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Elective endoscopic clipping for the treatment of symptomatic diverticular disease: a potential for ‘cure’
  1. Amyn Haji1,
  2. Aris Plastiras2,
  3. Monica Ortenzi2,
  4. Shraddha Gulati3,
  5. Andrew Emmanuel1,
  6. Bu’Hussain Hayee1
  1. 1 King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, UK
  2. 2 Department of Colorectal Surgery, King’s College Hospital NHS Foundation Trust, London, UK
  3. 3 Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Mr Amyn Haji, King’s Institute of Therapeutic Endoscopy, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK; amynhaji{at}me.com

https://doi.org/10.1136/gutjnl-2017-315509

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    Symptomatic diverticular disease (DD) is a major worldwide healthcare burden, and diverticular bleeding is one of its most common manifestations. Endoscopic clipping of selected diverticula in the acute or early posthaemorrhage period has been reported as a haemostatic intervention, but the effect of elective clipping is not known.

    We present the prospective series of elective endoscopic clipping with the aim of treating all visible diverticula in patients with previous bleeding, resulting in near-complete disappearance of DD.

    This may have significant implications for the management of DD worldwide and warrants further prospective research.

    In more detail

    This was a prospective, single-centre study enrolling consecutive patients attending a specialist DD clinic at our institution, who had been previously hospitalised for lower GI bleeding due to DD (table 1). The procedures and follow-up colonoscopies were carried out from April 2015 to April 2017 at King’s College Hospital, London, UK. Patients with other GI pathologies were excluded from the study.

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    Table 1

    Episodes of confirmed diverticular bleeding requiring transfusion and hospitalisation before the procedure and in 1 year of follow-up

    Patients were enrolled only if the diagnosis had been confirmed by abdominopelvic CT scan and full colonoscopy during an episode of PR bleeding. The results and management plan were discussed in a multidisciplinary team meeting with informed consent from the patients. Any patients requiring previous admissions and transfusion for confirmed severe diverticular bleeding were included in the study.

    Patients underwent colonoscopy after full oral bowel preparation (Moviprep, Norgine Pharmaceuticals) under conscious sedation with midazolam and fentanyl. On withdrawal of the colonoscope (Olympus CF-H260DL or CF-H260AZL), all visible diverticula were carefully cleaned of residual stool using water delivered through the working channel …

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    Footnotes

    • Contributors Study conception and design: AH. Acquisition and interpretation of data: AP, AE, AH, MO. Writing and final approval of the manuscript: all authors.

    • Funding Funding was obtained from Cook Medical for the Instinct clips used in the study.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement Electronic patient record (EPR), Sunrise, Allscripts.