Over-the-Scope Clip for Control of a Recurrent Diverticular Bleed

An 87-year-old man with a history of diverticular bleed and abdominal aortic stenting presented with 3 episodes of hematochezia. Colonoscopy identified multiple diverticula, including one that was actively bleeding in the sigmoid colon (Figure 1). Two resolution clips were placed in the bleeding diverticulum with hemostasis (Figure 2). Twelve hours later, the patient had recurrent hematochezia. The previously placed aortic stent prevented cannulation of the inferior mesenteric artery by interventional radiology, so a repeat partial colonoscopy was performed without preparation, revealing fresh blood surrounding the 2 previously placed clips. An upper endoscope (Olympus 190 HQ; Olympus, Center Valley, PA) was fitted with a 13.6mm over-the-scope clip (OTSC®; Ovesco, Tübingen, Germany) that was deployed over the diverticulum and the previously placed clips (Figure 3). The bleeding stopped immediately. The patient did not require surgery and was discharged the next day; he was followed over period of 4 months after discharge and had no further bleeding.