This study aimed to investigate the risk factors for difficult
endoscopic hemostasis in patients with colonic
diverticular bleeding and to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for colonic
diverticular bleeding. This study included 208 patients with colorectal diverticular
hemorrhage. The non-interventional
radiotherapy group consisted of patients who underwent successful spontaneous hemostasis (n = 131) or
endoscopic hemostasis (n = 56), whereas the interventional
radiotherapy group consisted of patients who underwent TAE (n = 21). Patient clinical characteristics were compared to identify independent risk factors for the interventional
radiotherapy group. Furthermore, the hemostasis success rate, rebleeding rate, complications, and recurrence-free survival were compared between patients who underwent
endoscopic hemostasis and those who underwent TAE.
Bleeding from the right colon (odds ratio [OR]: 7.86; 95% confidence interval [CI]: 1.6-38.8; P = .0113) and systolic blood pressure <80 mm Hg (OR: 0.108; 95% CI: 0.0189-0.62; P = .0126) were identified as independent risk factors for the interventional radiology group. The hemostasis success rate (P = 1.00), early rebleeding rate (within 30 days) (P = .736), late rebleeding rate (P = 1.00), and recurrence-free survival rate (P = .717) were not significantly different between the patients who underwent TAE and those who underwent
endoscopic hemostasis. Patients in the TAE group experienced more complications than those in the
endoscopic hemostasis group (P < .001). Complications included mild intestinal
ischemia (19.0%) and perforation requiring surgery (4.8%). Patients who required interventional
radiotherapy were more likely to bleed from the right colon and presented with a systolic blood pressure of <80 mm Hg. TAE is an effective treatment for patients with colonic diverticular
hemorrhage that is refractory to
endoscopic hemostasis. However, complications must be monitored carefully.