Effective Management of Severe Diverticular Bleeding in Japanese Patients

Lower gastrointestinal bleeding is defined as bleeding from the anal side of the ligament of Treitz. Gastrointestinal bleeding can be broadly classified into small intestinal and large intestinal bleeding. Colonic diverticular bleeding is considered a major cause of large intestinal bleeding in addition to benign anorectal diseases, such as ischemic colitis, colorectal tumors, infectious enteritis, hemorrhoidal bleeding, and hemorrhagic rectal ulcers.

Diverticular Bleeding

Treatment options for lower gastrointestinal bleeding depend on the underlying etiology. Ischemic colitis reportedly resolves with conservative treatment and requires aggressive treatment only in cases of vaso-occlusive disease. Benign anorectal diseases, such as hemorrhoids or hemorrhagic rectal ulcers, are treated transanally and/or by pharmacological therapy and bleeding sites can usually be easily identified. Arteriovenous malformations can often be treated by endoscopic clipping or argon plasma coagulation. Furthermore, bleeding caused by colorectal tumors, inflammatory bowel disease, or infectious colitis should be controlled by treating the respective underlying causes. Diverticular bleeding is known to spontaneously resolve in the majority of cases and therefore requires aggressive treatment only in severe cases. At our hospital, the treatment options for severe cases of diverticular bleeding include endoscopic clipping, high-dose barium impaction, angiographic hemostasis, and intestinal resection. However, currently, there is a lack of consensus regarding the most appropriate treatment methods for particular clinical presentations. Furthermore, the severity of diverticular bleeding cannot be accurately determined in all cases. Patients may be at increased risk due to the time required to decide on treatment plans where there is a lack of definitive treatment strategy. Furthermore, endoscopists in our hospital have varied levels of skills and competencies.

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