Complete closure of a colonic bleeding diverticulum using endoclips.

probe coagulation, and endoclipping at the neck or dome of the diverticulum are the treatments most frequently used for bleeding diverticula [1,2]. We obtained hemostasis of a bleeding diverticulum by approximating the margins of the diverti− culum. A 77−year−old man was admitted for painless hematochezia. At admission he had hemoglobin level 8.1 g/dL and hematocrit 24%. After bowel preparation an urgent colonoscopy was done using a colonoscope with transparent cap on the tip. A diverticulum oozing blood was seen in the ascending colon (l" Fig. 1). After injection of epinephrine, the proxi− mal edge of the diverticulum was moved down using the cap, the mucosa was suc− tioned, and two endoclips were used to bring together the margins of the diverti− culum, obtaining complete closure of the diverticulum and cessation of hemor− rhage (l" Fig. 2). At 4−months follow−up the patient had experienced no recur− rence of bleeding. This is the first report of closure of an ac− tively bleeding diverticulum by using en− doclips to draw its margins together. En− doscopic hemoclipping at the dome of the diverticulum might be at risk of per− foration; however the margins of the di− verticulum, drawn up with the cap after suction, present a thicker wall for endo− clipping. With the present case, we indi− cate that complete closure of the diverti− culum with hemoclips appears to be the safest method for hemostasis of a bleed− ing diverticulum.