Ichita Chikamasa, Kishino Takaaki, Aoki Tomonori, Machida Tomohiko, Murakami Takashi, Sato Yoshinori, Nagata Naoyoshi
Gastroenterology Medicine Center Shonan Kamakura General Hospital Kanagawa Japan.
Department of Health Data Science Yokohama City University Kanagawa Japan.
DEN Open. 2025 May 6;6(1):e70122. doi: 10.1002/deo2.70122. eCollection 2026 Apr.
Since 2020, multiple large-scale studies (CODE BLUE-J) in Japan have accelerated the accumulation of evidence on colonic diverticular bleeding (CDB). This review summarizes the latest findings regarding CDB epidemiology and endoscopic hemostasis. Recent data show that CDB has become the most common cause of lower gastrointestinal bleeding in Japan, driven by an aging population and the increased use of antithrombotic medications. Although 70%-90% of patients achieve spontaneous hemostasis, rebleeding occurs in up to 35% of cases within 1 year. Despite an overall mortality rate of < 1%, patients with CDB can present with hypovolemic shock and may require urgent intervention. There are no effective pharmacological treatments for controlling CDB. Therefore, endoscopic therapy plays a crucial role in its management. Based on available evidence, both clipping and endoscopic band ligation are considered effective initial treatments. Recent studies indicate that direct clipping reduces early rebleeding compared with indirect clipping, while endoscopic band ligation achieves lower rebleeding rates (13%-15%) than clipping. The choice between direct clipping and endoscopic band ligation depends on the diverticulum location and the presence of active bleeding. Newer techniques, such as over-the-scope clip and self-assembling peptide application, have shown potential, but require further study. The detection of the bleeding source remains challenging because accurate identification is essential for successful hemostasis. Additional research is needed to refine the endoscopic diagnostic and therapeutic techniques, prevent rebleeding, and improve patient outcomes.
自2020年以来，日本开展的多项大规模研究（CODE BLUE-J）加速了结肠憩室出血（CDB）证据的积累。本综述总结了关于CDB流行病学和内镜止血的最新研究结果。最新数据显示，在老龄化人口和抗血栓药物使用增加的推动下，CDB已成为日本下消化道出血最常见的原因。尽管70%-90%的患者可实现自发止血，但高达35%的病例在1年内会再次出血。尽管总体死亡率<1%，但CDB患者可能会出现低血容量性休克，可能需要紧急干预。目前尚无控制CDB的有效药物治疗方法。因此，内镜治疗在其管理中起着关键作用。根据现有证据，夹子夹闭和内镜下套扎术均被认为是有效的初始治疗方法。最近的研究表明，与间接夹闭相比，直接夹闭可减少早期再出血，而内镜下套扎术的再出血率（13%-15%）低于夹子夹闭术。直接夹闭和内镜下套扎术的选择取决于憩室的位置和活动性出血的情况。诸如套入式夹子和自组装肽应用等新技术已显示出潜力，但仍需进一步研究。出血源的检测仍然具有挑战性，因为准确识别对于成功止血至关重要。需要进一步研究以完善内镜诊断和治疗技术，预防再出血，并改善患者预后。
