Successful Hemostasis With Direct Clipping Using a Tapered-Tip Hood and Slim Endoscope for Colonic Diverticular Bleeding Refractory to Endoscopic Band Ligation: A Case Report.

Endoscopic band ligation (EBL) is performed for hemostasis in patients with colonic diverticular bleeding (CDB) due to its low rebleeding rate. However, suction and ligation are not successful in some cases. We describe the case of a 93-year-old woman with CDB in whom EBL failed. Because of tissue rigidity, the sigmoid diverticulum could not be adequately suctioned into the ligation device, which resulted in band detachment and subsequent rebleeding. A slim endoscope fitted with a calibrated, small-caliber-tip, transparent hood enabled visualization of the bleeding point within the diverticulum. Complete hemostasis was then achieved by direct clipping using a reopenable clip. This case suggests that direct clipping using a tapered-tip hood with a slim endoscope can be a useful rescue technique after unsuccessful EBL.