Management of a large mucosal defect after duodenal endoscopic resection

Figure 3 Delayed bleeding after duodenal endoscopic submucosal dissection. A: An adenoma, 20 mm in size, was located in the posterior wall of the second part of the duodenum; B: Prophylactic closure with a hemoclip was performed after ESD; C: The patient complained of melena at post-ESD day 13, and esophagoduodenoscopy revealed bleeding at the base of the ulcer because several clips had fallen off; D: The large mucosal defect was closed with multiple clips and Endoloops. ESD: Endoscopic submucosal dissection.