Jejunal diverticular bleeding treated with hemoclips at double-balloon enteroscopy.

uation of melena and hematochezia. The initial esophagogastroduodenoscopy, a colonoscopy, and a computed tomo− graphic scan all failed to identify the source of the bleeding. Double−balloon enteroscopy was performed using the oral approach (EN−450T5/20; Fujinon Co. Ltd., Saitama, Japan). A blood clot adher− ing to a jejunal diverticulum was found 20 cm distal to the ligament of Treitz and linear submucosal vessels could be traced proximal to the bleeding point (l" Fig. 1). Two endoclips (Resolution Clip; Boston Scientific Co., Natick, Massachusetts, USA) were deployed on the feeding ves− sels. A blood clot was removed with tri− pod grasping forceps and the diverticu− lum was gently irrigated with water. We were then able to confirm that the bleed− ing had stopped (l" Fig. 2, l" Video 1). The patient had no further episodes of bleeding during his hospital stay and was discharged. Although massive bleeding from a jejunal diverticulum is extremely rare, surgery has traditionally been the treatment of choice, with or without identification of the bleeding site [1]. However, studies have suggested that endoscopic therapy could be an initial treatment option in co− lonic diverticular disease [2, 3], and endo− scopic hemostasis of diverticular bleed− ing in the small bowel could be possible during double−balloon enteroscopy. When applied to the thin dome of a diver− ticulum, thermal endoscopic hemostatic treatments could carry a high risk of per− foration. Endoclipping would be the mod− Jejunal diverticular bleeding treated with hemoclips at double−balloon enteroscopy