LAUSR

Colorectal endoscopic procedures can be technically difficult in cases of poor endoscopic operability [1, 2]. Recently, the usefulness of traction devices in gastrointestinal endoscopic submucosal dissection has been demonstrated, and there have been several reports on their application in other endoscopic procedures [3, 4]. Herein, we report a case of successful endoscopic hemostasis using a traction device for colonic diverticular bleeding with poor scope operability. A 94-year-old womanwas diagnosed with diverticular hemorrhage in the ascending colon, and hemostasis was achieved using endoclips despite poor scope operability (▶Fig. 1). Nonetheless, rebleeding occurred 10 days later. An emergency colonoscopy was performed using a water-jet scope (PCF-H290ZI; Olympus, Tokyo, Japan) with a long distal attachment (MAJ-663; Olympus), which revealed pulsatile bleeding in the same diverticulum where hemostasis had been achieved (▶Video 1). Owing to the edematous changes associated with the previous hemostatic procedure, the bleeding point was located behind the mucosa (▶Fig. 2). Although endoscopic hemostasis using endoclips was attempted, it was challenging to accurately apply the endoclips to the bleeding point owing to poor scope operability. Although we repositioned the patient to change the scope manipulation, applying an endoclip at the target site was technically impossible. To overcome this challenge, a multi-loop traction device (Boston Scientific Co. Ltd., Tokyo, Japan) was applied to the distal mucosa as close as possible to the diverticulum and anchored to the opposite colonic wall with another endoclip (▶Fig. 3). Fixation of the colonic lumen stabilized the manipulation of the scope. Since the opposite lumen was fixed, the bleeding site did not shift when the endoclip was pressed. Thus, we achieved successful hemostasis without complications (▶Fig. 4, ▶Fig. 5). In this case, the clips were advantageous for improving scope manipulation, enabling successful hemostasis. E-Videos