Case Report
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 28, 2010; 16(16): 2061-2064
Published online Apr 28, 2010. doi: 10.3748/wjg.v16.i16.2061
Active gastrointestinal bleeding: Use of hemostatic forceps beyond endoscopic submucosal dissection
Dimitri Coumaros, Niki Tsesmeli
Dimitri Coumaros, Niki Tsesmeli, Department of Hepatogastroenterology, University Hospital of Strasbourg, Strasbourg 67091, France
Author contributions: Coumaros D made substantial contributions to conception of the study and revision of the paper; Tsesmeli N contributed to designing the study, acquisition and analysis of data, and paper writing.
Correspondence to: Niki Tsesmeli, MD, Department of Hepatogastroenterology, University Hospital of Strasbourg, Strasbourg 67091, France.
Telephone: +33-369-550402 Fax: +33-369-551857
Received: August 5, 2009
Revised: September 19, 2009
Accepted: September 26, 2009
Published online: April 28, 2010

To the best of our knowledge, this is the first report of the application of hemostatic forceps in active gastrointestinal (GI) bleeding that is not related to endoscopic submucosal dissection. An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy’s lesion of the third duodenal portion. Bleeding control with epinephrine injection was unsuccessful. A 60-year-old man presented with a bleeding ulcer in the duodenal bulb. Ten days after combined endotherapy, he had recurrent bleeding from two minimal lesions in the same location. A 66-year-old woman under combined antithrombotic treatment was referred to us for chronic GI bleeding of unexplained origin. Endoscopy revealed active diverticular bleeding in the second duodenal portion. A 61-year-old woman underwent endoscopic mucosal resection of superficial gastric adenocarcinoma, which was complicated with immediate bleeding. In all cases, the blood was washed out using a water-jet-equipped, single-channel gastroscope with a large working channel. The bleeding points were pinched and retracted with hemostatic forceps. Monopolar electrocoagulation was performed using an electrosurgical current generator. Hemostasis was achieved. No complications occurred. In conclusion, hemostatic forceps may be an effective as well as safe alternative approach for active GI bleeding of various origins.

Keywords: Hemostasis, Forceps, Blood coagulation, Hemorrhage, Endoscopic submucosal dissection