Azeezia Medical College, Kollam, Kerala, India.
University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines.
Dis Mon. 2023 Nov;69(11):101543. doi: 10.1016/j.disamonth.2023.101543. Epub 2023 Mar 12.
Colonic diverticular bleeding is the most common cause of lower gastrointestinal (GI) bleeding, which can be life-threatening and frequently recurrent. In recent years, the prevalence of diverticulosis has increased in developed countries, with a documented incidence of 50% in patients older than 60 years. Based on the evidence, the use of anticoagulants and/or antiplatelets in the elderly population has resulted in an increased incidence of acute diverticular bleeding. According to the literature, about 50% of patients with diverticular bleeding require a blood transfusion, and 18% - 53% need emergency surgery. Although endoscopic identification of the culprit diverticula and appropriate intervention is a challenge, the newer treatment modality, over-the-scope clip method (OTSC) has been demonstrated to be an effective endoscopic hemostatic method in severe diverticular bleeding, especially in cases of rebleeding after first-line conventional endoscopic procedures. In this review, we summarize the pathophysiology of colonic diverticulosis and diverticular bleeding, recent evidence in its management, and existing theories on various preventive strategies to control diverticular bleeding. We also discuss the efficacy and treatment outcome of the OTSC technique in controlling diverticular bleeding.
结肠憩室出血是下消化道 (GI) 出血最常见的原因，可危及生命且常反复发作。近年来，发达国家憩室病的患病率有所增加，60 岁以上患者的发病率有记录在案为 50%。基于证据，老年人中抗凝剂和/或抗血小板药物的使用导致急性憩室出血的发生率增加。根据文献，约 50%的憩室出血患者需要输血，18%-53%需要紧急手术。尽管内镜识别出血憩室和适当干预是一个挑战，但较新的治疗方法，即过内镜器械用夹（OTSC）方法已被证明是治疗严重憩室出血的有效内镜止血方法，尤其是在一线常规内镜治疗后再次出血的情况下。在这篇综述中，我们总结了结肠憩室病和憩室出血的病理生理学、其治疗的最新证据以及各种预防策略的现有理论，以控制憩室出血。我们还讨论了 OTSC 技术在控制憩室出血方面的疗效和治疗结果。
