Colonoscopic Treatment of Acute Diverticular Hemorrhage

Abstract

Purpose: Although colonoscopy is routinely used in the diagnostic evaluation of patients with suspected diverticular hemorrhage, data are limited concerning colonoscopic treatment of acute diverticular bleeding. Previous reports of colonoscopic hemostasis for diverticular hemorrhage have mostly consisted of thermocoagulation and/or epinephrine injection. We report our experience using a relatively newer technique: endoclips. Methods: We reviewed colonoscopy records of all inpatients from March 2004-March 2005 who underwent colonoscopy for evaluation of overt lower GI bleeding within the University of California San Francisco Hospital system. We identified those with the colonoscopic diagnosis of acute diverticular hemorrhage, defined as findings of active bleeding or a nonbleeding visible vessel from/within a diverticulum. The following data were retrospectively collected: patient demographics, procedural findings, endoscopic treatment techniques and success, and hospital course. Results: Ten patients (9M/1F) had acute diverticular hemorrhage at colonoscopy. Their mean age was 71.7 years and the majority (70%) had comorbid cardiopulmonary, liver, and/or renal diseases. Patients underwent urgent colonoscopy at a median time of 20 hours after presentation and required a mean of 5 units packed red cell transfusion prior to procedure. At colonoscopy, all diverticula were vigorously irrigated, diverticular clots were removed (using irrigation, mechanical instruments, or suction), and all were meticulously examined. Active diverticular bleeding was identified in six patients, and a visible vessel was identified in four patients. Bleeding sites were located in the ascending colon (4), transverse colon (3), descending colon (1), and sigmoid colon (2). All diverticular bleeding sites were successfully treated with endoclips with or without dilute epinephrine injection (used in 70%). There were no procedure-related complications. All patients were discharged within three days without further clinical evidence of bleeding, transfusion requirements, or need for additional endoscopic, angiographic, or surgical therapy. Conclusions: Colonoscopic treatment of patients with acute diverticular hemorrhage using endoclips appears to be effective and safe. Urgent colonoscopy should be considered in patients with suspected diverticular hemorrhage, as it may enable treatment without need for more invasive therapeutic measures.