학술논문
Advances in endoscopic management of colonic diverticular bleeding.
Document Type
Academic Journal
Author
Shiratori Y; Department of Gastroenterology, Maimonides Medical Center.; Kodilinye SM; Department of Medicine, Maimonides Medical Center, New York.; Salem AE; Department of Medicine, Maimonides Medical Center, New York.; Department of Gastroenterology, Johns Hopkins University Hospital, Baltimore, USA.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 8506887 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-7056 (Electronic) Linking ISSN: 02671379 NLM ISO Abbreviation: Curr Opin Gastroenterol Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose of Review: This review is focused on diagnostic and management strategies for colonic diverticular bleeding (CDB). It aims to present the current state of the field, highlighting the available techniques, and emphasizing findings that influence the choice of therapy.
Recent Findings: Recent guidelines recommend nonurgent colonoscopy (>24 h) for CDB. However, factors such as a shock index ≥1, which may warrant an urgent colonoscopy, remain under investigation.The standard approach to detecting the source of CDB requires a water-jet scope equipped with a cap. Innovative diagnostic techniques, such as the long-cap and tapered-cap, have proven effective in identifying stigmata of recent hemorrhage (SRH). Furthermore, the water or gel immersion methods may aid in managing massive hemorrhage by improving the visualization and stabilization of the bleeding site for subsequent intervention. Innovations in endoscopic hemostasis have significantly improved the management of CDB. New therapeutic methods such as endoscopic band ligation and direct clipping have substantially diminished the incidence of recurrent bleeding. Recent reports also have demonstrated the efficacy of cutting-edge techniques such as over-the-scope clips, which have significantly improved outcomes in complex cases that have historically necessitated surgical intervention.
Summary: Currently available endoscopic diagnostic and hemostatic methods for CDB have evolved with improved outcomes. Further research is necessary to refine the criteria for urgent colonoscopy and to confirm the effectiveness of new endoscopic hemostasis techniques.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Recent Findings: Recent guidelines recommend nonurgent colonoscopy (>24 h) for CDB. However, factors such as a shock index ≥1, which may warrant an urgent colonoscopy, remain under investigation.The standard approach to detecting the source of CDB requires a water-jet scope equipped with a cap. Innovative diagnostic techniques, such as the long-cap and tapered-cap, have proven effective in identifying stigmata of recent hemorrhage (SRH). Furthermore, the water or gel immersion methods may aid in managing massive hemorrhage by improving the visualization and stabilization of the bleeding site for subsequent intervention. Innovations in endoscopic hemostasis have significantly improved the management of CDB. New therapeutic methods such as endoscopic band ligation and direct clipping have substantially diminished the incidence of recurrent bleeding. Recent reports also have demonstrated the efficacy of cutting-edge techniques such as over-the-scope clips, which have significantly improved outcomes in complex cases that have historically necessitated surgical intervention.
Summary: Currently available endoscopic diagnostic and hemostatic methods for CDB have evolved with improved outcomes. Further research is necessary to refine the criteria for urgent colonoscopy and to confirm the effectiveness of new endoscopic hemostasis techniques.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)