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Dig Dis Sci (2008) 53:24802485 DOI 10.1007/s10620-007-0151-4
ORIGINAL PAPER
Colonoscopic Treatment of Acute Diverticular Hemorrhage Using Endoclips
Eugene F. Yen Uri Ladabaum V. Raman Muthusamy John P. Cello Kenneth R. McQuaid Janak N. Shah
Received: 12 July 2007 / Accepted: 26 November 2007 / Published online: 20 December 2007 Springer Science+Business Media, LLC 2007
Abstract Although colonoscopy is used in the diagnostic evaluation of patients with diverticular hemorrhage, data on colonoscopic treatment outcomes are limited. We reviewed records of inpatients undergoing colonoscopy to identify patients that were colonoscopically diagnosed and treated for acute diverticular hemorrhage. Eleven patients with acute diverticular hemorrhage had active bleeding (n = 7) or non-bleeding visible vessel (n = 4) at colon-oscopy. Endoclip treatment (preceded by epinephrine injection in 64%) achieved hemostasis in all patients without procedural complications. Patients were discharged within three days without evidence of early rebleeding. During a median follow-up of 15 months, late recurrent bleeding occurred in two patients (18.2%). Colonoscopic treatment of patients with acute diverticular hemorrhage using endoclips appears to be effective and safe, with high rates of immediate and long-term success. Colonoscopy should be considered in patients with suspected acute diverticular hemorrhage, as it may enable
denitive therapy without the need for more invasive treatment.
Keywords Diverticulosis Diverticular hemorrhage Colonoscopy Hematochezia
Diverticular hemorrhage is the most common identiable cause of lower gastrointestinal (GI) bleeding, comprising 1555% of cases [1], and remains a common cause of hospitalization [2]. There is recent interest in performing urgent colonoscopy with endoscopic treatment of diver-ticular bleeding at many centers. The success of colonoscopic treatment for diverticular hemorrhage, especially regarding long-term outcome after initial treatment, is largely unknown. Here, we report a relatively large experience to date of colonoscopic therapy, utilizing endoclips, in controlling acute diverticular hemorrhage.
Patients and methods
We reviewed endoscopic records of all patients admitted from March 2004 to December 2005 who underwent inpatient colonoscopy for evaluation of overt lower GI bleeding within the University of California San Francisco academic program, which includes Moftt-Long Hospital, San Francisco General Hospital, and the San Francisco Veterans Affairs Medical Center. In our system there are no pre-dened algorithms for managing acute lower GI bleeding. Initial triage was performed by housestaff and emergency department attendings. Specic evaluation and management of...