Clin Endosc.  2022 May;55(3):443-446. 10.5946/ce.2020.294.

Endoscopic hemostasis using an over-the-scope clip for massive bleeding after percutaneous endoscopic gastrostomy removal: a case report

• Moon SY
• Jung MK
• Heo J

• KMID: 2529967
• DOI: http://doi.org/10.5946/ce.2020.294

Abstract

Percutaneous endoscopic gastrostomy (PEG) is a common method for providing long-term enteral nutrition to patients. PEG tube placement and removal are relatively safe; generally, a PEG tube can be removed using gentle traction, and excessive bleeding is rare. The over-the-scope clip system is a new device that can be used for gastrointestinal hemostasis and for closing gastrointestinal fistulae. In the present case, a 68-year-old male patient had to remove the PEG tube because of persistent leakage around the PEG tube. Although it was gently removed using traction, incessant bleeding continued, with a Rockall score of 5 points, even after hemocoagulation was attempted. An over-the-scope clip device was used to achieve hemostasis and fistula closure.

Keyword

Bleeding; Gastrocutaneous fistula; Over-the-scope clip; Percutaneous endoscopic gastrostomy

Figure

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  Fig. 1. Endoscopic findings. (A) A well-positioned percutaneous endoscopic gastrostomy (PEG) tube before removal. (B) Blood jetting from the PEG tract after removing the PEG tube. (C) Persistence of active bleeding despite endoscopic hemocoagulation therapy. (D) The tissue at the gastric orifice was captured with the over-the-scope clip device. The gastrocutaneous fistula was closed, and endoscopic hemostasis was also successfully achieved.

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