Endoscopic hemostasis of diverticular hemorrhage in a colonic conduit by use of an over-the-scope clip

A 64-year-old woman with a history of esophageal adenocarcinoma underwent Ivor Lewis esophagectomy. Twelve years later, she was found to have gastric adenocarcinoma, for which she underwent total gastrectomy with colonic interposition. The patient subsequently underwent Roux-en-Y surgical revision because of frequent reflux and bilious emesis. She presented with a 1-day history of hematemesis and melena and was found to be hypotensive, with acute anemia. She was not taking any antithrombotic medications. EGD revealed the esophagocolonic anastomosis to be 23 cm from the incisors. Fresh blood was seen within the colonic conduit. A diverticulum with an adherent clot was seen within the proximal colonic conduit, just distal to the anastomosis. Removal of the clot by suction and lavage resulted in brisk bleeding. Using an over-the-scope clip, we suctioned the bleeding diverticulum, and the clip was deployed with hemostasis (Fig. 1 and Video 1, available online at www.VideoGIE.org). She