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Prophylactic Elective Clipping of Colonic Diverticula

This study is currently recruiting participants.
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Verified April 2016 by King's College Hospital NHS Trust
Information provided by (Responsible Party):
King's College Hospital NHS Trust Identifier:
First received: March 20, 2014
Last updated: April 7, 2016
Last verified: April 2016

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 mid1990s. Patients selected would have had previous colonoscopy to exclude other causes of bleeding (e.g. angiodysplasia, colorectal cancer).

The investigators 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. The investigators would later reevaluate patients for colonoscopic appearance of diverticula to assess their diverticular disease.

The investigators hypothesize that patients undergoing endoscopic diverticular clipping will not have repeat episodes of bleeding.

Condition Intervention
Diverticular Disease Procedure: Endoscopic clipping of diverticula Procedure: Follow-up colonoscopy

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Prophylactic Elective Clipping of Colonic Diverticula in Patients Who Have Had Sustained Lower Gastrointestinal Haemorrhage

Resource links provided by NLM:

Further study details as provided by King's College Hospital NHS Trust:

Primary Outcome Measures:
  • The primary outcome will be episodes of recurrent bleeding requiring hospitalization. [ Time Frame: 12 months ]
    Postprocedure, patients will follow-up every 6 months either in Diverticular Disease clinic or via telephone checkup. These visits will ascertain whether patients have had recurrent bleeding episodes.

Estimated Enrollment: 24
Study Start Date: March 2016
Estimated Study Completion Date: May 2018
Estimated Primary Completion Date: May 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Endoscopic clipping of diverticula
Endoscopic clipping of diverticula Follow-up colonoscopy
Procedure: Endoscopic clipping of diverticula
Colonoscopy with identification of each individual colonic diverticula and endoscopic clipping.
Procedure: Follow-up colonoscopy
Patients will undergo a repeat colonoscopy 6 months after endoscopic clipping procedure.

  Show Detailed Description


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patients will be included if they have been hospitalized at least once with diverticular bleeding.

Exclusion Criteria:

  • Patients who had a definitive procedure to stop diverticular bleeding, including colectomy or angiography with embolization.
  • Patients who are considered too high risk for colonoscopy or bowel preparation. There will be no exclusion criteria based on age. Rather, patients will be individually evaluated and judged for frailty.
  • Patients on anticoagulant agents that may not be stopped for colonoscopy.
  • Patients without colonic diverticula
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT02094456

Contact: Charlotte Kvasnovsky, MD, MPH +44(0)7539 078 406
Contact: Amyn Haji, MSc MD FRCS +44(0)7970 292 532

United Kingdom
King's College Hospital Recruiting
London, United Kingdom, SE5 9RS
Principal Investigator: Amyn Haji, MSc MD FRCS         
Sponsors and Collaborators
King's College Hospital NHS Trust
Principal Investigator: Amyn Haji, MSc MD FRCS King's College Hospital NHS Trust
Study Director: Charlotte Kvasnovsky, MD MPH King's College Hospital NHS Trust
  More Information

Responsible Party: King's College Hospital NHS Trust Identifier: NCT02094456     History of Changes
Other Study ID Numbers: 14/LO/0032
Study First Received: March 20, 2014
Last Updated: April 7, 2016

Keywords provided by King's College Hospital NHS Trust:
diverticular disease
diverticular bleeding
endoscopic clipping
lower gastrointestinal bleeding

Additional relevant MeSH terms:
Diverticulum, Colon
Gastrointestinal Hemorrhage
Diverticulosis, Colonic
Gastrointestinal Diseases
Digestive System Diseases
Pathologic Processes
Pathological Conditions, Anatomical
Colonic Diseases
Intestinal Diseases processed this record on August 18, 2017