Transparent cap scope tamponade: an inexpensive, efficient, and underappreciated maneuver for bleeding visualization and hemostasis

Background and Aims: Low-grade bleeding is commonly encountered during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), and there are several hemostasis techniques that can be used, each with advantages and disadvantages. One efficient, inexpensive, and underappreciated technique is the use of a distal attachment on the endoscope to provide immediate scope tamponade that quickly stops most low-grade bleeding. Methods: The use of the distal attachment during endoscopic resection improves scope stability, and when low- to moderate-grade bleeding occurs, it can be used in conjunction with water infusion to quickly allow visualization of the source of the bleed. Subsequently, the tip of the distal attachment can be easily applied to the source of the bleeding, allowing immediate control or allowing time to retrieve a more definitive hemostatic device. Results: Four cases are presented demonstrating the valuable uses of the transparent distal cap attachment during EMR of a variety of colonic lesions. Conclusions: Using the distal attachment cap to provide scope tamponade is an effective, inexpensive, and underappreciated strategy to achieve hemostasis in low- to moderate-grade intraprocedural bleeding.