Diverticular bleeding: diagnostic and treatment modalities—a narrative review

Background and Objective: Diverticulosis is a common cause of gastrointestinal (GI) bleeding. The management of GI bleeding due to diverticulosis involves the participation of numerous specialties who can provide differing evaluation and treatment modalities. The goal of this narrative review is to describe treatment and diagnostic modalities provided by surgeons, gastroenterologists, radiology, and interventional radiology (IR) and how these can be best coordinated in a multidisciplinary fashion. 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”. Key Content and Findings: Treatment of a patient with diverticular bleeding requires multidisciplinary collaboration. Initial radiographic studies such as computed tomography angiography (CTA) provide important localization information. A patient in whom bleeding is difficult to localize with CTA may consider subsequent radiographic studies such as tagged red blood cell scan and magnetic resonance angiography. Catheter-based angiography with embolization is an effective treatment modality for the patient with bleeding localized on CTA. Many patients can have their bleeding controlled with endoscopic techniques such as injection of epinephrine, thermal coagulation, endoscopic clipping, endoscopic band ligation, and over the scope clips. Surgery is reserved for patients who are too unstable to undergo endoscopic or interventional radiology-based interventions despite resuscitation, patients for whom these interventions have failed, or patients who have suffered complications of these interventions. Conclusions: Diverticular bleeding is best managed in a multidisciplinary fashion. Collaboration between IR, gastroenterology, and surgical teams treating the patient is associated with improved outcomes. Interventions by gastroenterology and IR are often able to effectively control bleeding, but surgery should be offered to patients whose bleeding is not controlled by these treatments.