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Comparison of long-term outcomes between endoscopic band ligation and endoscopic clipping for colonic diverticular hemorrhage.

Nakano K, Ishii N, Ikeya T, Ego M, Shimamura Y, Takagi K, Nakamura K, Fukuda K, Fujita Y - Endosc Int Open (2015)

Bottom Line: Time-to-event analysis revealed statistically significant data (Log-rank test, P = 0.0036).EBL was superior to EC in the treatment of colonic diverticular hemorrhage.However, the risk of rebleeding was not avoided even after the diverticula had been resolved using EBL.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.

ABSTRACT

Background and study aims: Long-term outcomes of endoscopic band ligation (EBL) for colonic diverticular hemorrhage have not been reported to date. The aim of this study was to determine the long-term outcomes of EBL and to retrospectively compare them with those of endoscopic clipping (EC) in the treatment of colonic diverticular hemorrhage.

Patients and methods: The study included patients with colonic diverticular hemorrhage who were treated with EBL or EC from January 2004 to November 2014 and followed up more than 1 year (61 patients in the EBL group and 39 patients in the EC group). Time-to-event analysis of rebleeding was performed with the Kaplan-Meier method. A follow-up colonoscopy was performed to confirm the disappearance of the banded diverticula in the EBL group.

Results: Rebleeding occurred in 21 patients in the EBL group and in 26 patients in the EC group. The cumulative incidence of rebleeding at 1, 12, 24, and 36 months after first treatments was 14 %, 23 %, 26 %, and 41 % in the EBL group and 38 %, 49 %, 59 %, and 68 % in the EC group, respectively. Time-to-event analysis revealed statistically significant data (Log-rank test, P = 0.0036). Scar formation with fold convergence at the previously banded site was observed in 11 of 24 patients who underwent follow-up colonoscopy (46 %). However, late rebleeding (rebleeding more than 30 days after EBL) occurred in five of these 11 cases.

Conclusions: EBL was superior to EC in the treatment of colonic diverticular hemorrhage. However, the risk of rebleeding was not avoided even after the diverticula had been resolved using EBL.

No MeSH data available.


Related in: MedlinePlus

Scar formation was observed at the previously banded site in a follow-up colonoscopy.
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FI219-4: Scar formation was observed at the previously banded site in a follow-up colonoscopy.

Mentions: In the EBL group, follow-up colonoscopy was performed after the procedure to confirm the disappearance of the banded diverticula, except in patients with severe comorbid conditions such as cardiovascular disease. A convergence of folds at the site of the previously banded diverticula, seen on follow-up colonoscopy, was considered as the disappearance of the diverticula with SRH (Fig. 4) 28. However, the presence or absence of the previously banded diverticula could not be confirmed in all cases because tattooing was not performed near the bleeding point. In such cases, we recorded the results as unknown. This study was approved by the ethics committee of our hospital, and written informed consent was obtained from all patients. The patients who were not followed up at St. Luke’s International Hospital were contacted by telephone to confirm the presence or absence of massive hematochezia after endoscopic treatments.


Comparison of long-term outcomes between endoscopic band ligation and endoscopic clipping for colonic diverticular hemorrhage.

Nakano K, Ishii N, Ikeya T, Ego M, Shimamura Y, Takagi K, Nakamura K, Fukuda K, Fujita Y - Endosc Int Open (2015)

Scar formation was observed at the previously banded site in a follow-up colonoscopy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612232&req=5

FI219-4: Scar formation was observed at the previously banded site in a follow-up colonoscopy.
Mentions: In the EBL group, follow-up colonoscopy was performed after the procedure to confirm the disappearance of the banded diverticula, except in patients with severe comorbid conditions such as cardiovascular disease. A convergence of folds at the site of the previously banded diverticula, seen on follow-up colonoscopy, was considered as the disappearance of the diverticula with SRH (Fig. 4) 28. However, the presence or absence of the previously banded diverticula could not be confirmed in all cases because tattooing was not performed near the bleeding point. In such cases, we recorded the results as unknown. This study was approved by the ethics committee of our hospital, and written informed consent was obtained from all patients. The patients who were not followed up at St. Luke’s International Hospital were contacted by telephone to confirm the presence or absence of massive hematochezia after endoscopic treatments.

Bottom Line: Time-to-event analysis revealed statistically significant data (Log-rank test, P = 0.0036).EBL was superior to EC in the treatment of colonic diverticular hemorrhage.However, the risk of rebleeding was not avoided even after the diverticula had been resolved using EBL.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.

ABSTRACT

Background and study aims: Long-term outcomes of endoscopic band ligation (EBL) for colonic diverticular hemorrhage have not been reported to date. The aim of this study was to determine the long-term outcomes of EBL and to retrospectively compare them with those of endoscopic clipping (EC) in the treatment of colonic diverticular hemorrhage.

Patients and methods: The study included patients with colonic diverticular hemorrhage who were treated with EBL or EC from January 2004 to November 2014 and followed up more than 1 year (61 patients in the EBL group and 39 patients in the EC group). Time-to-event analysis of rebleeding was performed with the Kaplan-Meier method. A follow-up colonoscopy was performed to confirm the disappearance of the banded diverticula in the EBL group.

Results: Rebleeding occurred in 21 patients in the EBL group and in 26 patients in the EC group. The cumulative incidence of rebleeding at 1, 12, 24, and 36 months after first treatments was 14 %, 23 %, 26 %, and 41 % in the EBL group and 38 %, 49 %, 59 %, and 68 % in the EC group, respectively. Time-to-event analysis revealed statistically significant data (Log-rank test, P = 0.0036). Scar formation with fold convergence at the previously banded site was observed in 11 of 24 patients who underwent follow-up colonoscopy (46 %). However, late rebleeding (rebleeding more than 30 days after EBL) occurred in five of these 11 cases.

Conclusions: EBL was superior to EC in the treatment of colonic diverticular hemorrhage. However, the risk of rebleeding was not avoided even after the diverticula had been resolved using EBL.

No MeSH data available.


Related in: MedlinePlus