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Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: Systematic review and meta‐analysis
Author(s) -
Nagata Naoyoshi,
Niikura Ryota,
Ishii Naoki,
Kaise Mitsuru,
Omata Fumio,
Tominaga Naoyuki,
Kitagawa Tomoyuki,
Ikeya Takashi,
Kobayashi Katsumasa,
Furumoto Yohei,
Narasaka Toshiaki,
Iwata Eri,
Sugimoto Mitsushige,
Itoi Takao,
Uemura Naomi,
Kawai Takashi
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15370
Subject(s) - medicine , ligation , clipping (morphology) , hemostasis , surgery , diverticulitis , meta analysis , linguistics , philosophy
Background and Aim Either clipping or band ligation will become the most common endoscopic treatment for colonic diverticular bleeding (CDB). Rebleeding is a significant clinical outcome of CDB, but there is no cumulative evidence comparing reduction of short‐term and long‐term rebleeding between them. Thus, we conducted a systematic review and meta‐analysis to determine which endoscopic treatment is more effective to reduce recurrence of CDB. Methods A comprehensive search of the databases PubMed/MEDLINE and Embase was performed through December 2019. Main outcomes were early and late rebleeding rates, defined as bleeding within 30 days and 1 year of endoscopic therapy for CDB. Initial hemostasis, need for transcatheter arterial embolization, or surgery were also assessed. Overall pooled estimates were calculated. Results Sixteen studies fulfilled the eligibility criteria, and a total of 790 participants were included. The pooled prevalence of early rebleeding was significantly lower for band ligation than clipping (0.08 vs 0.19; heterogeneity test, P = 0.012). The pooled prevalence of late rebleeding was significantly lower for band ligation than clipping (0.09 vs 0.29; heterogeneity test, P = 0.024). No significant difference of initial hemostasis rate was noted between the two groups. Pooled prevalence of need for transcatheter arterial embolization or surgery was significantly lower for band ligation than clipping (0.01 vs 0.02; heterogeneity test, P = 0.031). There were two cases with colonic diverticulitis due to band ligation but none in clipping. Conclusion Band ligation therapy was more effective compared with clipping to reduce recurrence of colonic diverticular hemorrhage over short‐term and long‐term durations.