Overview of the Japanese Guideline for Colonic Diverticular Bleeding

Abstract

In December 2017, the Japanese Gastrointestinal Association, in collaboration with related academic societies, published a guideline for the management of colonic diverticulosis (diverticular bleeding, diverticulitis). Here, we summarize the key statements in the guideline that pertain to colonic diverticular bleeding. In Japan, the prevalence of colonic diverticulosis and the incidence rate of colonic diverticular bleeding have been increasing. Colonic diverticular bleeding ceases spontaneously in 70％-90％ cases, but the rate of re-bleeding is as high as 20％-40％. Colonoscopy, which is also useful for executing hemostatic procedures, is recommended as the first-line modality for the diagnosis of colorectal diverticular bleeding. In the endoscopic clipping method, as compared to direct placement of a hemoclip at the bleeding point, the rebleeding rate tends to be higher in the indirect placement, in which the bleeding diverticulum is closed with hemoclips in a zipper fashion. As compared to other hemostatic procedures, including endoscopic clipping, the transition rate to trans-arterial embolization or surgical operation is lower with diverticular ligation therapy, in which the bleeding diverticulum is mechanically ligated with a band or a plastic snare. In patients treated by the diverticular ligation method, a few cases with late-onset intestinal perforations have been reported. For prevention of rebleeding, withdrawal of NSAIDs and aspirin for primary prevention should be considered.