LAUSR

WHEN IDENTIFYING THE source of gastrointestinal bleeding, securing the visual field is difficult because the injected water rapidly mixes with the blood and residue. The use of gas insufflation to displace luminal contents causes significant discomfort and makes endoscope operation difficult. Gel immersion endoscopy has recently been reported as a useful method when bleeding occurs during the endoscopic treatment. Gel immersion endoscopy is effective for a narrow lumen, as these are often filled with blood. This blood can easily be replaced with gel. The present report describes a case of diverticular bleeding in the sigmoid colon that was successfully treated via gel immersion endoscopy. A 69-year-old man complained of fresh bloody stools without abdominal pain.On admission, the contrast-enhanced abdominal computed tomography revealed multiple diverticula in the ascending colon. Diverticular bleeding was suspected, and a colonoscopy was performed. The vital signs were stable, and an oral bowel preparation was administered. A large amount of fresh blood was found in the sigmoid colon, but not in the ascending colon. Gas insufflation and water immersion were performed to identify the bleeding point; however, it was difficult to secure the visual field. The use of gel immersion endoscopy secured the visual field, and the bleeding source was detected in the sigmoid-descending colon (SDJ) (Figs 1,2). A total of 600 mL of gel was used. The operability of the endoscope was poor, and the bleeding point could not be precisely identified due to severe bleeding. There was no diverticulum around the SDJ, and bleeding from the vascular lesion was suspected. Therefore, hemostasis was achieved using hemostasis forceps. Subsequently, bleeding from the bottom