Colonic diverticular hemorrhage: Etiology, diagnostic challenges, and evolving therapeutic strategies

Table 1 Comparison of endoscopic hemostatic modalities for colonic diverticular hemorrhage

Modality	Initial hemostasis rate, %	Early rebleeding rate (≤ 30 days), %	Late rebleeding rate (> 30 days), %	Typical complications	Key advantages	Limitations/optimal indications
Endoscopic clipping	90-98	15-25	20-35	Rare perforation (< 1%), clip dislodgement	Simple, short procedure time; widely available	Limited durability; higher rebleeding in right-sided lesions or deep diverticula
Endoscopic band ligation	95-100	5-10	8-15	Ulcer formation (< 2%), transient pain	Superior long-term hemostasis; low recurrence; effective for right-sided bleeding	Technically difficult in narrow lumen; risk of post-ligation ulcer
Endoscopic detachable snare ligation	94-100	5-12	10-18	Rare perforation; mild post-procedure discomfort	Combines advantages of clipping + ligation; low recurrence	Requires specialized device; longer setup time
Over-the-scope clip	92-100	0-8	< 10 (limited data)	Local mucosal tear (< 1%), transient pain	Strong closure force; effective rescue for refractory bleeding	Higher cost; limited availability; bulky cap limits use in tortuous colon