title: Colonoscopy with clipping is useful in the diagnosis and treatment of diverticular bleeding.
abstract: OBJECTIVE
  Diverticular bleeding is the most common cause of acute severe lower gastrointestinal bleeding (LGIB) in Western countries. Diagnostic and therapeutic approaches, including endoscopy, radiology, or surgery, have not been standardized. We investigated colonoscopy as a first-line modality to diagnose and manage patients with LGIB.
  
  
  METHODS
  We performed a retrospective study of data collected from 2 tertiary Veterans hospitals of 64 patients (61 men, 76 ± 11 years) with acute severe diverticular bleeding, based on colonoscopy examination. We assessed primary hemostasis using endoscopic clipping for diverticular bleeding and described the bleeding stigmata. We measured early (<30 days) and late rebleeding, blood transfusion requirements, hospital stay and complications.
  
  
  RESULTS
  Patients received 3.1 ± 3.0 and 0.9 ± 2.2 U of blood before and after colonoscopy, respectively. Twenty-four of the 64 patients (38%) had diverticular stigmata of recent hemorrhage; and 21 of these patients (88%) were treated successfully using endoscopic clips, without complication or early rebleeding. Hospital stays averaged 6.4 ± 5.6 days. Endoscopic clipping provided primary hemostasis in 9/12 patients (75%) with active diverticular bleeding. During 35 ± 18 months of follow-up, late recurrent diverticular bleeding occurred in 22% of the patients (14/64) after a mean time period of 22 months; 5 of the patients (21%) with stigmata of recent hemorrhage who received clip treatment had rebleeding at 43 months. Rebleeding was self-limited in 8 patients (57%), was clipped in 4 (29%), or was embolized in 2 (14%).
  
  
  CONCLUSIONS
  Colonoscopy can be a safe first-line diagnostic and therapeutic approach for patients with severe LGIB. Endoscopic clipping provides hemostasis of active diverticular bleeding. Recurrent bleeding occurs in about 21% of patients who were treated with clips, at approximately 4 years; most bleeding is self-limited or can be retreated by endoscopic clipping.
authors: Veterans Affairs Palo Alto, Stanford University School of Medicine, Palo Alto, California 94304, USA. endoresection@me.com
authors: Tonya
authors: T
authors: Kaltenbach
authors: Rabindra
authors: R
authors: Watson
authors: Janak
authors: J
authors: Shah
authors: Shai
authors: S
authors: Friedland
authors: Tohru
authors: T
authors: Sato
authors: Amandeep
authors: A
authors: Shergill
authors: Kenneth
authors: K
authors: McQuaid
authors: Roy
authors: R
authors: Soetikno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000379:methods*; D004241:Diverticulum, Colon / Q000473:pathology* / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome