Underwater Narrow-band Imaging in Colonic Diverticular Bleeding.

A 49-year-old woman presented with hematochezia. Computed tomography revealed numerous diverticula in the ascending colon (Picture 1). No active bleeding was found at the time of colonoscopy. We inspected the diverticula one-by-one using water immersion to dilate the diverticula (1). The diverticula were evaluated by next-generation narrow-band imaging (NBI), which provides superior visibility to white light (WL) observation (2). On inspection, we encountered a suspicious site with protrusion under WL observation (Picture 2). NBI verified that this was an exposed vessel penetrating the bottom of the diverticulum by eliminating fuzziness and clearly demarcating the vessel from the surrounding mucosa via improved brightness and color contrast (Picture 3). Protrusion into the endoscopically ligated diverticulum was also confirmed (Picture 4). This case suggests that underwater NBI provides more information in colonic diverticular bleeding cases than WL observation, as it avoids missing the culprit vessel during the inspection of numerous diverticula.

Picture 1.

Picture 2.

Picture 3.

Picture 4.

This work was supported by departmental resources only.

The authors state that they have no Conflict of Interest (COI).