Outcomes and recurrent bleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study
Ligation therapy, including endoscopic detachable snare ligation (EDSL) and endoscopic band ligation (EBL), has emerged as an endoscopic treatment for colonic diverticular bleeding (CDB); its comparative effectiveness and risk of recurrent bleeding remain unclear, however. Our goal was to compare the outcomes of EDSL and EBL in treating CDB and identify risk factors for recurrent bleeding 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 Colonic Diverticular Bleeding Leaders Update Evidence From Multicenter Japanese Study (CODE BLUE-J Study). Outcomes were compared by using propensity score matching. Logistic and Cox regression analyses were performed for recurrent bleeding risk, and a competing risk analysis was used to treat death without recurrent bleeding as a competing risk.
Results
No significant differences were found between the 2 groups in terms of initial hemostasis, 30-day recurrent bleeding, interventional radiology or surgery requirements, 30-day mortality, blood transfusion volume, length of hospital stay, and adverse events. Sigmoid colon involvement was an independent risk factor for 30-day recurrent bleeding (odds ratio, 1.87; 95% confidence interval, 1.02-3.40; P = .042). History of acute lower GI bleeding (ALGIB) was a significant long-term recurrent bleeding risk factor on Cox regression analysis. A performance status score of 3/4 and history of ALGIB were long-term recurrent bleeding 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 performance status at admission are important risk factors for long-term recurrent bleeding after discharge.
Abbreviations
ALGIB
acute lower GI bleeding
ASD
absolute standardized difference
CCI
Charlson Comorbidity Index
CDB
colonic diverticular bleeding
CI
confidence interval
EBL
endoscopic band ligation
EDSL
endoscopic detachable snare ligation
IQR
interquartile range
IVR
interventional radiology
LOS
length of hospital stay
PRBC
packed red blood cell
PS
performance status
SHR
subdistribution hazard ratio
SRH
stigmata of recent hemorrhage
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DISCLOSURE: All authors disclosed no financial relationships. This work was partiallysupportedbygrantsfrom theMinistry of Health, Labour and Welfare, Japan (grantno.19HB1003),JSPS KAKENHI(grantnos.JP17K09365and20K08366), and the Smoking Research Foundation, Takeda Science Foundation, andGrants-in-Aid for Research from theNational Center for Global Health and Medicine(29-2001,29-2004,19A1011,19A1022,19A-2015,29-1025, and30-1020). The funders played no role in the study design, analysis, or decision to publish the manuscript.
DIVERSITY, EQUITY, AND INCLUSION: We worked to ensure gender balance in the recruitment of human subjects. We worked to ensure ethnic or other types of diversity in the recruitment of human subjects. We worked to ensure that the language of the study questionnaires reflected inclusion.