Safety and Effectiveness of Endoscopic Band Ligation for Colonic Diverticular Bleeding in Elderly Patients

Abstract

<b><i>Introduction:</i></b> Colonic diverticulosis increases with age, leading to a higher risk of colonic diverticular bleeding (CDB) in the elderly. As life expectancy continues to increase, the need for endoscopic hemostasis for CDB in the elderly can also be expected to increase. However, there have been no reports to date on the feasibility of endoscopic hemostasis for elderly CDB patients. Several recent studies have addressed the effectiveness of endoscopic band ligation (EBL) for CDB. In this study, we evaluate the safety and effectiveness of EBL in elderly CDB patients compared to younger CDB patients. <b><i>Methods:</i></b> We retrospectively analyzed the medical records of consecutive patients treated with EBL for the first time at a tertiary referral center between March 2011 and November 2017. Patients were grouped according to age into those at least 75 years old (the Elderly) and those &#x3c;75 years old (the Nonelderly). Patient characteristics, technical success, and complications were compared between the two groups. <b><i>Results:</i></b> EBL was performed in 153 patients during the study period (49 Elderly patients and 104 Nonelderly patients). Elderly patients were less likely to be male (<i>p</i> &#x3c; 0.001) and had lower hemoglobin levels on admission (<i>p</i> &#x3c; 0.001). Bleeding on the right side of the splenic flexure was observed more frequently in the Nonelderly (<i>p</i> = 0.002). Charlson Comorbidity Index (CCI) and use of antithrombotic agents were significantly higher in the Elderly (<i>p</i> &#x3c; 0.001 and <i>p</i> &#x3c; 0.001, respectively). Active bleeding tended to be observed more frequently in the Elderly (<i>p</i> = 0.054), while the difference was not significant. There were no significant differences in the shock index, procedure time, or units of packed red blood cells transfused between the 2 groups. No significant differences in the technical success rate (97.1 vs. 98%, <i>p</i> = 0.76), early rebleeding rate (10.2 vs. 14.4%, <i>p</i> = 0.47), or other complications (2 vs. 1%, <i>p</i> = 0.58) were observed. Perforation and abscess formation were not observed in either group. Female gender, left-sidedness, higher CCI, and lower hemoglobin level were all significantly more frequently observed in the Elderly on multiple logistic regression analysis. <b><i>Discussion/Conclusion:</i></b> EBL may be similarly safe and effective for the treatment of CDB in the elderly as in the nonelderly.