Endoscopic Coagulation with Clipping for Colonic Diverticular Bleeding: A Practical Hemostatic Strategy

Background and study aims Endoscopic management of colonic diverticular bleeding remains challenging. Endoscopic coagulation with clipping (ECC) has been performed at our institution, but real-world outcome data remain limited. We aimed to describe the clinical outcomes and safety of ECC. Patients and methods We conducted a single-center retrospective case series of consecutive patients with colonic diverticular bleeding who underwent ECC for endoscopically confirmed diverticular bleeding between January 2017 and December 2025. Rebleeding was defined as clinically significant recurrent hematochezia within 30 days after initial hemostasis. Rebleeding rates and procedure-related adverse events were evaluated. Results Among 256 patients presenting with hematochezia and clinically suspected diverticular bleeding, 238 underwent colonoscopy. Of these, 83 patients who underwent ECC for endoscopically confirmed diverticular bleeding were included in the analysis. Rebleeding within 30 days occurred in 7 patients (8.4%), including 6 cases within 7 days. Among the 83 patients treated with ECC, stigmata of recent hemorrhage were identified in 81 patients. Among these, rebleeding occurred in 3 of 54 patients (5.6%) with active bleeding and in 4 of 27 patients (14.8%) with non-bleeding visible vessels or adherent clots. Procedure-related adverse events were observed in 3 patients (3.6%), all managed conservatively. Conclusions In this single-center case series, ECC was associated with a low rebleeding rate in this cohort. ECC may represent a practical hemostatic option when the bleeding diverticulum is clearly identified.