LAUSR

Endoscopic hemostasis is the first choice for bleeding due to endoscopic sphincterotomy (EST). Various methods are available, including local injection, clipping, balloon compression, and coagulation, each with its advantages and disadvantages [1]. Hemostatic forceps interfere with the forceps erecting mechanism, and there is currently no absolute device for coagulation hemostasis. We used the EndoSaver Plus (Sumitomo Bakelite/Yamashina Seiki), which has a water supply function and large electrodes, to stop bleeding due to EST (▶Fig. 1, ▶Fig. 2, ▶Fig. 3). The EndoSaver Plus is a monopolar device developed using the development platform of Project ENGINE. It has a powerful water supply function and is capable of not only incision and dissection but also hemostasis while applying pressure with its large 1.6-mm diameter electrode. Although it is not compatible with a guidewire, the flexible Teflon sheath allows the forceps to be raised sufficiently by the forceps erection mechanism. Three cases of bleeding due to EST (two intraoperative and one postoperative; no antithrombotic medication) were thermostatically treated with the EndoSaver Plus. The bleeding area due to EST was washed with water, and coagulation and hemostasis were performed carefully so as not to cauterize the pancreatic duct orifice. Hemostasis was possible in all cases (▶Video 1). The large spherical electrode provided little resistance to insertion into the bile duct after EST, and washing by the water supply function was also useful for confirmation of the bleeding area. The large spherical electrode also made it possible to confirm bleeding from the bile duct by applying pressure to the bleeding area, and coagulation and hemostasis could be performed as it was. No postoperative pancreatitis, rebleeding, or perforation was observed. The EndoSaver Plus, which has a large electrode and water delivery function, is useful for post-EST hemorrhage and is considered to be an option.