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

Table 6 Comparison of endoscopic hemostatic modalities for colonic diverticular bleeding (revised)

Outcome	EBL	TTS clip (direct)	OTSC	Evidence base and quality
Initial hemostasis	93%-100%	95%-100%	Approximately 95%-100%	All modalities equivalent; pooled 98.9% (Meine et al[30], 21 studies, 3161 pts)
Early rebleeding (≤ 30 days)	8%	19%	OR 0.16 vs EBL (PSM cohort, n = 303)	EBL vs TTS: Nagata et al[31], 16 studies/790 pts, P = 0.012; CODE-BLUE J[7]: 1679 pts, aOR = 0.46; OTSC: Ohashi et al[32]
Late rebleeding (≤ 1 year)	9%	29%	Not yet reported	EBL vs TTS: Nagata et al[31], P = 0.024; CODE-BLUE J[7]: AOR = 0.62
Need for TAE/surgery	1%	2% (P = 0.031 vs EBL)	0% (single-center, n = 36)	CODE-BLUE J[7]: AOR = 0.37, P = 0.006; Meine et al[30]
Adverse events	Perforation 0.31%; diverticulitis 0.16%	Perforation 0%; diverticulitis 0.19%	0% (limited data)	CODE-BLUE J[7]: 1679 pts; OTSC: Very limited n
Length of stay	Shorter (aOR = 0.35 vs clip, P < 0.001)	Reference	Shorter vs EBL (P = 0.026)	CODE-BLUE J[7]; Ohashi et al[32]
Number of supporting studies	2 meta-analyses + CODE-BLUE J (638 EBL pts)[5,7,35]	Largest volume: CODE-BLUE J 1041 clip pts[7]; all meta-analyses	1 PSM cohort (n = 303)[32]; 1 single-center (n = 36); case reports
Overall quality of evidence	Moderate: Meta-analyses of observational data + large multicenter retrospective cohort; No RCTs; Predominantly Japanese data	Moderate: Same evidence base; Globally established technique	Very low: 1 small PSM retrospective study; No RCTs

No randomized controlled trials exist comparing these modalities. All evidence derives from observational studies and retrospective cohorts. Endoscopic band ligation data derive predominantly from Japanese cohorts with right-sided diverticulosis predominance; generalizability to Western populations with left-sided disease requires prospective validation. EBL: Endoscopic band ligation; TTS: Through-the-scope; OTSC: Over-the-scope clip; TAE: Transcatheter arterial embolization; aOR: Adjusted odds ratio; pts: Patients; RCT: Randomized controlled trial; PSM: Propensity score matched.