Location in the ascending colon is a predictor of refractory colonic diverticular hemorrhage after endoscopic clipping

Abstract

Predictors of refractory colonic diverticular hemorrhage after endoscopic clipping (EC) remain unclear. To elucidate the predictors of uncontrolled bleeding after EC. Retrospective study. Two tertiary referral centers. Eighty-nine patients with colonic diverticular hemorrhage who underwent EC as a first-line treatment were included. If bleeding remained uncontrolled after 1 or 2 EC sessions, other interventions (transcatheter arterial embolization, endoscopic band ligation, or surgery) were performed. Patients were divided into EC-controlled and EC-uncontrolled groups; the characteristics of each group were compared. Comorbidities, location of bleeding diverticula, and EC technique (direct vs indirect placement). Initial treatment with EC was successful in 87 patients. Early rebleeding (primary failure) occurred in 30 of 87 patients (34%). Secondary failure occurred in 6 of 22 patients treated with reclipping (27%). Cumulatively, 78 patients were successfully managed with EC. Non-EC treatments were required in 11 patients. Location in the right side of the colon, particularly in the ascending colon, was significantly more common in the EC-uncontrolled group than in the EC-controlled group (P = .017 and P = .0029, respectively). Although the difference was not significant, bleeding was successfully managed in all 13 patients treated with direct placement. Bleeding remained uncontrolled after EC in 11 of 52 ascending cases (21%) treated with indirect placement. Diverticular hemorrhage in other locations was managed regardless of EC technique. Retrospective study. Location in the ascending colon is a significant predictor of refractory colonic diverticular hemorrhage after EC. Indirect placement of hemoclips in ascending lesions is ineffective.