title: Endoscopic management of duodenal diverticular bleeding.
abstract: BACKGROUND
  Although the presence of a duodenal diverticulum is usually asymptomatic, bleeding in this tissue is sometimes difficult to diagnose and treat.
  
  
  OBJECTIVE
  To investigate the strategy for treatment, we reviewed the clinical data of patients diagnosed and treated for duodenal diverticular bleeding.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Single tertiary-referral center.
  
  
  METHODS
  Seven consecutive patients with bleeding from a duodenal diverticulum (mean age, 73.7 +/- 3.4 years old).
  
  
  METHODS
  The clinical characteristics, endoscopic findings, and treatment strategy for duodenal diverticular bleeding.
  
  
  METHODS
  All 7 patients achieved hemostasis. Six of 7 patients were treated endoscopically. There were no complications with endoscopic treatment.
  
  
  RESULTS
  Three patients bled from diverticula located at the second portion of the duodenum, and 4 patients bled from that located at the third portion. In 6 of 7 patients, lesions were identified and treated endoscopically with hemoclips, hypertonic saline solution and epinephrine (HSE), and/or 1% polidocanol injection. In 1 case, the lesion could not be detected during the first endoscopic examination, and the patient, therefore, was treated with transarterial embolization followed by surgical resection.
  
  
  CONCLUSIONS
  This preliminary case series described the feasibility of the endoscopic treatment. However, optimal management, including angiography and/or surgery, should be individualized to the patients, location, and type of hemorrhage.
  
  
  CONCLUSIONS
  Bleeding from a duodenal diverticulum should be considered in the case of upper-GI bleeding of unknown origin. An endoscopy may be an effective alternative to surgery in the management of a bleeding duodenal diverticulum.
authors.affiliation: Center of Gastroenterology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Onozato
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishihara
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Iizuka
authors.forename: Naondo
authors.initials: N
authors.lastname: Sohara
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okamura
authors.forename: Masatomo
authors.initials: M
authors.lastname: Mori
authors.forename: Hideaki
authors.initials: H
authors.lastname: Itoh
mesh_terms: D000368:Aged; D004240:Diverticulum / Q000150:complications* / Q000175:diagnosis; D004378:Duodenal Diseases / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D041742:Upper Gastrointestinal Tract / Q000473:pathology