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Case Report
A simple cost-effective method of endoscopic clearance of large blood clots in upper gastrointestinal bleeding
1 MBChB, House Officer, Health New Zealand, Palmerston North, New Zealand
2 Registered Nurse, Department of Gastroenterology, Palmerston North, New Zealand
3 MBBS, MMedSc, FRACP, Consultant Gastroenterologist, Palmerston North, New Zealand
Address correspondence to:
Shaoyi (Bessie) Zhang
MBChB, House Officer, Health New Zealand, Palmerston North,
New Zealand
Message to Corresponding Author
Article ID: 101500Z01SZ2025
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Zhang S, Crooks J, Khan A. A simple cost-effective method of endoscopic clearance of large blood clots in upper gastrointestinal bleeding. Int J Case Rep Images 2025;16(1):64–67.ABSTRACT
Introduction: Patients with upper gastrointestinal (GI) bleeding with large clots and associated food can make clearance and adequate visualization via the standard gastroscope very challenging. There are a few proprietary systems for large clot clearance marketed for adjunct use in endoscopy; however, world-wide availability as well as general affordability can be difficult. Advancement in simple methods to safely and effectively clear the upper GI tract for good visualization is hence important and can prevent mortality and significant morbidity in severe GI bleeding.
Case Report: An 84-year-old patient with known end-stage achalasia presented with hematemesis and worsening dysphagia. Gastroscopy under general anesthetic found large amount of food bolus and blood clot in the dilated esophagus precluding further advancement. An overtube was used to facilitate repeated scope passages. A combination of endoscopic suction, irrigation, snare use, and Roth Net use provided little improvement in clearance. Hence a nasogastric (NG) tube was inserted via the overtube into the esophagus under direct visualization. With a combination of endoscopic irrigation and direct high suction with the NG tube, the food and clot were broken down and cleared effectively.
Conclusion: Compared to traditional extraction of blood clots with associated food in piecemeal fashion, this technique of incorporating direct suctioning from the NG tube with irrigation from the gastroscope is a simple and efficient way to clear large clots and food from the upper GI tract. The equipment needed is standard equipment available in any acute endoscopy suite.
Keywords: Blood clots, Endoscopy, Food bolus, Upper GI bleeding
SUPPORTING INFORMATION
Author Contributions
Shaoyi (Bessie) Zhang - Acquisition of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Jackie Crooks - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Afrasyab Khan - Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Shaoyi (Bessie) Zhang et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
