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Endoscopic clip tamponade of bleeding: a novel adjunct technique for endoscopic mucosal resection.

Endoscopic mucosal resection (EMR) of large nonpolypoid neoplasms of the colon may be complicated by immediate, early (first 24 hours), or delayed bleeding [1]. Endoscopic hemostasis of immediate bleeding can be achieved by epinephrine injection, cauterization of the bleeding site, and mechanical tamponade by resnaring the stalk or deployment of a band, clip, or detachable snare [1–4]. Inadvertent entrapment of tumor tissue during clip deployment to control immediate bleeding after snare resection during piecemeal EMR may interfere with further snare resections and require surgery, as highlighted by patient #1 (●" Table1;●" Fig.1). This problem could be easily overcome using a novel technique of “endoscopic clip tamponade” (ECT) for 3 minutes to control bleeding followed by reopening of the clip and completion of the EMR procedure, as described in patients #2–#4 (●" Table1). Piecemeal EMR was undertaken with a stiff snare after injection of indigo carmine solution into the submucosa to lift the lesion (●" Fig.2a). With this technique, bleeding after first resection was controlled using the technique of endoscopic clip tamponade (●" Fig.2b). After the bleeding site was localized with a water jet, a clipwith a reopening function (Resolution Clip, Boston Scientific, Natick, Massachusetts, USA) was applied immediately to the bleeding site. If bleeding persisted, the clip was reopened and reapplied more accurately to achieve hemostasis.