Endoscopic coagulation with clipping: a novel, simple, and effective strategy for colonic diverticular bleeding

Background and study aimsColonic diverticular bleeding (CDB) is a common cause of lower gastrointestinal bleeding, and rebleeding remains a significant clinical challenge despite various hemostatic techniques. Clipping and endoscopic band ligation are commonly performed; however, the efficacy of endoscopic coagulation with clipping (ECC) remains unclear. This study aimed to evaluate the efficacy and safety of ECC in treating CDB. Patients and methodsWe retrospectively analyzed 217 patients with suspected CDB seen at our institution between January 2017 and December 2024. Clinical outcomes, such as rebleeding rates within 30 days, adverse events, and length of hospital stay were assessed. ECC was defined as thermal coagulation of the bleeding vessel within the diverticulum, followed by closure with clips to reinforce hemostasis and prevent perforation. ResultsOf these, 202 patients underwent colonoscopic evaluation (15 were excluded due to spontaneous hemostasis or other reasons before endoscopy), 74 (36.6%) underwent ECC for hemostasis. Rebleeding occurred in 7 patients (9.5%) within 30 days. Diverticulitis with subsequent colonic perforation was observed in one patient (1.4%), who improved with conservative treatment, and exhibited no fatal adverse events. ConclusionsWith a favorable safety profile and low rebleeding rates, ECC can be a treatment option for CDB. Its simplicity and low reliance on specialized equipment make it a practical alternative to other hemostatic methods in clinical practice.