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DOI: 10.1055/a-2643-8550
Successful endoscopic hemostasis of arterial bleeding with concurrent technical troubleshooting during endoscopic sleeve gastroplasty using a single cinch
As endoscopic sleeve gastroplasty (ESG) gains popularity as a minimally invasive bariatric technique, its overall complication rate remains low; nevertheless, intraprocedural bleeding is a well-recognized risk (reported incidence ≈1%) [1]. We report a case in which the suturing needle punctured a submucosal vessel during ESG, producing brisk arterial spurting and a rapidly expanding hematoma, compounded by needle misalignment that complicated further stitching ([Fig. 1]). The hemorrhage appeared as pulsatile, bright-red flow, confirming an arterial source ([Video 1]). Using the same OverStitch endoscopic suturing system already in place, the endoscopist deployed a single full-thickness stitch at the bleeding site and secured it with one cinch, achieving immediate hemostasis ([Fig. 2]). No additional sutures, clips, or surgical intervention were required, and the procedure was completed uneventfully.
Choosing a single-stitch approach rather than escalating to more invasive measures was guided by the bleed’s focal location, its clearly visualized arterial spurting, and the suturing platform’s capacity for instantaneous tamponade. This case demonstrates that even substantial intraprocedural bleeding during ESG can be swiftly and effectively controlled with a single cinch, thereby avoiding surgical conversion and preserving the minimally invasive advantages of ESG, in which most adverse events can be managed non-operatively [2].
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Publication History
Article published online:
25 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 Giannopoulos S, Pokala B, Stefanidis D. Management of gastrointestinal bleeding following bariatric surgery. Mini-invasive Surg 2022; 6: 22
- 2 Kasprzyk P, Wysocka-Konieczna K, Sobczak M. et al. Endoscopic sleeve gastroplasty safety profile – retrospective, single-center analysis of 222 consecutive patients including the learning curve period. Wideochir Inne Tech Maloinwazyjne 2024; 19: 243-248