P0732 - Endoscopic Direct Clipping vs Indirect Clipping for Colonic Diverticular Bleeding: A Systematic Review and Meta-Analysis

Aamir Saeed, MD¹, Saira Yousuf, MD¹, Muhammad Hayat, MD¹, Marjan Haider, MD², Preeyati Chopra, MD³, Maham Tariq, MD⁴, Maitree Patel, MD⁵, Manesh Kumar Gangwani, MD⁶, Muhammad Aziz, MD⁷, Umar Hayat, MD⁸, Umer Farooq, MD⁹, Faisal Kamal, MD^10
1Vanderbilt University Medical Center, Nashville, TN; ²Trinity Health Ann Arbor Hospital, Ann Arbor, MI; ³Medical College, Patiala, Punjab, India; ⁴Services Institute of Medical Sciences, Lahore, Punjab, Pakistan; ⁵Palmetto General Hospital, Hialeah, FL; ⁶University of Toledo, Toledo, OH; ⁷Bon Secours Mercy, Toledo, OH; ⁸Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; ⁹SSM Health Saint Louis University Hospital, St. Louis, MO; ¹⁰Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA

Introduction: Acute colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding (LGIB). Various endoscopic treatments for diverticular bleeding include endoscopic band ligation (EBL), endoscopic clipping (EC), and detachable snare ligation therapy. EBL is associated with a lower risk of early rebleeding; however, adverse events have been reported with this therapy. Endoscopic clipping has an advantage over other therapies due to less damage to adjacent tissue however there is paucity of data regarding its efficacy and safety. We conducted a systematic review and meta-analysis to compare the outcomes of endoscopic direct and indirect clipping in colonic diverticular bleeding.

Methods: Several databases were reviewed to identify studies comparing outcomes of endoscopic direct clipping and indirect clipping in patients with LGIB due to diverticulosis from inception to April 30^th, 2024. The databases searched included PubMed, Web of Science Core Collection, Embase, and the Cochrane Database of Systematic Reviews. Our outcomes of interest were early rebleeding, late rebleeding, and initial hemostasis, blood transfusion rate, and hospital stay > 7 days. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for all dichotomous variables and mean difference with 95% CI for continuous variables. Data was analyzed using Mantel-Haenszel random effect model. Heterogeneity was assessed using the I² statistic.

Results: Six studies comprising 1321 patients (Direct clipping 453 and Indirect clipping 868) met the inclusion criteria. We found that, endoscopic direct clipping was associated with a significantly lower risk of early rebleeding compared to endoscopic indirect clipping, RR (95% CI): 0.64 (0.52, 0.80). (Figure 1A). There was no significant difference in rate of initial hemostasis between groups, RR (95% CI): 1.01 (0.99, 1.04), p=0.24 (Figure 1B). We also found no significant difference rate of rebleeding between groups, RR (95% CI): 0.85 (0.72, 1.01), p=0.06. We also found no significant difference in other outcomes between groups, such as rate of blood transfusion; RR (95% CI): 0.93 (0.56, 1.52), p=0.77, and the hospital stay > 7 days; RR (95% CI): 0.97 (0.88, 1.07), p=0.51.

Discussion: Our meta-analysis demonstrates the superiority of endoscopic direct clipping over indirect clipping in reducing the risk of early rebleeding in patients with LGIB associated with diverticulosis. We found no significant difference in other outcomes between groups.



Disclosures:


Aamir Saeed, MD¹, Saira Yousuf, MD¹, Muhammad Hayat, MD¹, Marjan Haider, MD², Preeyati Chopra, MD³, Maham Tariq, MD⁴, Maitree Patel, MD⁵, Manesh Kumar Gangwani, MD⁶, Muhammad Aziz, MD⁷, Umar Hayat, MD⁸, Umer Farooq, MD⁹, Faisal Kamal, MD¹⁰. P0732 - Endoscopic Direct Clipping vs Indirect Clipping for Colonic Diverticular Bleeding: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.