Control of immediate post-EMR bleeding

Dr. KomanduriSrinadh Komanduri, MD from the Division of Gastroenterology, Feinberg School of Medicine at Northwestern University in Chicago, Illinois, USA presents this case from the VideoGIE series, “Control of immediate post-EMR bleeding by using monopolar hemostatic forceps.”

The video depicts a case of a significant post-polypectomy arterial bleed and the appropriate management of this adverse event.

I felt this video was important to readership as we have no high level studies or guidelines on management of post-polypectomy bleeding. The use of the monopolar hemostatic forceps has come to light with the advent of endoscopic submucosal dissection (ESD) but is the best treatment for active vessel bleeds in the base of any polypectomy resection bed.

The current case highlights the importance of having all the tools when performing large polyp resection or EMR. When a bleed or visible vessel is encountered in the base of EMR, the optimal treatment should be use of the monopolar hemostatic forcep. While hemoclips are effective for closure of the defect they are not as effective for vessels in the base of resection and can increase risk of perforation. Other thermal bipolar modalities (BICAP) or APC have been used but also do not allow the endoscopist to apply very direct focused energy and can also increase risk. If monopolar forceps are not available, others have used the tip of a polypectomy snare or a hot biopsy forcep.

For those of us performing EMR frequently, our understanding of the impact of the monopolar hemostatic forceps has been a game changer and a tool that we can rely on for bleeding complications. It is a must for all therapeutic endoscopists!

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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