Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko191110.18499/2070-478X-2026-19-2-92-100Review of literatureОбзор литературыReview ArticleChoice of diagnostic and treatment options in diverticular colonic bleedingВыбор методов диагностики и лечения дивертикулярных толстокишечных кровотеченийEktovVladimir N.ЭктовВладимир Николаевич
Russian Federation

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

д.м.н., профессор кафедры специализированных хирургическмх дисциплин

ektov.vladimir@yandex.ruKhodorkovskiyMark A.ХодорковскийМарк Анатольевич
Russian Federation

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

д.м.н., профессор кафедры специализированных хирургическмх дисциплин

vgmi_30@mail.ruKurkinAlexander V.КуркинАлександр Васильевич
Russian Federation

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

к.м.н., ассистент кафедры специализированных хирургическмх дисциплин

specsurg@vrngmu.comN.N. Burdenko Voronezh State Medical UniversityВоронежский государственный медицинский университет им. Н.Н. Бурденко26062026192921001510202507042026Copyright ©; 2026, Voronezh N.N. Burdenko State Medical UniversityCopyright ©; 2026, ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России2026Voronezh N.N. Burdenko State Medical UniversityФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава Россииhttps://vestnik-surgery.com/journal/about/editorialPolicieshttps://vestnik-surgery.com/journal/article/view/1911

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.

Обзор выполнен на основании поиска литературы по электронным базам данных eLibrary.ru, PubMed и Cochrane Library за период с 2005 по 2025 год путем использования поисковых запросов «colonic diverticular bleeding diagnosis and treatment and endoscopic therapy and surgery». После скрининга и оценки резюме с последующим изучением полных текстов отобрано 47 статей, среди них - 4 метаанализа, 5 обзоров, 34 клинических исследования, 5 клинических рекомендаций. За последние 20 лет в структуре гастроинтестинальных кровотечений значительно увеличилась частота толстокишечных дивертикулярных кровотечений (ДТК). В настоящее время в качестве основного метода диагностики ДТК рекомендуется выполнение ранней колоноскопии с использованием эндоскопического колпачка и водоструйного ирригатора. Компьютерная томография с контрастным усилением может быть выбрана начальным диагностическим методом обследования в тех случаях, когда качественная экстренная колоноскопия не может быть выполнена, а также при неэффективности эндоскопического гемостаза, когда обсуждается возможное применение транскатетерной артериальной эмболизации или выполнение хирургического вмешательства. Применение селективной ангиографии оправдано при продолжающемся массивном или длительном рецидивирующем ДТК, когда с помощью колоноскопии не удается определить место кровотечения. Эндоскопическое лечение является эффективным методом первой линии при ДТК с меньшим количеством осложнений, чем трансартериальная эмболизация или хирургическое вмешательство. Появляется все больше данных в поддержку таких эндоскопических методов лечения, как прямое клипирование и латексное лигирование, которые позволяют снизить частоту повторных кровотечений ниже 15%. Сохраняющаяся высокая частота рецидивов ДТК даже после применения латексного лигирования свидетельствует о том, что эндоскопический гемостаз при ДТК не оказывает долгосрочного профилактического воздействия, в связи с чем транскатетерную артериальную эмболизацию целесообразно рассматривать в качестве терапии второй линии для пациентов с дивертикулярным кровотечением, у которых на компьютерной томографии с контрастным усилением выявлена экстравазация. С учетом необходимости экстренного применения современных методов эндоскопической и лучевой визуализации, высокой потребности в высокотехнологичных миниинвазивных вмешательствах оказание лечебно-диагностической помощи пациентам с ДТК целесообразно проводить в условиях многопрофильных специализированных стационаров.

colonic diverticular bleeding colonoscopyendoscopic hemostasistranscatheter arterial embolizationдивертикулярное толстокишечное кровотечениеколоноскопияэндоскопический гемостазтранскатетерная артериальная эмболизацияIchita C, Goto T, Sasaki A, Shimizu S. National trends in hospitalizations for gastrointestinal bleeding in Japan. Journal of Clinical Biochemistry and Nutrition. 2024; 75(1): 60-64. DOI: 10.3164/jcbn.23-111.Amano H, Yamamoto T, Ikusaka K, Aoki N, Sakurai M, Honda T, Maruyama K, Aoyagi H, Isono A, Abe K, Asaoka Y, Kodashima S, Tanaka A. Clinical Factors Associated with Severity of Colonic Diverticular Bleeding and Impact of Bleeding Site. Journal of Clinical Medicine. 2023; 12(5): 1826. DOI: 10.3390/jcm12051826.Kaise M, Nagata N, Ishii N, Omori J, Goto O, Iwakiri K. Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding. Digestive Endoscopy. 2020; 32(2): 240-250. DOI: 10.1111/den.13547.Okada T, Mikamo T, Nakashima A, Yanagitani A, Tanaka K, Isomoto H. Construction of a Model for Predicting the Severity of Diverticular Bleeding in an Elderly Population. Internal Medicine. 2022; 61(15): 2247-2253. DOI: 10.2169/internalmedicine.8761-21.Chang LS, Nishida T, Hosokawa K, Fujii Y, Osugi N, Sugimoto A, Mukai K, Nakamatsu D, Matsumoto K, Hayashi S, Yamamoto M, Inada M. Impact of anticoagulants on the clinical outcomes of colonic diverticular bleeding comparing warfarin and direct oral anticoagulants. Scientific Reports. 2022; 12(1): 16795. DOI: 10.1038/s41598-022-21166-8.Nagata N, Ishii N, Manabe N, Tomizawa K, Urita Y, Funabiki T, Fujimori S, Kaise M. Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association. Digestion. 2019; 99 Suppl 1: 1-26. DOI: 10.1159/000495282.Zia Ziabari SM, Rimaz S, Shafaghi A, Shakiba M, Pourkazemi Z, Karimzadeh E, Amoukhteh M. Blood Urea Nitrogen to Creatinine ratio in Differentiation of Upper and Lower Gastrointestinal Bleedings; a Diagnostic Accuracy Study. Archives of Academic Emergency Medicine. 2019; 7(1): e30.Kruis W, Germer CT, Böhm S, Dumoulin FL, Frieling T, Hampe J, Keller J, Kreis ME, Meining A, Labenz J, Lock JF, Ritz JP, Schreyer A, Leifeld L; German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the German Society of General and Visceral Surgery (DGAV) (AWMF-Register 021-20). German guideline diverticular disease/diverticulitis: Part I: Methods, pathogenesis, epidemiology, clinical characteristics (definitions), natural course, diagnosis and classification. United European Gastroenterology Journal. 2022; 10(9): 923-939. DOI: 10.1002/ueg2.12309.Sengupta N, Feuerstein JD, Jairath V, Shergill AK, Strate LL, Wong RJ, Wan D. Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. American Journal of Gastroenterology. 2023; 118(2): 208-231. DOI: 10.14309/ajg.0000000000002130.Jensen DM. Endoscopic Diagnosis and Treatment of Colonic Diverticular Bleeding. Gastrointestinal Endoscopy Clinics of North America. 2024; 34(2): 345-361. DOI: 10.1016/j.giec.2023.10.002.Niikura R, Nagata N, Yamada A, Honda T, Hasatani K, Ishii N, Shiratori Y, Doyama H, Nishida T, Sumiyoshi T, Fujita T, Kiyotoki S, Yada T, Yamamoto K, Shinozaki T, Takata M, Mikami T, Mabe K, Hara K, Fujishiro M, Koike K. Efficacy and Safety of Early vs Elective Colonoscopy for Acute Lower Gastrointestinal Bleeding. Gastroenterology. 2020; 158(1): 168-175.e6. DOI: 10.1053/j.gastro.2019.09.010.Gralnek IM, Neeman Z, Strate LL. Acute Lower Gastrointestinal Bleeding. New England Journal of Medicine. 2017; 376(11): 1054-1063. DOI: 10.1056/NEJMcp1603455.Malik A, Inayat F, Goraya MHN, Shahzad E, Zaman MA. Severe Acute Colonic Diverticular Bleeding: The Efficacy of Rapid Bowel Preparation With 1 L Polyethylene Glycol Ascorbate Solution and Direct Endoscopic Hemoclipping for Successful Hemostasis. Journal of Investigative Medicine High Impact Case Reports. 2021; 9:2324709621994383. DOI: 10.1177/2324709621994383.Maida M, Macaluso FS, Sferrazza S, Ventimiglia M, Sinagra E. Effectiveness and safety of NER1006 versus standard bowel preparations: A meta-analysis of randomized phase-3 clinical trials. Digestive and Liver Disease. 2020; 52(8): 833-839. DOI: 10.1016/j.dld.2020.05.046.Kishino T, Kitamura Y, Okuda T, Okamoto N, Sawa T, Yamakawa M, Kanemasa K. Useful treatment selection strategy for endoscopic hemostasis in colonic diverticular bleeding according to endoscopic findings (with video). Endoscopy International Open. 2025; 13: a24711016. DOI: 10.1055/a-2471-1016.Yano T, Nemoto D, Ono K, Miyata Y, Numao N, Iwashita C, Nagayama M, Takahashi H, Lefor AK, Yamamoto H. Gel immersion endoscopy: a novel method to secure the visual field during endoscopy in bleeding patients (with videos). Gastrointestinal Endoscopy. 2016; 83(4): 809-811. DOI: 10.1016/j.gie.2015.09.048.Yamamoto K, Shiratori Y, Ikeya T. Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding. Clinical Endoscopy. 2021; 54(2): 256-260. DOI: 10.5946/ce.2020.081.Yahagi N, Fujimoto A, Horii J, Uraoka T, Shimoda M, Takabayashi K, Nisizawa T, Goto O, Ochiai Y, Maehata T, Nakayama A, Kato M, Hosoe N, Naganuma M. Dual red imaging: a novel endoscopic imaging technology visualizing thick blood vessels in the gastrointestinal wall. Endoscopy International Open. 2019; 7(12): E1632-E1635. DOI: 10.1055/a-0749-0075.Fukuda S, Sakamoto T, Suzuki H, Narasaka T, Tsuchiya K. Utility of red dichromatic imaging for identifying the bleeding point in endoscopic hemostasis of colonic diverticular bleeding. VideoGIE. 2022; 7(4): 149-151. DOI: 10.1016/j.vgie.2022.01.002.Oguri N, Ikeya T, Kobayashi D, Yamamoto K, Yoshimoto T, Takasu A, Okamoto T, Shiratori Y, Okuyama S, Takagi K, Nakamura K, Fukuda K. Effectiveness of risk scoring systems in predicting endoscopic treatment in colonic diverticular bleeding. Journal of Gastroenterology and Hepatology. 2020; 35(5): 815-820. DOI: 10.1111/jgh.14901.García-Blаzquez V, Vicente-Bаrtulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J; EBM-Connect Collaboration. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. European Radiology. 2013; 23(5): 1181-90. DOI: 10.1007/s00330-012-2721-x.Takada H, Kadokura M, Yasumura T, Yoda H, Okuwaki T, Imagawa N, Shimamura N, Tanaka K, Amemiya F, Enomoto N. Extravasation and fluid collection on computed tomography imaging in patients with colonic diverticular bleeding. PLoS One. 2020; 15(4): e0229884. DOI: 10.1371/journal.pone.0229884.Ichiba T, Hara M, Miyahara K, Urashima M, Shintani A, Naitou H, Higashi R. Impact of Computed Tomography Evaluation Before Colonoscopy for the Management of Colonic Diverticular Hemorrhage. Journal of Clinical Gastroenterology. 2019; 53(2): e75-e83. DOI: 10.1097/MCG.0000000000000988.Ueda T, Mori H, Sekiguchi T, Mishima Y, Sano M, Teramura E, Fujimoto R, Kaneko M, Nakae H, Fujisawa M, Matsushima M, Suzuki H. Successful endoscopic hemostasis compared to transarterial embolization in patients with colonic diverticular bleeding. Journal of Clinical Biochemistry and Nutrition. 2022; 70(3): 283-289. DOI: 10.3164/jcbn.21-123.Jensen DM. Diagnosis and treatment of definitive diverticular hemorrhage (DDH). American Journal of Gastroenterology. 2018; 113(11): 1570-1573. DOI: 10.1038/s41395-018-0061-4.Doi H, Sasajima K, Takahashi M, Sato T, Ootsu I, Chinzei R. Effectiveness of Conservative Treatment without Early Colonoscopy in Patients with Colonic Diverticular Hemorrhage. Canadian Journal of Gastroenterology and Hepatology. 2020; 2020: 3283940. DOI: 10.1155/2020/3283940.Gobinet-Suguro M, Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kawagishi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Uemura N, Itawa E, Sugimoto M, Fukuzawa M, Kawai T, Kaise M, Itoi T. Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study. Gastrointestinal Endoscopy. 2022; 95(6): 1210-1222.e12. DOI: 10.1016/j.gie.2021.12.023.Hayasaka J, Kikuchi D, Odagiri H, Nomura K, Ochiai Y, Okamura T, Suzuki Y, Mitsunaga Y, Dan N, Tanaka M, Yamashita S, Matsui A, Hoteya S. Effectiveness of Clipping for Definitive Colonic Diverticular Bleeding in Preventing Early Recurrent Bleeding. Internal Medicine. 2022; 61(4): 451-460. DOI: 10.2169/internalmedicine.7702-21.Nagata N, Ishii N, Kaise M, Shimbo T, Sakurai T, Akiyama J, Uemura N. Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band ligation versus clipping. Gastrointest Endosc. 2018; 88(5): 841-853.e4. DOI: 10.1016/j.gie.2018.07.018.Kishino T, Kanemasa K, Kitamura Y, Fukumoto K, Okamoto N, Shimokobe H. Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos). Endoscopy International Open. 2020; 8(3): E377-E385. DOI: 10.1055/a-1036-6077.Kishino T, Kitaichi T, Kanemasa K. Usefulness of water immersion observations to identify the stigmata of hemorrhage in colonic diverticular bleeding. Digestive Endoscopy. 2018;30(1): 121-122. DOI: 10.1111/den.12973.Saito M, Sudo G, Takai S, Yawata A, Nakase H. Direct clipping using underwater inversion method for colonic diverticular bleeding. VideoGIE. 2022; 7(5): 187-189. DOI: 10.1016/j.vgie.2022.01.008.Abiko S, Hirata K, Suzuki K, Kinoshita K, Hatanaka K, Yamamoto Y, Naruse H. Successful direct clipping of the bleeding source of a colonic diverticular hemorrhage using the "long-hood gel-filling" method. Endoscopy. 2023; 55(S 01): E606-E607. DOI: 10.1055/a-2048-6071.Nagata N, Niikura R, Ishii N, Kaise M, Omata F, Tominaga N, Kitagawa T, Ikeya T, Kobayashi K, Furumoto Y, Narasaka T, Iwata E, Sugimoto M, Itoi T, Uemura N, Kawai T. Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: Systematic review and meta-analysis. Journal of Gastroenterology and Hepatology. 2021; 36(7): 1738-1743. DOI: 10.1111/jgh.15370.Witte JT. Band ligation for colonic bleeding: modification of multiband ligating devices for use with a colonoscope. Gastrointestinal Endoscopy. 2000; 52(6): 762-765. DOI: 10.1067/mge.2000.109872.Ishii N, Imamura N. Advancements in endoscopic therapy for colonic diverticular bleeding and tips from public health viewpoints. Digestive Endoscopy. 2024; 36(12): 1367-1368. DOI: 10.1111/den.14883.Yamauchi A, Ishii N, Yamada A, Kobayashi K, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Gunji N, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Mori Y, Osawa K, Nakagami S, Kawai Y, Yoshikawa T, Kaise M, Nagata N. Outcomes and recurrent bleeding risks of detachable snare and band ligation for colonic diverticular bleeding: a multicenter retrospective cohort study. Gastrointestinal Endoscopy. 2023; 98(1): 59-72.e7. DOI: 10.1016/j.gie.2023.02.014.Okamoto N, Tominaga N, Sakata Y, Hara M, Yukimoto T, Tsuruta S, Yamanouchi K, Takeshita E, Matsunaga K, Ito Y, Miyahara K, Noda T, Yamaguchi D, Tsunada S, Tanaka Y, Kawakubo H, Tsuruoka N, Shimoda R, Ogata S, Fujimoto K. Lower Rebleeding Rate after Endoscopic Band Ligation than Endoscopic Clipping of the Same Colonic Diverticular Hemorrhagic Lesion: A Historical Multicenter Trial in Saga, Japan. Internal Medicine. 2019; 58(5): 633-638. DOI: 10.2169/internalmedicine.1473-18.Delaleeuwe I, Aoun J, Reynaert H, Gkolfakis P, Eisendrath P. Early rebleeding rate following endoscopic treatment of colonic diverticular bleeding: a systematic review and meta-analysis. Annals of Gastroenterology. 2025; 38(1): 41-50. DOI: 10.20524/aog.2025.0940.Yamaguchi D, Ishida S, Nomura T, Mizuta Y, Fujimoto S, Tanaka Y, Tsunada S. Endoscopic hemostasis of spurting colonic diverticular bleeding using the combination of self-assembling peptide solution and endoscopic band ligation. Endoscopy. 2023; 55(S 01): E418-E419. DOI: 10.1055/a-2008-0599.Ozawa N, Yamazaki K, Hasebe N, Yamauchi K, Koide K, Murase H, Hayashi S, Hino T, Hirota D, Soga A, Otani K, Masuda N, Taniguchi H, Shimizu S, Shimizu M. Endoscopic band ligation alone and combined with clipping for colonic diverticular bleeding: Retrospective comparative study. Endoscopy International Open. 2025;13: a25367884. DOI: 10.1055/a-2536-7884.Nagayama M, Nakaya S, Sasaki A. Challenges in Managing Rebleeding After Endoscopic Hemostasis With Over-the-Scope Clip for Colonic Diverticular Bleeding: A Case Series. Cureus. 2025; 17(2): e78641. DOI: 10.7759/cureus.78641.Ohashi Y, Sugiyama H, Ideta T, Hino T, Mizutani S, Adachi H, Oshima Y, Shimizu M. Comparison of endoscopic band ligation versus over-the-scope clip for colonic diverticular bleeding: a propensity score-matched cohort analysis. Gastrointestinal Endoscopy. 2025:S0016-5107(25)01914-5. DOI: 10.1016/j.gie.2025.08.013.Yamagishi T, Kashiura M, Shindo Y, Yamanaka K, Tsuboi K, Shinhata H. Effectiveness of endoscopic hemostasis in preventing diverticular bleeding with extravasation detected by contrast-enhanced computed tomography: A single-center retrospective cohort study. Medicine. 2021; 100(8): e24736. DOI: 10.1097/MD.0000000000024736.Sato Y, Yasuda H, Nakamoto Y, Kiyokawa H, Yamashita M, Matsuo Y, Maehata T, Yamamoto H, Mimura H, Itoh F. Risk factors of interventional radiology/surgery for colonic diverticular bleeding. JGH Open. 2021; 5(3): 343-349. DOI: 10.1002/jgh3.12499.Kinoshita M, Kondo H, Hitomi S, Hara T, Zako R, Yamamoto M, Hiraoka J, Takaoka Y, Enomoto H, Matsunaga N, Takechi K, Shirono R, Akagawa Y, Osaki K, Ohnishi N, Tani H. Ultraselective transcatheter arterial embolization with small-sized microcoils for acute lower gastrointestinal bleeding. CVIR Endovascular. 2021; 4(1): 28. DOI: 10.1186/s42155-021-00215-9.Lee HH, Oh JS, Park JM, Chun HJ, Kim TH, Cheung DY, Lee BI, Cho YS, Choi MG. Transcatheter embolization effectively controls acute lower gastrointestinal bleeding without localizing bleeding site prior to angiography. Scandinavian Journal of Gastroenterology. 2018; 53(9): 1089-1096. DOI: 10.1080/00365521.2018.1501512.