A novel technique using a multiloop traction device for colonic diverticular bleeding

Colorectal endoscopic procedures can be technically difficult in cases of poor endoscopic operability [1] [2]. Recently, the usefulness of traction devices in gastrointestinal endoscopic submucosal dissection has been demonstrated, and there have been several reports on their application in other endoscopic procedures [3] [4]. Herein, we report a case of successful endoscopic hemostasis using a traction device for colonic diverticular bleeding with poor scope operability.

A 94-year-old woman was diagnosed with diverticular hemorrhage in the ascending colon, and hemostasis was achieved using endoclips despite poor scope operability ([Fig. 1]). Nonetheless, rebleeding occurred 10 days later. An emergency colonoscopy was performed using a water-jet scope (PCF-H290ZI; Olympus, Tokyo, Japan) with a long distal attachment (MAJ-663; Olympus), which revealed pulsatile bleeding in the same diverticulum where hemostasis had been achieved ([Video 1]).

Fig. 1 Endoscopic hemostasis using endoclips was performed for hemorrhagic diverticulum in the ascending colon.

Video 1 Endoscopic hemostasis for diverticular bleeding in the ascending colon was challenging owing to the difficulty of manipulating the scope. The multi-loop traction device improved scope operability and enabled successful hemostasis using endoclips.

Owing to the edematous changes associated with the previous hemostatic procedure, the bleeding point was located behind the mucosa ([Fig. 2]). Although endoscopic hemostasis using endoclips was attempted, it was challenging to accurately apply the endoclips to the bleeding point owing to poor scope operability. Although we repositioned the patient to change the scope manipulation, applying an endoclip at the target site was technically impossible. To overcome this challenge, a multi-loop traction device (Boston Scientific Co. Ltd., Tokyo, Japan) was applied to the distal mucosa as close as possible to the diverticulum and anchored to the opposite colonic wall with another endoclip ([Fig. 3]). Fixation of the colonic lumen stabilized the manipulation of the scope. Since the opposite lumen was fixed, the bleeding site did not shift when the endoclip was pressed. Thus, we achieved successful hemostasis without complications ([Fig. 4], [Fig. 5]).

Fig. 2 An emergency colonoscopy revealed rebleeding of the diverticulum.

Fig. 3 A multi-loop traction device was applied to the distal mucosa of the hemorrhagic diverticulum and anchored to the opposite colonic wall with another endoclip.

Fig. 4 The fixation of the colonic lumen stabilized scope operability, which enabled the endoclip to be applied at the bleeding point.

Fig. 5 Successful hemostasis was achieved using endoclips without any complications.

In this case, the clips were advantageous for improving scope manipulation, enabling successful hemostasis.

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Competing interests

The authors declare that they have no conflict of interest.

• References

• 1 Imai K, Hotta K, Yamaguchi Y. et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 2016; 83: 954-962
• 2 Hayashi N, Tanaka S, Nishiyama S. et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 2014; 79: 427-435
• 3 Matsui H, Tamai N, Futakuchi T. et al. Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience. BMC Gastroenterol 2022; 22: 10
• 4 Ishii T, Kin T, Katanuma A. Successful intervention using multiloop traction for cases with difficult biliary cannulation due to periampullary diverticula. Dig Endosc 2021; 33: e111-e113

Publication History

Article published online:
22 September 2022