ENDOSCOPIC BAND LIGATION FOR COLONIC DIVERTICULAR HEMORRHAGE : TIPS AND TRICKS (WITH A VIDEO)

Abstract

Our institution has treated colonic diverticular hemorrhage using endoscopic band ligation (EBL). Based on our experience, we have divided the EBL method into three steps : detection of the responsible diverticula (step A), the EBL procedure (step B), and post-EBL management (step C). In step A, it is important to detect stigmata of recent hemorrhage (SRH) before colonic spasm starts. SRH include not only active bleeding, but also non-bleeding visible vessels and adherent clots. In step B, the key to the EBL procedure is to place two marking clips on both sides of the diverticulum. Endoclips and/or epinephrine injection may be needed if EBL is not successful. In step C, we explain how to manage early re-bleeding after EBL. There are several case reports of delayed perforation after EBL from other institutions, although we have not experienced this complication.