Post written by Kenji Yamazaki, MD, PhD, from the Department of Gastroenterology, Gifu Prefectural General Medical Center, Gifu, Japan.

We describe a case of an 86-year-old woman with a history of hypertension and colonic diverticular bleeding (CDB) who presented with severe hematochezia to a nearby medical institution. Emergency colonoscopy revealed an active diverticular hemorrhage in the sigmoid colon. An endoclip was placed on the responsible diverticulum, but active bleeding persisted. She was then referred to the emergency department of our hospital. Initially, we decided to proceed with endoscopic band ligation (EBL). We attempted to suction the diverticulum with the ligation device; however, we were unable to sufficiently perform it due to the firmness of the diverticulum and could not ligate the diverticulum. Subsequently, we decided to use an over-the-scope clip (OTSC). The clip was applied, leading to immediate bleeding cessation. The patient’s further course was uneventful.

Although several reports found that EBL had better results than endoscopic clipping, EBL cannot be performed in all patients. If the diverticulum is firm, sufficient suction may not be obtained, and EBL treatment may fail. When using the OTSC, the diverticulum involved should be sufficiently suctioned and inverted. Furthermore, even if the aspiration is not sufficient, as in our case, the treatment can be completed using OTSC because the sawtooth-like clip in the OTSC system will spring forward when released. On the other hand, the OTSC system is very expensive compared with EBL (The prices of EBL and OTSC system are 10,000 yen/kit and 79,800 yen/set, respectively, in Japan!); therefore, if a responsible diverticulum is sufficiently suctioned, we should first perform hemostasis with EBL before using OTSC from a cost viewpoint.

This report demonstrates that the OTSC system can effectively treat CDB if EBL cannot be performed due to a firm diverticulum that cannot be sufficiently suctioned.

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