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

Objectives Colonic 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 the management of CDB. Methods We retrospectively analyzed 217 patients with suspected CDB treated at our institution between January 2017 and December 2024. Clinical outcomes, including 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 clip closure to reinforce hemostasis and minimize the risk of perforation. Results Of these, 202 patients underwent colonoscopic evaluation (15 were excluded due to spontaneous hemostasis or other reasons before endoscopy), 74 (36.6%) underwent ECC. Rebleeding occurred in 7 patients (9.5%) within 30 days. Diverticulitis with subsequent colonic perforation was observed in one patient (1.4%), who recovered with conservative treatment. No fatal adverse events were observed. Conclusions ECC demonstrated a favorable safety profile and a low rebleeding rate, suggesting that it is a viable treatment option for CDB. Its simplicity and minimal reliance on specialized equipment make it a practical and accessible alternative to other hemostatic methods in clinical practice.