Clin Endosc.  2021 Mar;54(2):256-260. 10.5946/ce.2020.081.

Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding

Affiliations
  • 1Division of Gastroenterology, St. Luke’s International Hospital, Tokyo, Japan

Abstract

Background/Aims
In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB.
Methods
This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records.
Results
A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events.
Conclusions
The gel immersion method was found to be effective, especially for massive right-sided CDB.

Keyword

Diverticular diseases; Diverticulum; Gastrointestinal hemorrhage

Figure

  • Fig. 1. (A) Colonoscopic view of massive bleeding in the right colon. (B) The gel immersion method successfully washed out the massive clots and revealed diverticula with adherent clot. (C) Peeling of the clot exposed a non-bleeding visible vessel.


Reference

1. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016; 111:459–474.
Article
2. Ghassemi KA, Jensen DM. Lower GI bleeding: epidemiology and management. Curr Gastroenterol Rep. 2013; 15:333.
Article
3. Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. N Engl J Med. 2017; 376:1054–1063.
Article
4. Painter NS, Burkitt DP. Diverticular disease of the colon, a 20th century problem. Clin Gastroenterol. 1975; 4:3–21.
Article
5. Warner E, Crighton EJ, Moineddin R, Mamdani M, Upshur R. Fourteen-year study of hospital admissions for diverticular disease in Ontario. Can J Gastroenterol. 2007; 21:97–99.
Article
6. Nagata N, Niikura R, Aoki T, et al. Increase in colonic diverticulosis and diverticular hemorrhage in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan. Int J Colorectal Dis. 2014; 29:379–385.
Article
7. Imaeda H, Hibi T. The burden of diverticular disease and its complications: West versus East. Inflamm Intest Dis. 2018; 3:61–68.
Article
8. Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T. Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum. 1984; 27:531–537.
Article
9. Markham NI, Li AK. Diverticulitis of the right colon--experience from Hong Kong. Gut. 1992; 33:547–549.
Article
10. Ngoi SS, Chia J, Goh MY, Sim E, Rauff A. Surgical management of right colon diverticulitis. Dis Colon Rectum. 1992; 35:799–802.
Article
11. Niikura R, Nagata N, Aoki T, et al. Predictors for identification of stigmata of recent hemorrhage on colonic diverticula in lower gastrointestinal bleeding. J Clin Gastroenterol. 2015; 49:e24–e30.
Article
12. Oguri N, Ikeya T, Kobayashi D, et al. Effectiveness of risk scoring systems in predicting endoscopic treatment in colonic diverticular bleeding. J Gastroenterol Hepatol. 2020; 35:815–820.
Article
13. McGuire HH Jr. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg. 1994; 220:653–656.
Article
14. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997; 92:419–424.
15. Jensen DM, Ohning GV, Kovacs TO, et al. Natural history of definitive diverticular hemorrhage based on stigmata of recent hemorrhage and colonoscopic Doppler blood flow monitoring for risk stratification and definitive hemostasis. Gastrointest Endosc. 2016; 83:416–423.
Article
16. Nakatsu S, Yasuda H, Maehata T, et al. Urgent computed tomography for determining the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding. Intern Med. 2015; 54:553–558.
Article
17. Mohammed Ilyas MI, Szilagy EJ. Management of diverticular bleeding: evaluation, stabilization, intervention, and recurrence of bleeding and indications for resection after control of bleeding. Clin Colon Rectal Surg. 2018; 31:243–250.
Article
18. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000; 342:78–82.
Article
19. Gilshtein H, Kluger Y, Khoury A, Issa N, Khoury W. Massive and recurrent diverticular hemorrhage, risk factors and treatment. Int J Surg. 2016; 33 Pt A:136–139.
Article
20. Faucheron JL, Roblin X, Bichard P, Heluwaert F. The prevalence of right-sided colonic diverticulosis and diverticular haemorrhage. Colorectal Dis. 2013; 15:e266–e270.
Article
21. Ishii N, Itoh T, Uemura M, et al. Endoscopic band ligation with a water-jet scope for the treatment of colonic diverticular hemorrhage. Dig Endosc. 2010; 22:232–235.
Article
22. Yano T, Nemoto D, Ono K, et al. Gel immersion endoscopy: a novel method to secure the visual field during endoscopy in bleeding patients (with videos). Gastrointest Endosc. 2016; 83:809–811.
Article
23. East JE, Suzuki N, Stavrinidis M, Guenther T, Thomas HJ, Saunders BP. Narrow band imaging for colonoscopic surveillance in hereditary non-polyposis colorectal cancer. Gut. 2008; 57:65–70.
Article
24. Obana T, Fujita N, Sugita R, et al. Prospective evaluation of contrast-enhanced computed tomography for the detection of colonic diverticular bleeding. Dig Dis Sci. 2013; 58:1985–1990.
Article
Full Text Links
  • CE
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr