Abel Joseph, MD1, Andrew Li, MD2, Shai Friedland, MD1 1Stanford University, Palo Alto, CA; 2Stanford University, Redwood City, CA
Introduction: Upper gastrointestinal (GI) bleeding is a medical emergency that requires prompt diagnosis and intervention. The presence of large blood clots in the gastric body or fundus can impair visualization and lead to prolonged or aborted procedures. Here we describe the first case of a novel suction overtube endoscopic device to manage a large clot-impairing visualization in the fundus, which traditional methods failed to address.
Case Description/Methods: A 65-year-old man with a history of ischemic cardiomyopathy, repaired abdominal aortic aneurysm post-fenestrated endovascular aortic repair, multifocal hemorrhagic stroke, end-stage renal disease requiring dialysis, and hypercarbic respiratory failure managed with a tracheostomy presented with melena and hypotension raising concern for an active upper GI bleed. Urgent endoscopy revealed large clots in the fundus, obstructing the clear view of the gastric fundus. Despite aggressive suctioning through the 2.8mm channel of the regular gastroscope, the clotted blood could not be removed. Utilizing the novel overtube device, we successfully suctioned the clots, revealing a bleeding vascular lesion in the cardia. Hemostatic clips were applied, effectively stopping the bleeding. Post-procedure, the patient had no adverse events and showed clinical improvement.
Discussion: The management of upper GI bleeding in patients with complex medical histories can be challenging, particularly when traditional methods fail. In this case, the inability to clear clots using a therapeutic scope and prokinetic agents such as erythromycin prompted the use of the overtube suction device, which proved successful in clot removal and visualization of the bleeding source. The deployment of hemostatic clips effectively controlled the bleeding, demonstrating the efficacy of combining advanced endoscopic tools with established hemostatic techniques. The successful use of the endoscopic overtube device highlights its potential as a valuable tool in the endoscopic management of difficult-to-treat GI bleeding cases. Future studies should consider evaluating the broader application of such devices to improve outcomes in similar clinical scenarios.
Disclosures:
Abel Joseph indicated no relevant financial relationships.
Andrew Li: Neptune Medical – Consultant.
Shai Friedland: Intuitive Robotics – Consultant.
Abel Joseph, MD1, Andrew Li, MD2, Shai Friedland, MD1. P0462 - Novel Modified Endoscopic Suction Overtube for Clearance of Gastric Blood Clots During Urgent Upper Endoscopy, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
