Endoscopic hemostasis in acute diverticular bleeding.
OBJECTIVE
Early reports of urgent colonoscopy in acute lower intestinal bleeding suggest a role for endoscopic therapy for bleeding colonic lesions, but scant data exist on bleeding diverticula. We report our experience with endoscopic hemostasis in acute diverticular bleeding.


METHODS
Bleeding diverticula were identified on urgent diagnostic endoscopy in five patients with acute gastrointestinal bleeding, two in the duodenum, and three in the colon. All patients had co-morbid conditions preventing more conventional therapeutic approaches. The five cases are described, including the technique of endoscopic hemostasis and outcome.


RESULTS
Endoscopic therapy using epinephrine injection, thermal cautery and/or laser therapy successfully induced hemostasis in all patients. One patient died of co-morbid illness during the hospital stay, while the remaining four patients had no recurrent bleeding over a mean follow-up period of 20.6 months.


CONCLUSIONS
Endoscopic therapy of bleeding diverticula is technically possible when the culprit diverticulum can be identified. This therapeutic modality may have a place in debilitated patients in whom other more invasive procedures are contraindicated, but further experience is needed to establish its safety.
Prakash
C
C
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. prakashc@medicine.wustl.edu
Chokshi
H
H
Walden
D T
DT
Aliperti
G
G
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004241:Diverticulum, Colon / Q000150:complications* / Q000175:diagnosis; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome