Bleeding malignant gastric ulcer: successful endoscopic hemostasis with an over-the-scope clip

Post written by João Carlos Silva, MD, Rolando Pinho, MD, from the Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, Portugal.

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We present a case of a 76-year-old male patient with medical history of Parkinson disease admitted to the ER for hematemesis. On EGD, an ulcerated neoformation with a large adherent blood clot was observed, and therefore hemostasis was not attempted once the patient was sent for surgical treatment. Staging exams were ordered, but the next day, after continued evidence of bleeding, an attempt of temporary endoscopic hemostasis to avoid urgent surgery, while awaiting for histological evaluation, was undertaken. Successful hemostasis was achieved with a type t over-the-scope clip (OTSC), which was chosen in order to assure tissue capture and decrease the risk of the clip slipping considering the presence of fibrotic tissue in the lesion. No rebleeding occurred, and 8-weeks later the patient was admitted for elective subtotal gastrectomy.

OTSC placement techniques have been previously demonstrated for upper-GI bleeding. Nonetheless, there are limited published data on the role of OTSC in hemostasis from upper-GI tract neoplasia. In this case, successful endoscopic hemostasis avoided urgent surgery and reduced blood transfusion requirements in a high-risk patient.

This is an exemplary case of endoscopic treatment for malignant upper-GI bleeding. In patients not fit for urgent surgery, endoscopic hemostasis must be considered. In this setting OTSC displays as a safe and effective strategy.

The OTSC is an innovative device that can be used in multiple settings namely benign GI bleeding, acute perforation, prophylaxis for perforation, anastomotic leakage, and stent fixation. In patients bleeding from gastric neoplasia, endoscopic hemostasis with OTSC may provide a temporary bridge to oncologic therapy.

Read the full article online.

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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