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

Background  Prior studies have shown the effectiveness of both endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Therefore, we investigated which was the more effective and safe treatment in a multicenter long-t...

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Autores principales: Kobayashi, Katsumasa, Nagata, Naoyoshi, Furumoto, Yohei, Yamauchi, Atsushi, Yamada, Atsuo, Omori, Jun, Ikeya, Takashi, Aoyama, Taiki, Tominaga, Naoyuki, Sato, Yoshinori, Kishino, Takaaki, Ishii, Naoki, Sawada, Tsunaki, Murata, Masaki, Takao, Akinari, Mizukami, Kazuhiro, Kinjo, Ken, Fujimori, Shunji, Uotani, Takahiro, Fujita, Minoru, Sato, Hiroki, Suzuki, Sho, Narasaka, Toshiaki, Hayasaka, Junnosuke, Kaise, Mitsuru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329063/
https://www.ncbi.nlm.nih.gov/pubmed/34820792
http://dx.doi.org/10.1055/a-1705-0921
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author Kobayashi, Katsumasa
Nagata, Naoyoshi
Furumoto, Yohei
Yamauchi, Atsushi
Yamada, Atsuo
Omori, Jun
Ikeya, Takashi
Aoyama, Taiki
Tominaga, Naoyuki
Sato, Yoshinori
Kishino, Takaaki
Ishii, Naoki
Sawada, Tsunaki
Murata, Masaki
Takao, Akinari
Mizukami, Kazuhiro
Kinjo, Ken
Fujimori, Shunji
Uotani, Takahiro
Fujita, Minoru
Sato, Hiroki
Suzuki, Sho
Narasaka, Toshiaki
Hayasaka, Junnosuke
Kaise, Mitsuru
author_facet Kobayashi, Katsumasa
Nagata, Naoyoshi
Furumoto, Yohei
Yamauchi, Atsushi
Yamada, Atsuo
Omori, Jun
Ikeya, Takashi
Aoyama, Taiki
Tominaga, Naoyuki
Sato, Yoshinori
Kishino, Takaaki
Ishii, Naoki
Sawada, Tsunaki
Murata, Masaki
Takao, Akinari
Mizukami, Kazuhiro
Kinjo, Ken
Fujimori, Shunji
Uotani, Takahiro
Fujita, Minoru
Sato, Hiroki
Suzuki, Sho
Narasaka, Toshiaki
Hayasaka, Junnosuke
Kaise, Mitsuru
author_sort Kobayashi, Katsumasa
collection PubMed
description Background  Prior studies have shown the effectiveness of both endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Therefore, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study. Methods  We reviewed data for 1679 patients with CDH who were treated with EBL (n = 638) or clipping (n = 1041) 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 was independently associated with reduced risk of early rebleeding (adjusted odds ratio [OR] 0.46; P  < 0.001) and late rebleeding (adjusted OR 0.62; P  < 0.001) compared with clipping. These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant differences were found between the treatments in the rates of initial hemostasis or mortality. Compared with clipping, EBL independently reduced the risk of needing interventional radiology (adjusted OR 0.37; P  = 0.006) and prolonged length of hospital stay (adjusted OR 0.35; P  < 0.001), but not need for surgery. Diverticulitis developed in one patient (0.16 %) following EBL and two patients (0.19 %) following clipping. Perforation occurred in two 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 interventional radiology, and shorter length of hospital stay.
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spelling pubmed-93290632022-07-29 Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study Kobayashi, Katsumasa Nagata, Naoyoshi Furumoto, Yohei Yamauchi, Atsushi Yamada, Atsuo Omori, Jun Ikeya, Takashi Aoyama, Taiki Tominaga, Naoyuki Sato, Yoshinori Kishino, Takaaki Ishii, Naoki Sawada, Tsunaki Murata, Masaki Takao, Akinari Mizukami, Kazuhiro Kinjo, Ken Fujimori, Shunji Uotani, Takahiro Fujita, Minoru Sato, Hiroki Suzuki, Sho Narasaka, Toshiaki Hayasaka, Junnosuke Kaise, Mitsuru Endoscopy Background  Prior studies have shown the effectiveness of both endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Therefore, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study. Methods  We reviewed data for 1679 patients with CDH who were treated with EBL (n = 638) or clipping (n = 1041) 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 was independently associated with reduced risk of early rebleeding (adjusted odds ratio [OR] 0.46; P  < 0.001) and late rebleeding (adjusted OR 0.62; P  < 0.001) compared with clipping. These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant differences were found between the treatments in the rates of initial hemostasis or mortality. Compared with clipping, EBL independently reduced the risk of needing interventional radiology (adjusted OR 0.37; P  = 0.006) and prolonged length of hospital stay (adjusted OR 0.35; P  < 0.001), but not need for surgery. Diverticulitis developed in one patient (0.16 %) following EBL and two patients (0.19 %) following clipping. Perforation occurred in two 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 interventional radiology, and shorter length of hospital stay. Georg Thieme Verlag KG 2022-02-11 /pmc/articles/PMC9329063/ /pubmed/34820792 http://dx.doi.org/10.1055/a-1705-0921 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Kobayashi, Katsumasa
Nagata, Naoyoshi
Furumoto, Yohei
Yamauchi, Atsushi
Yamada, Atsuo
Omori, Jun
Ikeya, Takashi
Aoyama, Taiki
Tominaga, Naoyuki
Sato, Yoshinori
Kishino, Takaaki
Ishii, Naoki
Sawada, Tsunaki
Murata, Masaki
Takao, Akinari
Mizukami, Kazuhiro
Kinjo, Ken
Fujimori, Shunji
Uotani, Takahiro
Fujita, Minoru
Sato, Hiroki
Suzuki, Sho
Narasaka, Toshiaki
Hayasaka, Junnosuke
Kaise, Mitsuru
Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
title Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
title_full Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
title_fullStr Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
title_full_unstemmed Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
title_short Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
title_sort effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9329063/
https://www.ncbi.nlm.nih.gov/pubmed/34820792
http://dx.doi.org/10.1055/a-1705-0921
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