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Outcomes and rebleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study

Open AccessPublished:February 18, 2023DOI:https://doi.org/10.1016/j.gie.2023.02.014
Outcomes and rebleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study
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      Abstract

      Background and Aims

      Ligation therapy, including endoscopic detachable snare ligation (EDSL) and endoscopic band ligation (EBL), has emerged as an endoscopic treatment for colonic diverticular bleeding (CDB), but its comparative effectiveness and rebleeding risk remain unclear. We aimed to compare the outcomes of EDSL and EBL in treating CDB and identify risk factors for rebleeding after ligation therapy.

      Methods

      We reviewed data of 518 patients with CDB who underwent EDSL (n=77) or EBL (n=441) in a multicenter cohort study named the CODE BLUE-J Study. Outcomes were compared using propensity score matching. Logistic and Cox regression analyses were performed for rebleeding risk. A competing risk analysis was used to treat death without rebleeding as a competing risk.

      Results

      No significant differences were found between the two groups in terms of initial hemostasis, 30-day rebleeding, interventional radiology or surgery requirements, 30-day mortality, blood transfusion volume, and length of hospital stay, and adverse events. Sigmoid colon involvement was an independent risk factor for 30-day rebleeding (odds ratio, 1.87; 95% confidence interval, 1.02-3.40; P=0.042). History of acute lower gastrointestinal bleeding (ALGIB) was a significant long-term rebleeding risk factor on Cox regression analysis. Performance status (PS) 3/4 and history of ALGIB were long-term rebleeding factors on competing-risk regression analysis.

      Conclusions

      There were no significant differences in outcomes between EDSL and EBL for CDB. After ligation therapy, careful follow-up is required, especially in the treatment of sigmoid diverticular bleeding during admission. History of ALGIB and PS at admission are important risk factors for long-term rebleeding after discharge.

      Acronyms and abbreviations:

      ALGIB (acute lower gastrointestinal bleeding), ASD (absolute standardized difference), ATE (average treatment effect), ATT (average effect on the treated), BMI (body mass index), CCI (Charlson Comorbidity Index), CDB (colonic diverticular bleeding), CI (confidence interval), DOAC (direct oral anticoagulants), EBL (endoscopic band ligation), EDSL (endoscopic detachable snare ligation), HR (hazard ratio), IPTW (inverse probability of treatment weighting), IQR (interquartile range), IVR (interventional radiology), LDA (low-dose aspirin), LOS (length of hospital stay), n/a (not applicable), NSAIDs (nonsteroidal anti-inflammatory drugs), OR (odds ratio), PRBC (packed red blood cell), PS (performance status), PSM (propensity score matching), PT-INR (prothrombin time-international normalized ratio), SHR (subdistribution hazard ratio), SRH (stigmata of recent hemorrhage), USD (United States dollar)

      Article info

      Publication history

      Accepted: February 13, 2023
      Received in revised form: February 9, 2023
      Received: September 7, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Grant Support: This work was partially supported by grants from the Ministry of Health, Labour and Welfare, Japan (grant number:19HB1003), JSPS KAKENHI Grant (JP17K09365 and 20K08366), and the Smoking Research Foundation, Takeda Science Foundation, and Grants-in-Aid for Research from the National Center for Global Health and Medicine (29-2001, 29-2004, 19A1011, 19A1022, 19A-2015, 29-1025, and 30-1020). The funders played no role in the study design, analysis, or decision to publish this manuscript.

      Disclosures: All authors have no conflict of interests to disclose.

      Author contributions:

      All the authors have contributed significantly to and agree with the content of the manuscript. The contributions of each author to the manuscript are as follows:

      NN was the principal investigator of this study.

      AY (Kitano Hospital), NI, NN, and AY (University of Tokyo) designed and conducted this study. NI performed the statistical analyses.

      AY (Kitano Hospital), NI, NN, AY (University of Tokyo), KK (Bokutoh Hospital), JO, TI, TA, NT, YS (St Marianna University School of Medicine), TK (Nara city Hospital), TS, MM, AT, KM (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome), KK (Fukuoka University Chikushi Hospital), SF (Chiba Hokusoh Hospital), TU, MF, HS, SS, TN, JH, TF, YK (Naha City Hospital), AM, SK, TM (Hirosaki University Hospital), RG, HF, YF, NG, YT, KN (National Defense Medical College), NM, KN (Suita Municipal Hospital), TK (University of the Ryukyus Hospital), YS (National Hospital Organization Kyushu Medical Center), SF (Fukuoka University Hospital), KK (Kitasato University), TM (Akita University Graduate School of Medicine), YK (Kagoshima University Graduate School of Medical and Dental Sciences), KM (Tokyo Medical University), KW, YM, KO, SN, YK (Kitano Hospital), TY, and MK collected and interpreted the data.

      AY (Kitano Hospital) drafted the manuscript.

      NI, NN, and AY (University of Tokyo) critically revised the manuscript.

      AY (Kitano Hospital), NI, NN, AY (The University of Tokyo), KK (Bokutoh Hospital), JO, TI, TA, NT, YS (St Marianna University School of Medicine), TK (Nara city Hospital), TS, MM, AT, KM (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome), KK (Fukuoka University Chikushi Hospital), SF (Chiba Hokusoh Hospital), TU, MF, HS, SS, TN, JH, TF, YK (Naha City Hospital), AM, SK, TM (Hirosaki University Hospital), RG, HF, YF, NG, YT, KN (National Defense Medical College), NM, KN (Suita Municipal Hospital), TK (University of the Ryukyus Hospital), YS (National Hospital Organization Kyushu Medical Center), SF (Fukuoka University Hospital), KK (Kitasato University), TM (Akita University Graduate School of Medicine), YK (Kagoshima University Graduate School of Medical and Dental Sciences), KM (Tokyo Medical University), KW, YM, KO, SN, YK (Kitano Hospital), TY, and MK read and approved the final version of the manuscript.

      Identification

      DOI: https://doi.org/10.1016/j.gie.2023.02.014

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      © 2023 by the American Society for Gastrointestinal Endoscopy

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