Endoscopic Treatment of Bleeding Diversion Pouchitis with High-Concentration Dextrose Spray

Surgical closure of stoma with the reestablishment of gut continuity is the only curative intervention available for inflammatory bowel disease patients with diversion pouchitis, proctitis, or colitis. For patients who are not candidates for surgical reestablishment of bowel continuity, the alternative nonsurgical approaches, such as topical therapy with mesalamine, corticosteroids, or short-chain fatty acids, have only shown modest efficacy. The management of massive bleeding from diversion pouchitis has not been described. We present a patient with ulcerative colitis with severe hematochezia and diffuse mucosal bleeding in a diverted ileal pouch, which was successfully treated with endoscopic spray of hypertonic glucose.