Management of colonic diverticular bleeding: A narrative review with literature search of current evidence and therapeutic strategies

Table 5 Classification of stigmata of recent hemorrhage in colonic diverticular bleeding

Stigmata category	Endoscopic appearance	Rebleeding risk	Management implications
Active spurting bleeding	Pulsatile arterial bleeding from the diverticular neck or dome	Highest	Active bleeding present; mandatory endoscopic hemostasis
Active oozing bleeding	Non-pulsatile slow bleeding from the diverticulum	High	Endoscopic hemostasis indicated
Non-bleeding visible vessel	Pigmented protuberant lesion within the diverticulum without active bleeding	High	Endoscopic hemostasis recommended
Adherent clot	Clot tightly adherent to the diverticulum despite irrigation	Moderate	Consider removal and treatment; controversial
Flat pigmented spot	Black or red discoloration without protrusion, no active bleeding or clot	Lower	No proven benefit from endoscopic therapy; observation appropriate
Clean-based diverticulum (no SRH)	Diverticulum without stigmata in a patient with presumptive CDB	Lowest	Conservative management; consider further investigation

This classification was synthesized by the authors from criteria and outcome data reported in the CODE-BLUE J-study[7] and current society guidelines[5]; it is an original synthesis, not a reproduction of a single previously published table, and therefore does not require copyright permission. SRH: Stigmata of recent hemorrhage; CDB: Colonic diverticular bleeding.