Impact of endoscopy in the management of duodenal diverticular bleeding: experience of a single medical center and a review of recent literature.

BACKGROUND

Duodenal diverticulum (DD) is a rare cause of upper-GI bleeding. The diagnosis and treatment of DD bleeding (DDB) is challenging. Surgical management was the mainstay of therapy before the 1990s.

OBJECTIVE

To evaluate the clinical feature, diagnosis, and management of cases of DDB at our institution and the literature after the first description of endoscopic therapy of this disease.

DESIGN

Retrospective single-center clinical review.

SETTING

Primary- and tertiary-care centers.

PATIENTS

A retrospective study of patients with DDB from January 2000 to January 2005 at Changhua Christian Medical Center.

MAIN OUTCOME MEASUREMENTS

Diagnostic yield and therapy results of endoscopy on DDB.

RESULTS

At our institution, from January 2000 to January 2005, a total of 11 patients (4 men and 7 women, mean age 75 years) were found to have DDB. The diverticulum was located in the second portion (n = 10) and the third portion (n = 1). Endoscopy was used as the diagnostic method in all of these cases and as the therapeutic method in 72.73% of these cases. None of our patients experienced recurrent bleeding.

LIMITATIONS

The study is limited to the small case number and was retrospective.

CONCLUSIONS

To our knowledge, this is the first report and the largest series that studied endoscopic management of DDB in the literature. We concluded that endoscopy is useful to diagnose and treat patients with DDB.