Enodoscopic band ligation (EBL) is superior to endoscopic clipping for the treatment of colonic diverticular hemorrhage

Abstract

Background: Recently, endoscopic band ligation (EBL) has been used to treat colonic diverticular hemorrhage, but the number of EBL cases treated to date has been limited. This study aimed to evaluate the clinical outcomes of EBL in the treatment of colonic diverticular hemorrhage compared with those of endoclips.

Methods: At St. Luke's International Hospital in Tokyo, 66 patients were treated with EBL or endoclips from January 2004 to October 2010. Early rebleeding was defined as clinical evidence of recurrent bleeding within 30 days after initial treatment. Patients' demographics, rate of early rebleeding, and complications were retrospectively evaluated.

Results: Of the 66 patients, 18 were treated with EBL. The initial success rate for hemostasis with EBL was 100% with no complications. Early rebleeding was observed in one patient (6%), for whom eversion of a bleeding diverticulum in the sigmoid colon could not be obtained and early loss of the O-band occurred. However, the patient could be retreated with EBL. On the other hand, complete eversion could be obtained for all 10 patients with right-sided diverticula, and no early rebleeding occurred. Endoclips were used to treat 48 patients. Although the initial success rate for hemostasis was 100% without any complications, the rate of early rebleeding was 33% (16 patients), which was significantly higher than the rate for the EBL-treated group (P = 0.018).

Conclusions: According to the findings, EBL should be considered safe, effective, and superior to endoclips for the treatment of colonic diverticular hemorrhage. The EBL procedure should be attempted as the initial therapy especially for the right-sided disease.