Abstract
We encountered two cases of post-endoscopic sphincterotomy (EST) hemorrhage that was refractory to electrocoagulation using a sphincterotome, tamponade using a balloon, and spray/injection using epinephrine/ethanol, in which we finally achieved hemostasis by endoclip placement with the use of a forward-viewing endoscope. Although balloon tamponade, epinephrine/ethanol spray/injection, and electrocautery treatment have been reported as useful hemostatic techniques, hemoclip use has been limited for post-EST hemorrhage because of the technical difficulty of releasing the clips at the bleeding site when using a lateral-viewing endoscope. In the first case, we could easily place endoclips at the bleeding site on the post-EST papilla using a forward-viewing endoscope in the retroflexed position, while, in the second case, we could place endoclips using a forward-viewing endoscope in the straight position. There were no adverse events during or after the procedures. We could successfully obtain hemostasis by endoscopic clipping.
Although EST is widely accepted and commonly performed for patients with pancreatobiliary disorders, serious and refractory hemorrhage occasionally develops. Endoclip placement is one of the alternative hemostatic treatments that should be tried when post-EST bleeding proves refractory to conventional techniques such as balloon tamponade, epinephrine/ethanol spray/injection, and electrocautery treatment.
