Naoyoshi Nagata1,2, Ryota Niikura3, Naoki Ishii4, Mitsuru Kaise5, Fumio Omata6, Naoyuki Tominaga7, Tomoyuki Kitagawa8, Takashi Ikeya9, Katsumasa Kobayashi10, Yohei Furumoto11, Toshiaki Narasaka11,12, Eri Iwata1, Mitsushige Sugimoto1, Takao Itoi13, Naomi Uemura1,14, Takashi Kawai1. 1. Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan. 2. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan. 3. Department of Gastroenterology, The University of Tokyo, Tokyo, Japan. 4. Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan. 5. Gastroenterology Division, Nippon Medical School, Tokyo, Japan. 6. Gastroenterology Division, St. Luke's International University, Tokyo, Japan. 7. Department of Gastroenterology, Saga Medical Center Koseikan, Saga, Japan. 8. Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan. 9. Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan. 10. Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. 11. Department of Gastroenterology, University of Tsukuba, Tsukuba, Ibaraki, Japan. 12. Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan. 13. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 14. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Chiba, Japan.
Abstract
BACKGROUND AND AIM: Either clipping or band ligation will become the most common endoscopic treatment for colonic diverticular bleeding (CDB). Rebleeding is a significant clinical outcome of CDB, but there is no cumulative evidence comparing reduction of short-term and long-term rebleeding between them. Thus, we conducted a systematic review and meta-analysis to determine which endoscopic treatment is more effective to reduce recurrence of CDB. METHODS: A comprehensive search of the databases PubMed/MEDLINE and Embase was performed through December 2019. Main outcomes were early and late rebleeding rates, defined as bleeding within 30 days and 1 year of endoscopic therapy for CDB. Initial hemostasis, need for transcatheter arterial embolization, or surgery were also assessed. Overall pooled estimates were calculated. RESULTS: Sixteen studies fulfilled the eligibility criteria, and a total of 790 participants were included. The pooled prevalence of early rebleeding was significantly lower for band ligation than clipping (0.08 vs 0.19; heterogeneity test, P = 0.012). The pooled prevalence of late rebleeding was significantly lower for band ligation than clipping (0.09 vs 0.29; heterogeneity test, P = 0.024). No significant difference of initial hemostasis rate was noted between the two groups. Pooled prevalence of need for transcatheter arterial embolization or surgery was significantly lower for band ligation than clipping (0.01 vs 0.02; heterogeneity test, P = 0.031). There were two cases with colonic diverticulitis due to band ligation but none in clipping. CONCLUSION: Band ligation therapy was more effective compared with clipping to reduce recurrence of colonic diverticular hemorrhage over short-term and long-term durations.
BACKGROUND AND AIM: Either clipping or band ligation will become the most common endoscopic treatment for colonic diverticular bleeding (CDB). Rebleeding is a significant clinical outcome of CDB, but there is no cumulative evidence comparing reduction of short-term and long-term rebleeding between them. Thus, we conducted a systematic review and meta-analysis to determine which endoscopic treatment is more effective to reduce recurrence of CDB. METHODS: A comprehensive search of the databases PubMed/MEDLINE and Embase was performed through December 2019. Main outcomes were early and late rebleeding rates, defined as bleeding within 30 days and 1 year of endoscopic therapy for CDB. Initial hemostasis, need for transcatheter arterial embolization, or surgery were also assessed. Overall pooled estimates were calculated. RESULTS: Sixteen studies fulfilled the eligibility criteria, and a total of 790 participants were included. The pooled prevalence of early rebleeding was significantly lower for band ligation than clipping (0.08 vs 0.19; heterogeneity test, P = 0.012). The pooled prevalence of late rebleeding was significantly lower for band ligation than clipping (0.09 vs 0.29; heterogeneity test, P = 0.024). No significant difference of initial hemostasis rate was noted between the two groups. Pooled prevalence of need for transcatheter arterial embolization or surgery was significantly lower for band ligation than clipping (0.01 vs 0.02; heterogeneity test, P = 0.031). There were two cases with colonic diverticulitis due to band ligation but none in clipping. CONCLUSION: Band ligation therapy was more effective compared with clipping to reduce recurrence of colonic diverticular hemorrhage over short-term and long-term durations.