Research Article|Articles in Press

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

Open AccessPublished:February 18, 2023DOI:
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      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.


      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.


      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.


      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)