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re 1. Incomplete hemostasis after placement of OTSC in high-risk adverse outcome bleeding. A, A large vessel within a fibrotic ulcer seen in the enal bulb. B, Use of medium-sized (17.5-mm) OTSC to capture the visible vessel. C, Active bleeding after suction, resulting in poor visualization e bleeding site. D, Ulcer was suctioned but failed to invert completely; OTSC deployed. E, OTSC was deployed superficially, with failure to compress leeding vessel, causing continued bleeding (arrow). F, Epinephrine injected around the OTSC site. G, Bleeding slowed after epinephrine injection. emostatic powder was sprayed, and bleeding stopped completely. OTSC, over-the-scope clip.

Incomplete hemostasis of high-risk adverse outcome bleeding lesions after placement of the over-the-scope clip: causes and solutions