Prophylactic Elective Clipping of Colonic Diverticula
Research type
Research Study
Full title
Prophylactic elective clipping of colonic diverticula in patients who have had sustained lower gastrointestinal haemorrhage
IRAS ID
135192
Contact name
Amyn Haji
Contact email
Sponsor organisation
King's College Hospital
Research summary
Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding (LGIB) in Western populations. Although self-limited in 85% of cases, some patients may require hospitalization with blood transfusion and emergent intervention, with significant associated morbidity and mortality. Up to 25% of patients with an initial bleeding episode will have subsequent episodes.
Diverticula form at weak points along the colon wall, where the vasa recta enter the circular muscle layer of the colon. Diverticular bleeding is attributed to thinning of the blood vessels as they cross over the dome of a diverticulum. Endoscopic clipping of actively bleeding colonic diverticula has been recognized as a safe and effective treatment for acute LGIB since the mid-1990s. Patients selected would have had previous colonoscopy to exclude other causes of bleeding (e.g. angiodysplasia, colorectal cancer).
We propose prophylactic elective endoscopic diverticular clipping in patients who have had at least 1 episode of acute LGIB requiring hospitalization. This would involve applying endoscopic clips to the base of every diverticula in a patient’s colon, such that any bleeding source would effectively be excluded. We would later re-evaluate patients for colonoscopic appearance of diverticula to assess their diverticular disease.
REC name
London - Chelsea Research Ethics Committee
REC reference
14/LO/0032
Date of REC Opinion
25 Apr 2014
REC opinion
Further Information Favourable Opinion