S1343 To Treat or Not to Treat? A Meta-Analysis of Endoscopic Treatment vs Conservative Management of Diverticular Bleeding

Introduction: Colonoscopy is the diagnostic test of choice for patients admitted with lower gastrointestinal bleeding (GIB). Therapy options in the setting of diverticular bleeding include through the scope endoscopic clips, injection, banding, and coagulation. Although intervention is recommended by current guidelines, there is evidence that the therapy may not prevent re-bleeding events. This systematic review and meta-analysis aims to analyze short and long term outcome differences between conservative management and endoscopic treatment of diverticular bleeding. Methods: We searched PubMed, Embase, Cochrane, and Google Scholar from inception until May 2025 for studies comparing short and long term outcomes of endoscopic treatment versus conservative management of diverticular bleeds. Our pooled data was analyzed for early rebleeding defined as rebleeding within 30 days of hospitalization and late rebleeding defined as recurrence of diverticular bleeding beyond 30 days of hospitalization. We also compared baseline characteristics between the treatment and conservative management group. A random effects model was used, and the data was presented using odds ratios (OR) with 95% confidence intervals (CI). Statistics were performed using RevMan 5.4.1. Results: A total of 5 studies totaling 2377 patients (444 in the conservative management group, 1930 in the endoscopic treatment group) were included in this study. The average ages in the conservative management group and the endoscopic treatment group were 69.1 ± 12.2 and 70.9 ± 12.4 years, respectively. Patients in the conservative group were 70.7% man, while they were 70.5% man in the treatment group. In the conservative group, 35.9% of patients had a history of GIB compared to 39.3% of patients in the treatment group. Nonsteroidal anti-inflammatory drug use, smoking history, and alcohol use were similar between groups. There were no significant differences in early rebleeding (OR 0.43, 95% CI: 0.11-1.75, P = 0.24, I2 78%) or late rebleeding (OR 1.48, 95% CI: 0.61-3.59, P = 0.39, I2 72%) between groups. Conclusion: The results of our study suggest that conservative treatment has similar outcomes compared to endoscopic treatment in early and late rebleeding. Therefore, an individualized approach is likely appropriate for patients presenting with suspect diverticular bleeding. Future studies will be needed to assess which hemodynamically stable diverticular bleeding presentations warrant definitive endoscopic treatment.