingGeneral hospital.PatientsA total of 29 patients with 31 colonic diverticula with stigmata of recent hemorrhage (SRH).InterventionsUrgent colonoscopy was performed after bowel preparation. When diverticula with SRH were identified, marking with hemoclips was done near the diverticula. The endoscope was removed and reinserted after a band-ligator device was attached to the tip of endoscope. At first, EBL was attempted. In patients who could not be treated with EBL, epinephrine injection or endoscopic clipping was performed.Main Outcome MeasurementsProcedure time, rate of hemostasis and rebleeding, complications.ResultsThe mean procedure time was 47 ± 19 minutes. EBL was successfully completed in 27 colonic diverticula (87%); except in 3 diverticula with a small orifice and large dome and 1 diverticula in which the orifice was too large. Early rebleeding after EBL occurred in 3 of 27 cases (11%). Although 2 cases of sigmoid rebleeding could be managed by repeat EBL or conservatively, right hemicolectomy was performed in 1 ascending diverticulum, in which the bleeding source was not identified on repeat colonoscopy. Scar formation at previously banded diverticula was identified in 7 of 11 patients who underwent follow-up colonoscopy. There were no complications after EBL in any of the patients.LimitationsRetrospective study.ConclusionsEBL is a safe and effective treatment for colonic diverticular hemorrhage, and colonic diverticula resolve after EBL.