Commentary

Clinically significant hemorrhage occurs in about 2 % of patients undergoing endoscopic sphincterotomy and is severe in a quarter of cases (i. e., necessitates transfusion of ≥ 5 units of blood, surgery, or angiography). Endoscopic therapies (epinephrine injection, thermal methods, clipping, or tamponade with a covered self-expanding metal stent [SEMS]) are effective in all but rare cases, in which angiographic embolization or surgery may be required. Endoscopic ultrasound (EUS)-guided deployment of an embolization coil as a means to stop bleeding, as in the presented case, is an interesting, outside-the-box approach. The feeding vessel, although small (around 1 mm) was well-visualized on color flow Doppler, it was not obscured by the SEMS, and was favorably located for targeting with an EUS needle. The coil was most likely deployed around the vessel rather than in its lumen; however, this was effective in achieving hemostasis.

Publication History

Article published online:
28 July 2020