Diverticular bleeding: diagnostic and treatment modalities—a narrative review

Introduction

Diverticular bleeding is one of the most common causes of lower gastrointestinal (GI) bleeding in the United States in people over 60 years of age (1). Among hospitalized patients for lower GI bleeding, 30–40% are due to diverticular bleeding (2). Bleeding occurs when a segment of vasa recta artery which penetrates the muscular wall of the colon erodes; the vessel becomes exposed at the diverticulum thereby increasing the vessel’s vulnerability to rupture. The rupture is often spontaneous and not associated with or preceded by inflammation. Bleeding can be massive and abrupt, potentially leading to hemodynamic instability (3). There is a disproportionate impact of this disease process on aging adults. The majority of cases occur in elderly patients who often have comorbidities and limited physiological reserve (2). Annually, the incidence of diverticular bleeding is 0.3–0.6% (4). The prevalence of diverticulosis is 50–60% by age 60 years (2). Among those with diverticulosis, 15–20% will experience bleeding in their life-time (2). Patients who present with colonic diverticular bleeding have a rate of spontaneous hemostasis of 70–90% (2,5,6). Patients who have undergone hospitalization with successful nonoperative treatments have 1-year rebleeding rates of 20–30% and 2-year rebleeding rates 30–40% (5). Risk factors for rebleeding include elderly age, diverticulitis, peripheral vascular disease, and chronic renal disease (7). A study of the National Inpatient Sample data from 2016–2020 demonstrated an in-hospital mortality rate of 0.8% with an increased risk of mortality being associated with age over 85 years, hypovolemic shock, need for blood transfusion, moderate or severe Charlson Comorbidity Index, or need for colon resection (8).

The goal of this article is to review evidence-based management strategies for patients who present with diverticular bleeding. The literature regarding specific treatment and diagnostic modalities is extensive, but individual papers are often focused on treatment provided by a single specialty. The team caring for a patient with diverticular bleeding will involve specialists from a variety of disciplines including emergency medicine, surgery, gastroenterology, radiology, interventional radiology (IR), internal medicine, and critical care. It is important for the treating physicians to have a thorough knowledge of the available diagnostic and treatment modalities available to the patient who presents with diverticular bleeding. An evidence-based multidisciplinary treatment strategy for patients presenting with diverticular bleeding can reduce hospital length of stay, improve detection of the site of bleeding, and reduce the need for surgery in patients hospitalized with diverticular bleeding (9). We present this article in accordance with the Narrative Review reporting checklist (available at https://ales.amegroups.com/article/view/10.21037/ales-25-37/rc).

Methods

A thorough search of relevant studies was performed across major electronic databases, including PubMed, Ovid, MEDLINE, and Google Scholar, to identify English-language articles published up to November 13, 2025. Search terms included combinations of keywords such as “diverticular bleeding”, “lower GI bleed”, “surgery for diverticular bleeding”, “colonoscopic interventions for diverticular bleeding”, and “interventional radiology interventions for diverticular bleeding”. The literature search and study selection process are outlined in Table 1.

Management at initial presentation

The initial management priorities for a patient presenting with a lower GI bleed are stabilization and resuscitation. The goal of initial resuscitation is maintenance of hemodynamic stability via volume expansion, oxygen delivery to the tissues via adequate hemoglobin levels, and sustaining adequate clotting capability. In addition to a physical exam and history, initial laboratory testing should be performed that includes a complete blood count (CBC), international normalized ratio (INR), an electrolyte panel with creatinine and blood urea nitrogen (BUN), liver function tests, and a type and cross match for blood (10,11).

A patient who presents with hemodynamic instability or ongoing bleeding should be initially resuscitated with intravenous fluid (IVF) (11). Resuscitation should include blood products when appropriate. A patient with ongoing bleeding may require resuscitation with red blood cells (RBCs), platelets, and/or plasma (12). Current guidelines for resuscitation recommend a target hemoglobin of 7 g/dL in an average risk patient and a hemoglobin of 8 g/dL in a patient with a history of coronary artery disease (11,13). A thorough history including a complete list of the patient’s current medications will help guide resuscitation requirements. Patients taking direct oral anticoagulants (DOAC) or antiplatelet agents may require the use of pharmacological reversal agents if they have life-threatening bleeding that doesn’t respond to initial resuscitation efforts (11).

After the patient has been stabilized with initial resuscitation efforts, the goal becomes localization of the source of GI bleeding. Various diagnostic modalities including anoscopy/proctoscopy, nasogastric tube (NGT), tagged RBC scan, computed tomography angiography (CTA), colonoscopy, esophagogastroduodenoscopy (EGD), and catheter angiography can be employed.

Management of diverticular bleeding after initial stabilization

Diagnostic and treatment modalities for diverticular bleeding encompass endoscopic interventions, radiographic and angiographic studies, and surgery as outlined in Table 2. These interventions are administered by physicians from different specialties. After initial stabilization of the patient occurs, the treating physicians will need to collaborate to decide what diagnostic and treatment modalities should be performed next. Communication among the physicians rendering care to the patient with a diverticular bleed is crucial. A retrospective study analyzing the implementation of a mandatory conference call upon patient presentation between the treating IR, gastroenterology, and surgical teams demonstrated that a multidisciplinary communication protocol was associated with earlier intervention, fewer packed red blood cell (PRBC) transfusions, shorter hospital length of stay, and fewer readmissions with GI bleeding (14).

The following treatment algorithm (Figure 1) should therefore be considered for treatment of a patient with a GI bleed after initial resuscitation and stabilization by the emergency room staff. Consults should be placed for surgery, gastroenterology, and IR if the treating institution is staffed by members of these specialties. After these consults have been placed, a conference call should occur between members of these specialties (Figure 2) to discuss the next step in treatment and whether additional diagnostic studies are needed before initial treatment decisions can be made. In the setting of ongoing bleeding, further communication between these specialties should occur following unrevealing diagnostic studies or unsuccessful interventions (14).

Figure 1 Diverticular bleeding treatment pathway. CTA, computed tomography angiography; EGD, esophagogastroduodenoscopy; GI, gastrointestinal; IR, interventional radiology; IV, intravenous; MRA, magnetic resonance angiography; PRBC, packed red blood cell; RBC, red blood cell.

Figure 2 Multidisciplinary coordination of care pathway. GI, gastrointestinal; IR, interventional radiology.

Diverticular bleeding: diagnostic modalities

Anoscopy and proctoscopy

It is imperative that patients who present with a GI bleed have a digital rectal exam performed. Anoscopy and proctoscopy may be used to augment digital rectal exam. This is essential to rule out an anorectal source such as a hemorrhoidal bleed which can be potentially treated at the bedside. A study of patients presenting to the emergency room with a GI bleed found that 44.4% of them did not have a rectal exam performed. It was also found that patients who had a digital rectal exam performed were less likely to be admitted to the hospital and were less likely to undergo endoscopy than those who did not have a digital rectal exam performed on presentation (15).

NGT

An upper GI source of bleeding should be excluded in addition to ongoing workup to evaluate for a lower GI source. Modalities to evaluate for an upper GI bleed include NGT lavage or EGD. NGT placement has a sensitivity of 42–84% and a specificity of 54–91% for the detection of an upper GI bleed (16,17). Due to the low sensitivity of NGT placement this intervention has low clinical utility in the management of GI bleeds and does not have to be routinely employed in the workup of a GI bleed.

EGD

EGD is much more sensitive than NGT placement in the exclusion of an upper GI bleed, with a sensitivity of 90–95% at identifying an upper GI source (18). This can be done at the same time as a diagnostic colonoscopy. In the patient who is undergoing a diagnostic colonoscopy for an unlocalized GI bleed, a concurrent EGD should be strongly considered.

Tagged RBC scan

Tagged RBC scanning utilizes technetium-labeled RBC (99mTc) to localize the source of bleeding. RBC labeling requires less than 30 minutes to perform (19). Tagged RBC scanning is able to detect bleeding at a rate of 0.05–0.2 mL/min (20). Scanning can be performed up to 24 hours after RBC labeling has occurred (19). Tagged RBC scanning has the advantage of being able to detect intermittent bleeding, but is not as accurate as other modalities such as CTA with regards to precise localization (21).

CTA

Another initial test to localize a GI bleed is CTA (11,22). Performing a CTA does not require a bowel preparation or sedation. It can therefore be performed rapidly upon presentation to an emergency room after initial resuscitation has been completed. CTA has been found in a meta-analysis to have a sensitivity of 90% and a specificity of 92% in the detection of a lower GI bleed (23). CTA is capable of detecting bleeding at a rate of 0.3 mL/min (20). Compared to tagged RBC scans, CTA is able to be performed more quickly and also provides more precise localization of the bleeding (20). CTA may not detect an intermittent GI bleed and the sensitivity of the test is improved if it is done as quickly as possible after the onset of bleeding (24), with one study finding that sensitivity is improved if it is performed within 4 hours of hematochezia (25).

Magnetic resonance angiography

MRA is an alternative test to detect GI bleed. It is sensitive to slow rates of bleeding and it can detect flow rates as low as 0.05–0.2 mL/min (26). Magnetic resonance pool agent (Gadofosveset trisodium) permits delayed imaging and can detect slower, intermittent bleeds. A repeat imaging performed up to 24 hours after administration is possible. It does not require contrast or radiation exposure which is advantageous for patients who are either allergic to contrast dye or are pregnant (26).

Colonoscopy: role in diagnosis

Colonoscopy is the cornerstone of diagnosis and treatment for most patients presenting with a lower GI bleed. The timing of colonoscopy should be based on patient specific factors such as the severity of the bleeding and the stability of the patient (27). Guidelines from the American Society of Gastrointestinal Endoscopy published in 2014 advocated for colonoscopy to be performed within 8–24 hours of presentation with hematochezia (28). However, subsequent studies demonstrated that colonoscopy performed within 24 hours of presentation does not improve clinical outcomes in patients who have diverticular bleeding (29), but does shorten the hospital length of stay (8). The current guidelines from the American College of Gastroenterology do not stipulate that a colonoscopy should be performed for all patients within 24 hours of presentation (11). However, patients who present with hemodynamic instability or active extravasation on CTA should be considered for colonoscopy within 24 hours of presentation (27). When colonoscopy is performed, a source of hemorrhage cannot be found in 58–69% of cases, but detection can be improved by cap assisted colonoscopy or water immersion colonoscopy (27). In cases where a GI bleed is diverticular in origin, the rate of identification of the diverticulum from which the bleeding is emanating is 15–25% (30).

Diverticular bleeding: therapeutic interventions

Colonoscopy

There have been significant advances in the use of endoscopy to not only localize but also to treat diverticular bleeding. In cases where a source of bleeding has been identified endoscopically, colonoscopic interventions are preferable to interventions by both surgery and IR. Patients who undergo colonoscopic interventions have been demonstrated to have fewer intensive care unit (ICU) days, a shorter hospital length of stay, and fewer postoperative complications than patients who undergo surgery or embolization (31). Interventions available at the time of colonoscopy include injection of epinephrine, thermal coagulation, endoscopic clipping, endoscopic band ligation (EBL), and over the scope clips (OTSC) (27,32). These various interventions have not been compared to one another with prospective randomized studies (33).

Colonoscopy: epinephrine injection:

Epinephrine injection (1:10,000) promotes hemostasis through vasoconstrictive effects and local tamponade (30,34). Epinephrine injection is mostly used in combination with other techniques such as clipping or thermal coagulation rather than in isolation (5,34). Epinephrine injection performed in isolation, without other interventions such as clipping or thermal coagulation, is very likely to produce temporary hemostasis with high likelihood of rebleed (5). A study of patients with diverticular bleeding comparing clipping as monotherapy to clipping combined with epinephrine injection found that combination therapy resulted in higher rates of immediate hemostasis. However, combination therapy provided no benefit with regards to rebleeding risk and avoidance of surgery, insinuating that benefits of epinephrine injection are temporary (34).

Colonoscopy: thermal coagulation

Thermal coagulation therapies, such as heater probe therapy and bipolar coagulation, have been utilized for hemostasis in diverticular bleeding. Thermal coagulation therapy can be complicated by colonic perforation owing to the thermal effects on the thin wall of the treated diverticulum (30). Thermal coagulation has a reported average hemostasis rate of 97%. Average rebleeding rates are 24% with need for surgery or radiographic interventions of 12% (5).

Colonoscopy: endoscopic clipping

Endoscopic clipping is often used in combination with epinephrine injection. There are direct and indirect methods of applying endoscopic clips. In the direct method, the clip is applied directly on the bleeding vessel, whereas in the indirect method the opening to the bleeding diverticulum is closed with clips thereby providing tamponade (5). A recent meta-analysis of 1,435 patients with diverticular bleeding demonstrated a rebleeding rate of 12.04% in patients who underwent direct clipping compared to a rebleeding rate of 27.74% in those who underwent indirect clipping (33).

Colonoscopy: EBL

While there are multiple methods to attempt to obtain endoscopic hemostasis, EBL is a promising therapy. A recent multicenter cohort study comparing EBL to endoscopic clipping demonstrated early hemostasis rates of 95–98% for both techniques. However, EBL demonstrated superiority to endoscopic clipping with regard to early and late recurrent bleeding rates, hospital length of stay, and also demonstrated a reduction in the need for surgery, repeat endoscopy, or angiographic embolization (35). A meta-analysis of 1,435 patients comparing EBL to endoscopic clipping, demonstrated a 9.83% rate of rebleeding for EBL compared to an overall rate of rebleeding of 22.32% in the endoscopic clipping group (33).

Colonoscopy: OTSCs

OTSCs represent an additional endoscopic therapy for diverticular bleeding that may be utilized in select cases. Case series using this technique are smaller and data comparing this technique to other techniques such as EBL are limited (32). A study of 36 patients who underwent OTSC for diverticular bleed who either re-bled following EBL or who could not have EBL performed due to the anatomy of the diverticular bleed demonstrated a success rate of 100% for early control of bleeding. Re-bleeding rates were reported to be 8.3%, and no patients required arteriographic embolization or surgery in this series (36). A more recent study of patients who underwent EBL (231 patients) or OTSC (72 patients) demonstrated initial hemostasis rates of 99.1% for EBL and 100% for OTSC. The 30-day rebleeding rate of 2.8% with OTSC was significantly lower than the 10.9% rate associated with EBL. In addition, the length of hospital stay was shorter following OTSC than with EBL (37). Because the OTSC has to be loaded onto the end of the scope before it is advanced to the site of bleeding, it carries the risk of traumatizing or perforating the colon as it is advanced to the site of bleeding. Other complications reported with use of an OTSC include luminal stenosis, perforation at the site of application, and damage to adjacent organs such as the ureter or small bowel. Disadvantages associated with the use of an OTSC are the added time of the procedure compared to other techniques as well as the additional cost which is reported to be 6–7× that of other endoscopic treatment modalities (32). Because of these factors, OTSC as a therapy for diverticular bleeding is generally reserved for patients in whom EBL is either not possible or has failed.

Catheter-based angiography: role in diagnosis and treatment

Catheter-based angiography is not usually performed as an initial diagnostic modality for a GI bleed given the sensitivity and less invasive nature of CTA. When performed, conventional catheter-based angiography is capable of detecting bleeding rates of 0.5 to 1.0 mL/min (38). Patients should not have received any oral contrast agent before the angiography.

Catheter-based angiography with embolization is a valuable tool for treating a patient with a diverticular bleed. Indications for catheter-based angiography and embolization include a positive CTA, a GI bleed that has not been controlled with endoscopic interventions, and a patient requiring intervention that has not been able to achieve adequate bowel preparation to have a colonoscopy (22). The more quickly a catheter-based angiography is performed following a positive CTA, the more successful the catheter-based angiography will be at detection and treatment of a lower GI bleed (39,40). If a catheter-based angiography with embolization is planned following a positive CTA, this should therefore be expedited to facilitate success of the procedure (11). If the bleeding site is detected, transcatheter therapy with intraarterial infusion or preferably embolization can be performed. The site can also be injected with Methylene blue for the surgeon in case surgery is needed. When a site of lower GI bleeding is identified on catheter-based angiography and the site is embolized, success rates for control of bleeding are reported to be 97.8–100% with a 30-day rebleeding rate of 3.4–15.7% (41-43). The risk of complications ranges from 6.1–13.0% (41,42). The most common complication associated with this therapy is bowel infarction or ulcer formation (42).

Surgical intervention for diverticular bleeding

In the past, 10–25% of patients required surgery to control diverticular bleeding (44). However, more recent studies demonstrate lower rates of surgical intervention as diagnostic and treatment modalities evolve. A study of the National Inpatient Sample data from 2016–2020 demonstrated a rate of surgical intervention of 7.0% for patients hospitalized with a diverticular bleed. In this study, age >85 years, arterial embolization, female sex, and long-term antiplatelet or anticoagulation use were associated with a lower chance of requiring surgery (8). A Japanese study of trends in the treatment of diverticular bleeding from 2010–2019 demonstrated that the rates of surgical intervention decreased from 7% in 2010 to 3% in 2019. This corresponded to an increased use of computed tomography scan compared to colonoscopy as the initial diagnostic modality, increased use of EBL compared to endoscopic clipping when a therapeutic colonoscopy was performed, and increased use of distal colonoscopy attachments and water jet scopes (9).

There are several indications for surgery in the patient with bleeding attributed to diverticulosis. The first indication is ongoing bleeding after exhausting options for endoscopic or angiographic interventions. A second indication for surgery is ongoing hemodynamic instability despite adequate resuscitation. Third, patients who have active bleeding with transfusion requirements of 6 units or more of PRBCs in 24 hours should be considered for surgical intervention (38,44). A final indication for surgery is the treatment of complications of preceding IR or GI interventions such as colonoscopic perforation or colonic ischemia. Surgery to treat such complications is needed in 2–13% of patients who undergo these interventions for a lower GI bleed (45).

Surgical options for management of a diverticular bleed include either a segmental colectomy or a subtotal colectomy. Every possible effort to localize the site of bleeding should be made prior to embarking on a surgical procedure if the patient remains hemodynamically stable. If a patient has hemodynamic instability or malnutrition, the resection should be combined with an ostomy to minimize the risk of anastomotic leak. A patient who has not had preoperative localization of the site of bleeding should undergo a subtotal colectomy. If preoperative localization of the bleeding site has been done with either colonoscopy or radiographic imaging, a segmental colectomy can be offered to the patient. However, there is a risk of rebleeding ranging from 0–14% when segmental resections are performed (22,45). Whenever possible, localization of the bleeding should be performed to facilitate a segmental colectomy as patients who undergo a subtotal colectomy carry a higher risk of cardiac complications, renal complications (11), and death (46).

Patients who undergo surgery for a lower GI bleed have higher morbidity and mortality than those who undergo successful nonsurgical interventions. A National Surgery Quality Improvement Program (NSQIP) database study of 1,614 patients undergoing surgery for a lower GI bleed reported a 30-day mortality of 12.2%. Factors predictive of mortality at the time of surgery included increased age, more comorbidities, increased INR, decreased hemoglobin, increased American Society of Anesthesiologists (ASA) class, systemic inflammatory response syndrome, open surgery, and total/subtotal colectomy (46). When it becomes apparent that a surgical intervention is needed, it is important that the surgery be performed before further patient deterioration occurs so that the best possible outcome for that patient is obtained.

Conclusions

Diverticulosis is a common cause of GI bleeding. There are few prospective, randomized studies comparing the various treatment modalities available for the management of the patient with diverticular bleeding, presenting an opportunity for future research investigations. Collaboration between IR, gastroenterology, and surgical teams treating the patient is associated with improved outcomes. Expedited access to these interventions improves patient outcomes. Patients who continue to have clinically significant bleeding after exhausting management options by IR and gastroenterology should be considered for surgical intervention. Localization of the source of bleeding prior to surgical interventions is a priority. A segmental resection can be considered in a patient in whom the bleeding source has confidently been localized, but otherwise patients should be treated with a subtotal colectomy.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://ales.amegroups.com/article/view/10.21037/ales-25-37/rc

Peer Review File: Available at https://ales.amegroups.com/article/view/10.21037/ales-25-37/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://ales.amegroups.com/article/view/10.21037/ales-25-37/coif). The authors have no conflicts of interest to declare.

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References

1. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 2012;143:1179-1187.e3. [Crossref] [PubMed]
2. Hreinsson JP, Gumundsson S, Kalaitzakis E, et al. Lower gastrointestinal bleeding: incidence, etiology, and outcomes in a population-based setting. Eur J Gastroenterol Hepatol 2013;25:37-43. [Crossref] [PubMed]
3. Wedel T, Böttner M. Anatomy and pathogenesis of diverticular disease. Chirurg 2014;85:281-8. [Crossref] [PubMed]
4. Segev L, Ozuner G. Natural history of bleeding risk in colonic diverticulosis. Minerva Gastroenterol Dietol 2017;63:152-7. [Crossref] [PubMed]
5. Kaise M, Nagata N, Ishii N, et al. Epidemiology of colonic diverticula and recent advances in the management of colonic diverticular bleeding. Dig Endosc 2020;32:240-50. [Crossref] [PubMed]
6. Ichita C, Kishino T, Aoki T, et al. Updated evidence on epidemiology, diagnosis, and treatment for colonic diverticular bleeding. DEN Open 2026;6:e70122. [Crossref] [PubMed]
7. Aytac E, Stocchi L, Gorgun E, et al. Risk of recurrence and long-term outcomes after colonic diverticular bleeding. Int J Colorectal Dis 2014;29:373-8. [Crossref] [PubMed]
8. Patel P, Siraw BB, Mehadi AY, et al. Predictors of in-hospital outcomes for diverticular bleeding patients: a retrospective analysis of National Inpatient Sample data (2016-2020). Ann Gastroenterol 2024;37:449-57. [Crossref] [PubMed]
9. Narimatsu K, Ishii N, Yamada A, et al. Impact of long-term trends on outcomes in the management of colonic diverticular bleeding: mediation analyses in a large multicenter study. J Gastroenterol 2025;60:174-86. [Crossref] [PubMed]
10. Triantafyllou K, Gkolfakis P, Gralnek IM, et al. Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021;53:850-68. [Crossref] [PubMed]
11. Sengupta N, Feuerstein JD, Jairath V, et al. Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline. Am J Gastroenterol 2023;118:208-31. [Crossref] [PubMed]
12. Strate LL, Gralnek IM. ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol 2016;111:459-74. [Crossref] [PubMed]
13. Carson JL, Guyatt G, Heddle NM, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA 2016;316:2025-35. [Crossref] [PubMed]
14. Loftus TJ, Go KL, Hughes SJ, et al. Improved outcomes following implementation of an acute gastrointestinal bleeding multidisciplinary protocol. J Trauma Acute Care Surg 2017;83:41-6. [Crossref] [PubMed]
15. Shrestha MP, Borgstrom M, Trowers E. Digital Rectal Examination Reduces Hospital Admissions, Endoscopies, and Medical Therapy in Patients with Acute Gastrointestinal Bleeding. Am J Med 2017;130:819-25. [Crossref] [PubMed]
16. Witting MD, Magder L, Heins AE, et al. Usefulness and validity of diagnostic nasogastric aspiration in patients without hematemesis. Ann Emerg Med 2004;43:525-32. [Crossref] [PubMed]
17. Palamidessi N, Sinert R, Falzon L, et al. Nasogastric aspiration and lavage in emergency department patients with hematochezia or melena without hematemesis. Acad Emerg Med 2010;17:126-32. [Crossref] [PubMed]
18. Alzoubaidi D, Lovat LB, Haidry R. Management of non-variceal upper gastrointestinal bleeding: where are we in 2018? Frontline Gastroenterol 2019;10:35-42. [Crossref] [PubMed]
19. McDonald MA, Ziessman HA. Gastrointestinal bleeding scintigraphy. Appl Radiol 2016;19-22.
20. Grady E. Gastrointestinal Bleeding Scintigraphy in the Early 21st Century. J Nucl Med 2016;57:252-9. [Crossref] [PubMed]
21. Feuerstein JD, Ketwaroo G, Tewani SK, et al. Localizing Acute Lower Gastrointestinal Hemorrhage: CT Angiography Versus Tagged RBC Scintigraphy. AJR Am J Roentgenol 2016;207:578-84. [Crossref] [PubMed]
22. Elimeleh Y, Gralnek IM. Diagnosis and management of acute lower gastrointestinal bleeding. Curr Opin Gastroenterol 2024;40:34-42. [Crossref] [PubMed]
23. He B, Yang J, Xiao J, et al. Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: A meta-analysis. Eur J Radiol 2017;93:40-5. [Crossref] [PubMed]
24. Wortman JR, Landman W, Fulwadhva UP, et al. CT angiography for acute gastrointestinal bleeding: what the radiologist needs to know. Br J Radiol 2017;90:20170076. [Crossref] [PubMed]
25. Umezawa S, Nagata N, Arimoto J, et al. Contrast-enhanced CT for Colonic Diverticular Bleeding before Colonoscopy: A Prospective Multicenter Study. Radiology 2018;288:755-61. [Crossref] [PubMed]
26. Hanna RF, Browne WF, Khanna LG, et al. Gadofosveset trisodium-enhanced MR angiography for detection of lower gastrointestinal bleeding. Clin Imaging 2015;39:1052-5. [Crossref] [PubMed]
27. Shiratori Y, Kodilinye SM, Salem AE. Advances in endoscopic management of colonic diverticular bleeding. Curr Opin Gastroenterol 2024;40:363-8. [Crossref] [PubMed]
28. Pasha SF, Shergill A, et al. The role of endoscopy in the patient with lower GI bleeding. Gastrointest Endosc 2014;79:875-85. [Crossref] [PubMed]
29. Ichita C, Nakajima M, Ohbe H, et al. Effectiveness of early colonoscopy in patients with colonic diverticular hemorrhage: Nationwide inpatient analysis in Japan. Dig Endosc 2023;35:520-8. [Crossref] [PubMed]
30. Kato M. Endoscopic Therapy for Acute Diverticular Bleeding. Clin Endosc 2019;52:419-25. [Crossref] [PubMed]
31. Wangrattanapranee P, Jensen DM, Khrucharoen U, et al. Patient Outcomes of Definitive Diverticular Hemorrhage After Colonoscopic, Medical, Surgical, or Embolization Treatment. Dig Dis Sci 2024;69:538-51. [Crossref] [PubMed]
32. Sebastian SA, Co EL, Panthangi V, et al. Colonic diverticular bleeding: An update on pathogenesis and management. Dis Mon 2023;69:101543. [Crossref] [PubMed]
33. Delaleeuwe I, Aoun J, Reynaert H, et al. Early rebleeding rate following endoscopic treatment of colonic diverticular bleeding: a systematic review and meta-analysis. Ann Gastroenterol 2025;38:41-50. [Crossref] [PubMed]
34. Hamada S, Teramoto A, Zukeyama R, et al. Efficacy of Combination Therapy with Epinephrine Local Injection and Hemostatic Clips on Active Diverticular Bleeding. J Clin Med 2022;11:5195. [Crossref] [PubMed]
35. Kobayashi K, Nagata N, Furumoto Y, et al. Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: a large-scale multicenter cohort study. Endoscopy 2022;54:735-44. [Crossref] [PubMed]
36. Kawano K, Takenaka M, Kawano R, et al. Efficacy of Over-The-Scope Clip Method as a Novel Hemostatic Therapy for Colonic Diverticular Bleeding. J Clin Med 2021;10:2891. [Crossref] [PubMed]
37. Ohashi Y, Sugiyama H, Ideta T, et al. Comparison of endoscopic band ligation versus over-the-scope clip for colonic diverticular bleeding: a propensity score-matched cohort analysis. Gastrointest Endosc 2025; Epub ahead of print. [Crossref]
38. Mohammed Ilyas MI, Szilagy EJ. Management of Diverticular Bleeding: Evaluation, Stabilization, Intervention, and Recurrence of Bleeding and Indications for Resection after Control of Bleeding. Clin Colon Rectal Surg 2018;31:243-50. [Crossref] [PubMed]
39. Koh FH, Soong J, Lieske B, et al. Does the timing of an invasive mesenteric angiography following a positive CT mesenteric angiography make a difference? Int J Colorectal Dis 2015;30:57-61. [Crossref] [PubMed]
40. Bruce G, Erskine B. Analysis of time delay between computed tomography and digital subtraction angiography on the technical success of interventional embolisation for treatment of lower gastrointestinal bleeding. J Med Radiat Sci 2020;67:64-71. [Crossref] [PubMed]
41. Chevallier O, Comby PO, Guillen K, et al. Efficacy, safety and outcomes of transcatheter arterial embolization with N-butyl cyanoacrylate glue for non-variceal gastrointestinal bleeding: A systematic review and meta-analysis. Diagn Interv Imaging 2021;102:479-87. [Crossref] [PubMed]
42. Kim PH, Tsauo J, Shin JH, et al. Transcatheter Arterial Embolization of Gastrointestinal Bleeding with N-Butyl Cyanoacrylate: A Systematic Review and Meta-Analysis of Safety and Efficacy. J Vasc Interv Radiol 2017;28:522-531.e5. [Crossref] [PubMed]
43. Kitamura R, Higashiura W, Katsura M, et al. Transcatheter Arterial Embolization for Colonic Diverticular Bleeding: Outcomes and Risk Factors for Rebleeding. J Vasc Interv Radiol 2025;36:1983-90. [Crossref] [PubMed]
44. Feinman M, Haut ER. Lower gastrointestinal bleeding. Surg Clin North Am 2014;94:55-63. [Crossref] [PubMed]
45. Omori J, Kaise M, Nagata N, et al. Characteristics, outcomes, and risk factors of surgery for acute lower gastrointestinal bleeding: nationwide cohort study of 10,342 hematochezia cases. J Gastroenterol 2024;59:24-33. [Crossref] [PubMed]
46. Sue-Chue-Lam C, Castelo M, Baxter NN. Factors Associated With Mortality After Emergency Colectomy for Acute Lower Gastrointestinal Bleeding. JAMA Surg 2020;155:165-7. [Crossref] [PubMed]