Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3578-3582
Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3578
Promising way to address massive intragastric clotting in patients with acute upper gastrointestinal bleeding: A case report
Su-Xian Liu, Bei Shi, Ya-Feng Liu, Jing-Yi Shan, Bo Sun
Su-Xian Liu, Bei Shi, Ya-Feng Liu, Jing-Yi Shan, Bo Sun, Department of Gastroenterology, Longhua Affiliated Hospital of Shanghai Traditional Chinese Medicine, Shanghai 210000, China
Author contributions: Liu SX interpreted and reviewed the literature; Shi B contributed to manuscript drafting and revision; Shan JY was the patient’s attending doctor; Liu YF was the charge nurse of the patient; Sun B was the operator of the endoscopy and was responsible for revising the manuscript for important intellectual content; all authors issued final approval of the version to be submitted.
Supported by Natural Youth Science Foundation of China, No. 82104743; Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Innovation Project, No KY2056.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bo Sun, MD, Chief Physician, Department of, Longhua Affiliated Hospital of Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Road, Xuhui District, Shanghai 210000, China. gidrsunbo@126.com
Received: January 5, 2023
Peer-review started: January 5, 2023
First decision: February 8, 2023
Revised: February 16, 2023
Accepted: April 14, 2023
Article in press: April 14, 2023
Published online: May 26, 2023
Processing time: 140 Days and 1.8 Hours
Abstract
BACKGROUND

Massive intragastric clotting (MIC) makes endoscopic therapy difficult in patients with acute upper gastrointestinal bleeding. Literature data on how to address this problem are limited. Here, we report on a case of massive stomach bleeding with MIC that was successfully treated endoscopically using an overtube of single-balloon enteroscopy.

CASE SUMMARY

A 62-year-old gentleman with metastatic lung cancer was admitted to the intensive care unit due to tarry stools and hematemesis of 1500 mL of blood during hospitalization. Emergent esophagogastroduodenoscopy revealed massive blood clots and fresh blood in the stomach with evidence of active bleeding. Bleeding sites could not be observed even by changing the patient’s position and aggressive endoscope suction. The MIC was successfully removed using an overtube connected with a suction pipe, which was inserted into the stomach with an overtube of a single-balloon enteroscope. An ultrathin gastroscope was also introduced through the nose into the stomach to guide the suction. A massive blood clot was successfully removed, and an ulcer with oozing bleeding at the inferior lesser curvature of the upper gastric body was revealed, facilitating endoscopic hemostatic therapy.

CONCLUSION

This technique appears to be a previously unreported method to suction MIC out of the stomach in patients with acute upper gastrointestinal bleeding. This technique could be considered when other methods are not available or if they fail to remove massive blood clots in the stomach.

Keywords: Upper gastrointestinal bleeding; Massive intragastric clotting; Overtube for single-balloon enteroscope; Ultrathin gastroscope; Case report

Core Tip: It is difficult to deal with massive intragastric clotting (MIC) in the stomach in acute upper gastrointestinal bleeding (UGIB). We suggest a new and simple way to deal with acute UGIB with massive intragastric clotting when the suction of the endoscope can’t remove it with common materials found in the endoscope department. An ultrathin electronic gastroscope was inserted through the nose to provide vision and an over tube of single-balloon enteroscope was inserted into the mouth to suction the massive blood clots out with a negative pressure of 2 kPa. This is a good way to provide a visual field and to stop bleeding in UGIB when other methods are not available or are unhelpful.