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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(03): E356-E362
DOI: 10.1055/a-1322-2259
Original article

Step-clipping method can improve the detectability of the target lesion in colonic diverticular bleeding

Taiki Aoyama
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Hiroki Takemoto
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Yukari Takeuchi
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Kenjiro Shigita
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Naoki Asayama
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Akira Fukumoto
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Shinichi Mukai
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
,
Shinji Nagata
Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
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Abstract

Background and study aims Despite the information regarding extravasation from contrast-enhanced computed tomography (CECT), the detectability of the target diverticulum by colonoscopy remains unsatisfactory in colonic diverticular bleeding (CDB). The lack of common signs recognizable on CT and endoscopic images makes it difficult to set a region of interest; however, this can be overcome with the “step-clipping” method, a strategic marking technique for revealing the target. We aimed to investigate the clinical performance of the step-clipping method in patients with CDB.

Patients and methods Eighty-seven patients diagnosed with CDB with extravasation using CECT who underwent colonoscopy between August 2007 and February 2020 were included. Patients were divided into two categories: the traditional group (those who underwent colonoscopy from August 2007 to May 2017, n = 54) and the step-clipping group (those who underwent colonoscopy from June 2017 to February 2020, n = 33).

Results The detection rate for the responsible diverticulum was significantly higher in the step-clipping group than in the traditional group (94 % vs 63 %; P = .0013). The step-clipping group had a shorter average search time during colonoscopy (9.6 vs 40.5 minutes; P < .0001) and lower re-bleeding rate after the initial colonoscopy (6 % vs 26 %; P = .02) than the traditional group, which facilitated earlier hospital discharge (5.4 vs 6.8 days; P = .027).

Conclusions Colonoscopy using the step-clipping method can improve the detectability of the target lesion within a shorter time, thus leading to lower re-bleeding rates and earlier hospital discharge.



Publication History

Received: 02 October 2020

Accepted: 22 October 2020

Article published online:
19 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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