Endoscopy 2010; 42: E82-E83
DOI: 10.1055/s-0029-1243828
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic band ligation for the treatment of bleeding colonic and ileal diverticula

N.  Ishii1 , M.  Uemura1 , T.  Itoh1 , 2 , N.  Horiki1 , T.  Setoyama1 , M.  Matsuda1 , S.  Suzuki1 , Y.  Iizuka1 , K.  Fukuda1 , Y.  Fujita1
  • 1Department of Gastroenterology, St Luke’s International Hospital, Tokyo, Japan
  • 2Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan
Further Information

Publication History

Publication Date:
01 March 2010 (online)

Lower gastrointestinal bleeding accounts for about a fifth of all gastrointestinal bleeding cases, and generally has a less severe course and stops spontaneously in most cases (80 % – 85 %) [1] [2] [3]. However, some patients require endoscopic, surgical, or angiographic treatment, depending on the nature of the bleed [4]. Endoscopic band ligation (EBL) is effective for the treatment of both variceal and nonvariceal upper gastrointestinal bleeding [5]. Here we report our experiences of using EBL in the treatment of bleeding colonic and ileal diverticula.

A 58-year-old man with a history of hyperlipidemia was admitted to our hospital with painless hematochezia. A bleeding source could not be identified at urgent colonoscopy after bowel preparation following ingestion of 2 L of polyethylene glycol (PEG). At 12 hours after the first colonoscopy, the patient suddenly developed massive hematochezia and hypotension, requiring aggressive resuscitation. A second colonoscopy revealed active bleeding from the diverticulum in the distal ascending colon ([Fig. 1]). After making a mark with an endoclip near the bleeding diverticulum, the colonoscope was removed and then reinserted after attaching a band-ligator device (MD-48710 EVL Device, Sumitomo Bakelite Co. Ltd., Tokyo, Japan) to the tipp of the colonoscope. The colonic diverticulum was suctioned into the suction cup of the endoscopic ligator and the elastic O ring was released, which resulted in hemostasis ([Fig. 2]).

A second patient, 46-year-old man with alcoholic liver disease, was admitted due to episodes of hematochezia. Colonoscopy revealed active bleeding from an ileal diverticulum ([Fig. 3]). EBL was carried out, resulting in hemostasis ([Fig. 4]). Both patients showed no clinical evidence of further bleeding during the following 2 months.

Fig. 1 Endoscopic view of active bleeding from the diverticulum in the distal ascending colon.

Fig. 2 Suctioning of the colonic diverticulum into the suction cup of the endoscopic ligator with release of the elastic O ring, which resulted in hemostasis. A large vessel is seen on the everted and banded diverticulum.

Fig. 3 Endoscopic view of active bleeding from an ileal diverticulum.

Fig. 4 Endoscopic band ligation of the bleeding ileal diverticulum, resulting in hemostasis.

EBL is a safe and effective hemostatic method for bleeding colonic and ileal diverticula.

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References

N. Ishii

Department of Gastroenterology
St Luke’s International Hospital

9-1 Akashi-cho
Chuo-ku
Tokyo
Japan 104-8560

Fax: +81-3-35440649

Email: naoishi@luke.or.jp