| Theme | Diagnoses & Treatments for Gastrointestinal Bleeding on the Basis of JGES Guidelines | |
|---|---|---|
| Title | Approach to the Management of Colonic Diverticular Bleeding | |
| Publish Date | 2017/03 | |
| Author | Naoki Ishii | Center of Gastroenterology, St. Luke's International Hospital |
| Author | Takashi Ikeya | Center of Gastroenterology, St. Luke's International Hospital |
| Author | Shuichi Okada | Center of Gastroenterology, St. Luke's International Hospital |
| Author | Yoshiyuki Fujita | Center of Gastroenterology, St. Luke's International Hospital |
| [ Summary ] | Colonic diverticular hemorrhage is the most common cause of lower gastrointestinal bleeding (LGIB) and its incidence is rising due to increasing comorbidities, such as hypertension and arteriosclerosis, and the regular use of anti‒platelet agents and non‒steroidal anti‒inflammatory drugs (NSAIDs). Colonoscopy after purging should be the initial diagnostic procedure for patients with acute LGIB. However, hematochezia associated with hemodynamic instability may be indicative of upper gastrointestinal bleeding and esophagogastroduodenoscopy should be performed before colonoscopy in these cases. Studies of the optimal timing of colonoscopy in the setting of acute LGIB are limited. Early colonoscopy does not seem to be associated with rebleeding or length of stay. However, it can be associated with a higher rate of source localization and endoscopic treatments. Colonic diverticular hemorrhage appears to resolve spontaneously in about 75 % of cases but interventions are required in cases with severe or continuous bleeding. Endoscopic treatments for hemostasis include epinephrine injection, contact thermal therapy, and endoscopic clipping. Recently, endoscopic band ligation (EBL) has also been performed to achieve hemostasis. Even after successful endoscopic hemostasis is achieved, rebleeding sometimes occurs. Therefore, it is important to take steps to prevent rebleeding, such as encouraging the patient to refrain from taking NSAIDs. |
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