
==== Front
ACG Case Rep J
ACG Case Rep J
ACGCRJ
AC9
ACG Case Reports Journal
2326-3253
Wolters Kluwer Maryland, MD

ACGCR-24-0568
10.14309/crj.0000000000001504
00038
3
Video
Colon
Successful Indirect Clipping for the Bleeding Source of Colonic Diverticular Hemorrhage Using a Reopenable Clip (Regrasping Technique)
https://orcid.org/0000-0002-0962-8342
Abiko Satoshi PhD, MD 12
Tanaka Takatsugu MD tt712able@gmail.com
1
Sawaguchi Shintaro MD 1sawa.naika.med6426@gmail.com

Yamamura Takahiro PhD, MD 1taka_yama0218@yahoo.co.jp

Tokuchi Yoshimasa PhD, MD 1h.y.tokuchi112@gmail.com

Nagai Kosuke PhD, MD 1n.kosuke0620@gmail.com

Kinoshita Kenji PhD, MD 1sugarspice0118@yahoo.co.jp

Hatanaka Kazuteru PhD, MD 1k-hatanaka@hospital.hakodate.hokkaido.jp

Yamamoto Yoshiya PhD, MD 1yamamoto@hospital.hakodate.hokkaido.jp

Naruse Hirohito PhD, MD 1naruse@hospital.hakodate.hokkaido.jp

1 Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate, Japan
2 Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
Correspondence: Satoshi Abiko, PhD, MD (abiko1982@gmail.com).
9 2024
19 9 2024
11 9 e0150420 6 2024
09 8 2024
© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
SDCT
==== Body
pmcCASE REPORT

When repeated misfiring of clips is encountered for controlling colonic diverticular hemorrhage, it becomes difficult to achieve hemostasis, an intervention, such as transcatheter embolization procedure or surgery, is required for effective bleeding control. The usefulness of a reopenable clip (SureClip; Micro-Tech Co. Ltd, Nanjing, China) for endoscopic hemostasis has recently been reported.1–3 We report successful indirect clipping for the bleeding source of colonic diverticular hemorrhage using a reopenable clip (regrasping technique). Clips were placed directly onto the vessel if technically feasible (direct clipping). When direct placement of clips onto the vessel was not possible, the diverticulum was closed in a zipper fashion (indirect clipping).4

An 87-year-old man with a large volume of hematochezia was transported to our hospital. The transverse colon was carefully examined using an endoscope, and a large volume of blood clotting and severe active bleeding were observed (Figure 1). We performed clipping on the opposite side of the bleeding site so as not to lose it. We then identified the bleeding diverticulum, but we could not identify the bleeding vessels in the diverticulum because of the severe active bleeding (Figure 1). We then tried to perform indirect clipping using a reopenable clip for the bleeding diverticulum. The bleeding diverticulum was grasped with a reopenable clip (Figure 1) 4 times, but the bleeding could not be stopped. On the fifth attempt, the bleeding was successfully stopped (regrasping technique, Figure 2). Clips were then added to ensure hemostasis (Figure 2, Video 1).

Figure 1. Figure showing that we could identify the bleeding in the diverticulum, and we then tried to perform indirect clipping using a reopenable clip for the bleeding diverticulum. (A) The ascending colon was carefully examined using an endoscope, and a large volume of blood clotting and severe active bleeding were observed. (B) We identified the bleeding diverticulum, but we could not identify the bleeding vessels in the diverticulum because of the severe active bleeding. (C) We then tried to perform indirect clipping using a reopenable clip for the bleeding diverticulum. The bleeding diverticulum was grasped with a reopenable clip 4 times, but the bleeding could not be stopped.

Figure 2. Figure showing successful indirect clipping for the bleeding source of colonic diverticular hemorrhage using a reopenable clip (regrasping technique). (A) On the fifth attempt, the bleeding was successfully stopped (regrasping technique). (B) Clips were then added to ensure hemostasis.

Video 1 Video showing successful indirect clipping for the bleeding source of colonic diverticular hemorrhage using a reopenable clip (regrasping technique).

The merit of the regrasping technique is that misfiring of clips can be decreased. The use of this technique can prevent the difficulty in achieving hemostasis caused by misfired clips, potentially reducing the need for angiography or surgery. The regrasping technique may be effective for clipping the bleeding source of colonic diverticular hemorrhage.

DISCLOSURES

Author contributions: S. Abiko wrote the manuscript. T. Tanaka, S. Sawaguchi, T. Yamamura, Y. Tokuchi, K. Nagai, K. Kinoshita, K. Hatanaka, Y. Yamamoto, and H. Naruse edited the manuscript. S. Abiko is the article guarantor.

Acknowledgments: We are very grateful to the wonderful staff in the endoscopic room, outpatient care, and ward of Hakodate Municipal Hospital.

Financial disclosure: None to report.

Informed consent was obtained for this case report.
==== Refs
REFERENCES

1. Ohno K Waki K Gushima R . Successful hemostasis for arterial bleeding in duodenal malignant lymphoma using reopenable clip. Dig Endosc. 2024;36 (2 ):250–1.38112099
2. Miwa H Sugimori K Tsuchiya H Novel clip device for prevention of bleeding after endoscopic papillectomy. DEN Open. 2022;2 (1 ):e51.35310706
3. Inoue T Kanesaka T Ishihara R . Repositionable hemostasis clip for uncontrollable bleeding during gastric endoscopic submucosal dissection. Dig Endosc. 2020;32 (5 ):e91–2.32462671
4. Kishino T Kanemasa K Kitamura Y Fukumoto K Okamoto N Shimokobe H . Usefulness of direct clipping for the bleeding source of colonic diverticular hemorrhage (with videos). Endosc Int Open. 2020;8 (3 ):E377–85.32118110
