Endoscopic ultrasound-guided injection of coils for the treatment of refractory post-ERCP bleeding
An 82-year-old woman was referred for endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. After cannulation of the pancreatic duct, transpancreatic sphincterotomy and placement of a 5-fr stent in the pancreas were performed. A fully covered self-expandable metal stent was placed because of persistent post-biliary sphincterotomy bleeding. The next day, the patient showed melena, hematemesis, and decreased hemoglobin levels. A gastroscopy was performed and active oozing bleeding from the papilla was evident. Injection therapy with epinephrine and hemoclips was performed. A few hours later, a new episode of hematochezia occurred. Repeat endoscopy showed persistent active bleeding from the papilla ([ Fig. 1 ]). Hemostatic powder (Hemospray; Cook Medical, Winston Salem, North Carolina, USA) was used ([ Fig. 2 ]), but the bleeding persisted 24 hours later.