PMC4927213_01
Clot adherent to sphincterotomy and its removal by means of Dormia basket.
10.1177_2050313X16645756-fig1.jpg
PMC4927213_01_10.1177_2050313X16645756-fig1.jpg
fig1-2050313X16645756
Most probably, the self-expandable metal stent (SEMS) failed to achieve water-tight tamponade due to the large size of ES (Figures 1 and 2).
Active bleeding was spotted on the right edge of sphincterotomy despite presence of a covered metallic stent.
10.1177_2050313X16645756-fig2.jpg
PMC4927213_01_10.1177_2050313X16645756-fig2.jpg
fig2-2050313X16645756
Most probably, the self-expandable metal stent (SEMS) failed to achieve water-tight tamponade due to the large size of ES (Figures 1 and 2).
Hemostasis by epinephrine injection (1:20000).
10.1177_2050313X16645756-fig3.jpg
PMC4927213_01_10.1177_2050313X16645756-fig3.jpg
fig3-2050313X16645756
Temporary hemostasis was successfully achieved by submucosal injection of 20 cc of epinephrine (1:20000) on the edges and on the roof of sphincterotomy (Figure 3).
Complete hemostasis after injection and SEMS deployment.
10.1177_2050313X16645756-fig4.jpg
PMC4927213_01_10.1177_2050313X16645756-fig4.jpg
fig4-2050313X16645756
A new SEMS was deployed to guarantee biliary drainage and definitive hemostasis (Figures 4 and 5).
Radiological control of deployed SEMS.
10.1177_2050313X16645756-fig5.jpg
PMC4927213_01_10.1177_2050313X16645756-fig5.jpg
fig5-2050313X16645756
A new SEMS was deployed to guarantee biliary drainage and definitive hemostasis (Figures 4 and 5).