title: Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping.
abstract: BACKGROUND
  Predictors of refractory colonic diverticular hemorrhage after endoscopic clipping (EC) remain unclear.
  
  
  OBJECTIVE
  To elucidate the predictors of uncontrolled bleeding after EC.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Two tertiary referral centers.
  
  
  METHODS
  Eighty-nine patients with colonic diverticular hemorrhage who underwent EC as a first-line treatment were included.
  
  
  METHODS
  If bleeding remained uncontrolled after 1 or 2 EC sessions, other interventions (transcatheter arterial embolization, endoscopic band ligation, or surgery) were performed. Patients were divided into EC-controlled and EC-uncontrolled groups; the characteristics of each group were compared.
  
  
  METHODS
  Comorbidities, location of bleeding diverticula, and EC technique (direct vs indirect placement).
  
  
  RESULTS
  Initial treatment with EC was successful in 87 patients. Early rebleeding (primary failure) occurred in 30 of 87 patients (34%). Secondary failure occurred in 6 of 22 patients treated with reclipping (27%). Cumulatively, 78 patients were successfully managed with EC. Non-EC treatments were required in 11 patients. Location in the right side of the colon, particularly in the ascending colon, was significantly more common in the EC-uncontrolled group than in the EC-controlled group (P = .017 and P = .0029, respectively). Although the difference was not significant, bleeding was successfully managed in all 13 patients treated with direct placement. Bleeding remained uncontrolled after EC in 11 of 52 ascending cases (21%) treated with indirect placement. Diverticular hemorrhage in other locations was managed regardless of EC technique.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Location in the ascending colon is a significant predictor of refractory colonic diverticular hemorrhage after EC. Indirect placement of hemoclips in ascending lesions is ineffective.
authors.affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishii
authors.forename: Nobuto
authors.initials: N
authors.lastname: Hirata
authors.forename: Fumio
authors.initials: F
authors.lastname: Omata
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Itoh
authors.forename: Masayo
authors.initials: M
authors.lastname: Uemura
authors.forename: Michitaka
authors.initials: M
authors.lastname: Matsuda
authors.forename: Shoko
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Iizuka
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Fukuda
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujita
mesh_terms: D000368:Aged; D015331:Cohort Studies; D044682:Colon, Ascending / Q000473:pathology*; D003108:Colonic Diseases / Q000473:pathology / Q000628:therapy*; D003113:Colonoscopy / Q000295:instrumentation / Q000379:methods*; D004241:Diverticulum, Colon / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000473:pathology / Q000628:therapy*; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure