Choice of diagnostic and treatment options in diverticular colonic bleeding

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Abstract

The review is based on a systematic literature search in electronic databases. eLibrary.ru, PubMed and Cochrane Library for the period from 2005 to 2025 by using the search queries «colonic diverticular bleeding diagnosis and treatment and endoscopic therapy and surgery». After screening and evaluating the summaries, followed by a study of the full texts, 66 articles were selected, including 4 meta-analyses, 5 reviews, 34 clinical trials, and 5 clinical recommendations. Over the past 20 years, the frequency of colonic diverticular bleeding (CDB) has increased significantly in the structure of gastrointestinal bleeding. Currently, early colonoscopy using an endoscopic cap and a water jet irrigator is recommended as the main diagnostic option for CDB. Contrast-enhanced computed tomography can be chosen as the initial diagnostic technique of examination in cases where high-quality emergency colonoscopy cannot be performed, as well as when endoscopic hemostasis is ineffective, when the possible use of transcatheter arterial embolization or surgical intervention is being discussed. The use of selective angiography is justified in the case of ongoing massive or prolonged recurrent CDB, when colonoscopy fails to determine the site of bleeding. Endoscopic treatment is an effective first-line option for CDB with fewer complications than transarterial embolisation or surgical intervention. There is increasing evidence to support endoscopic treatments such as direct clipping and endoscopic band ligation, which can reduce the incidence of recurrent bleeding below 15%. The continued high incidence of CDB recurrence even after the use of endoscopic band ligation indicates that endoscopic hemostasis in CDB does not have a long-term preventive effect, and therefore transcatheter arterial embolization should be considered as a second-line therapy for patients with diverticular bleeding who have revealed extravasation on contrast-enhanced computed tomography. Taking into account the need for the urgent use of modern endoscopic and radiation imaging techniques, and the high need for high-tech minimally invasive interventions, it is advisable to provide therapeutic and diagnostic care to patients with CDB in multidisciplinary specialized hospitals.

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About the authors

Vladimir N. Ektov

N.N. Burdenko Voronezh State Medical University

Author for correspondence.
Email: ektov.vladimir@yandex.ru

M.D., Professor of the Department of Specialized Surgical Disciplines

Russian Federation, Voronezh

Mark A. Khodorkovskiy

N.N. Burdenko Voronezh State Medical University

Email: vgmi_30@mail.ru

M.D., Professor of the Department of Specialized Surgical Disciplines

Russian Federation, Voronezh

Alexander V. Kurkin

N.N. Burdenko Voronezh State Medical University

Email: specsurg@vrngmu.com

 Ph.D., Assistant of the Department of Specialized Surgical Disciplines

Russian Federation, Voronezh

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2. Fig. 1. Algorithm for the diagnosis and treatment of diverticular colonic bleeding [7].

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