Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: A large-scale multicenter cohort study

Abstract

Background and study aims: Prior studies have shown the effectiveness of endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Thus, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study. Patients and methods: We reviewed data for 1,679 patients with CDH who were treated with EBL (n=638) or clipping (n=1,041) between January 2010 and December 2019 at 49 hospitals across Japan (CODE BLUE-J Study). Logistic regression analysis was used to compare outcomes between the two treatments. Results: In multivariate analysis, EBL compared with clipping was independently associated with reduced risk of early rebleeding (adjusted odds ratio [AOR] 0.46; p<0.001) and late rebleeding (AOR 0.62; p<0.001). These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant difference was found between the treatments in the rate of initial hemostasis or mortality. EBL compared with clipping independently reduced the risk of need for interventional radiology (IVR) (AOR 0.37; p=0.006) and prolonged length of hospital stay (LOS) (AOR 0.35; p<0.001), but not need for surgery. Diverticulitis developed in 1 patient (0.16%) following EBL and 2 patients (0.19%) following clipping. Perforation occurred in 2 patients (0.31%) following EBL and none following clipping. Conclusions: Analysis of our large endoscopy dataset suggests that EBL is an effective and safe endoscopic therapy for CDH offering the advantages of lower early and late rebleeding rates, reduced need for IVR, and shorter LOS.