In their Review “Gastrointestinal bleeding in the elderly”, Yachimski and Friedman discussed epinephrine injection, thermal application and band ligation as endoscopic therapies for colonic diverticular hemorrhage, which is the most common source of lower gastrointestinal bleeding in the elderly.1 They failed to mention hemoclip application. Although there are no data available comparing the efficacy and safety of the various endoscopic hemostatic methods available, worldwide the impact of hemoclip application for colonic diverticular hemorrhage is increasing.2,3 Mechanical hemostasis by hemoclip application confers a theoretical decreased risk of perforation compared with thermal application in the thin-walled diverticula. In addition, hemoclip application may serve as a fluoroscopic marker to guide angiographic therapy if necessary. For these reasons, we believe that hemoclip application should be added to “...the armamentarium of all practicing endoscopists...” for the treatment of colonic diverticular hemorrhage in the elderly.
References
Yachimski PS and Friedman LS (2008) Gastrointestinal bleeding in the elderly. Nat Clin Pract Gastroenterol Hepatol 5: 80–93
Hokama A et al. (1997) Utility of endoscopic hemoclipping for colonic diverticular bleeding. Am J Gastroenterol 92: 543–546
Technology Assessment Committee et al. (2006) Endoscopic clip application devices. Gastrointest Endosc 63: 746–750
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Hokama, A., Kinjo, F. & Fujita, J. Hemoclip application for colonic diverticular hemorrhage. Nat Rev Gastroenterol Hepatol 5, E2 (2008). https://doi.org/10.1038/ncpgasthep1146
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DOI: https://doi.org/10.1038/ncpgasthep1146
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Authors' response to “Hemoclip application for colonic diverticular hemorrhage”
Nature Clinical Practice Gastroenterology & Hepatology (2008)
