Distal cap to facilitate removal of blood clots during endoscopic hemostasis for upper gastrointestinal bleeding

Abstract

Endoscopic treatment is available for var-iceal and nonvariceal upper gastrointesti-nal (UGI) bleeding [1,2]. Blood clots in thestomach hamper endoscopic treatmentby obscuring the bleeding source. Aspira-tion of clots, however, results in obstruc-tion of the working channel, while grasp-ing clots with a basket or snare leads tocutting up of the clots [3]. We describethe usefulness of an attachable distal capto remove blood clots from the stomachduring endoscopic treatment of UGIbleeding.Two patients in the intensive care unithad active UGI bleeding with hemody-namic instability requiring transfusion.Urgent UGI endoscopy revealed bloodclots filling the stomach, obscuring thebleeding source. Attempts to remove theclots using aspiration and a polypectomysnare were unsuccessful. To improve theaspiration force and contact surface, weattached a distal cap intended for esopha-geal endoscopic mucosal resection (Dis-posable Distal Attachment D-206-04;Olympus Medical Systems Corp., Tokyo,Japan). This cap has an oblique shape(18 mm diameter) with a distal rim. Ascan been seen from l