Barium impaction therapy with balloon occlusion for deep colonic diverticular bleeding: a three-case series

Background and aims: In hemostasis for colonic diverticular bleeding, the incidence of recurrent bleeding is higher in deep colonic diverticulum than in shallow. We aimed to improve and evaluate barium impaction therapy using an enteroscopic overtube with balloon.

Patients and method: We performed barium impaction therapy in three patients with a diagnosis of deep colonic diverticular bleeding. The tip of the overtube was inserted to reach the cecum using the conventional method. After deflating the colon, the enteroscope was removed. The balloon in the tube was inflated, followed by barium filling via the tube. Sufficient pressure was applied by ensuring no regurgitation into the small intestine side. The entire colon was continuously filled with barium in stages.

Results: Post-treatment bleeding was controllable without adverse events in all three patients.

Conclusion: This novel barium impaction therapy using an enteroscopic overtube with balloon was effectively performed without adverse events.

• References

• 1 Varnava 3rd AM, Moore BA, Longo WE et al. Lower gastrointestinal bleeding. Dis Colon Rectum 1997; 40: 846-858
• 2 Jensen DM, Machicado GA, Jutabha R et al. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. NEJM 2000; 342: 78-82
• 3 Khanna A, Oqnibene SJ, Koniaris LG. Embolization as first-line therapy for diverticulosis-related massive lower gastrointestinal bleeding: evidence from a meta-analysis. J Gastrointest Surg 2005; 9: 343-352
• 4 Mayakel JA, Opelka FG. Colonic diverticulosis and diverticular hemorrhage. Clin Colon Surg 2004; 17: 195-204
• 5 Nagata N, Niikura R, Shimbo T et al. High-dose barium impaction therapy for the recurrence of colonic diverticular bleeding. Ann Surg 2015; 261: 269-275
• 6 Miura S, Kodaira S, Shatari T et al. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital. Dis Colon Rectum 2000; 43: 1383-1389
• 7 Nakada I, Ubukata H, Goto Y et al. Diverticular disease of the colon at a regional general hospital in Japan. Dis Colon Rectum 1995; 38: 755-759
• 8 Matsuhashi N, Akahane M, Nakajima A. Barium impaction: a therapy for refractory colonic diverticular bleeding. AJR Am J Roentgenol 2003; 180: 490-492
• 9 Chorost MI, Fruchter G, Kantor AM et al. The therapeutic barium enema revisited. Clin Radiol 2001; 56: 856-858
• 10 Adams JT. Therapeutic barium enema for massive diverticular bleeding. Arch Surg 1970; 101: 457-460
• 11 Koperna T, Kisser M, Reiner G et al. Diagnosis and treatment of bleeding colonic diverticula. Hepatogastroenterology 2001; 48: 702-705
• 12 Iwamoto J, Mizokami Y, Shimokobe K et al. Therapeutic barium enema for bleeding colonic diverticula: four case series and review of the literature. World J Gastroenterol 2008; 14: 6413-6417
• 13 Niikura R, Nagata N, Yamano K et al. High-dose barium impaction therapy is useful for the initial hemostasis and for preventing the recurrence of colonic diverticular bleeding unresponsive to endoscopic clipping. Case Rep Gastrointest Med 2013; 2013: 365954
• 14 Ishii N, Setoyama T, Deshpande GA et al. Endoscopic band ligation for colonic diverticular hemorrhage. Gastrointest Endosc 2012; 75: 382-387
• 15 Miller RE, Skucas J, Violante MR et al. The effect of barium on blood in the gastrointestinal tract. Radiology 1975; 117: 527-530
• 16 Fujimoto A, Sato S, Kurakata S et al. Effectiveness of high-dose barium enema filling for colonic diverticular bleeding. Colorectal Dis 2011; 13: 896-898