title: Cap-assisted hemoclip application with forward-viewing endoscope for hemorrhage induced by endoscopic sphincterotomy: a prospective case series study.
abstract: BACKGROUND
  Endoscopic sphincterotomy (ES) is a therapeutic technique developed as an advanced application of endoscopic retrograde cholangiopancreatography (ERCP). An important adverse event associated with this procedure is hemorrhage, which may sometimes be uncontrollable. We sought to examine whether cap-assisted hemoclip application is effective in controlling ES-induced hemorrhage.
  
  
  METHODS
  In this prospective study, we investigated the outcomes in 10 patients who had uncontrolled ES-induced hemorrhage and were treated by cap-assisted application of hemoclip with a forward-viewing endoscope.
  
  
  RESULTS
  Nine of the 10 investigated patients were successfully treated using the cap-assisted hemoclip technique with forward-viewing endoscope, yielding a success rate of 90 %. The patient with hemorrhage non-responsive to hemoclipping required catheter embolization of the bleeding artery after its identification by digital subtraction angiography. One of the 10 patients developed mild pancreatitis after the procedure, but was successfully managed conservatively.
  
  
  CONCLUSIONS
  Cap-assisted hemoclip application with a forward-viewing endoscope appears to be an effective therapeutic modality for achieving hemostasis in cases of ES-induced hemorrhage, without the occurrence of any severe adverse events; we believe that this method should be considered as an option in the management of ES-induced hemorrhage.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China. drliuffeng@hotmail.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, 411 Hospital of PLA, 15 Dongjiangwan Road, Shanghai, 200081, China. wgyyab@126.com.
authors.forename: Guang-Yong
authors.initials: GY
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China. drlizhaoshen@hotmail.com.
authors.forename: Zhao-Shen
authors.initials: ZS
authors.lastname: Li
mesh_terms: D000368:Aged; D042883:Choledocholithiasis / Q000628:therapy; D020776:Endoscopes, Gastrointestinal; D005260:Female; D016558:Hemostasis, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*; D013525:Surgical Instruments; D016896:Treatment Outcome