Shamayel Safdar, MBBS, Joseph Soucy, MD, Aaron Yam, , Rabbia Irfan, MBBS, Mohsin Chundrigar, MBBS, Jad Moumen, MD, Zarbakht Nisar, MBBS, Robert Gianotti, MD Albany Medical Center, Albany, NY Introduction: Colonic diverticular bleeding is a leading cause of lower gastrointestinal bleeding in older adults, accounting for up to 40% of cases [1]. While many episodes resolve spontaneously, 20-30% require intervention. Endoscopic clipping is often preferred due to its safety and durable hemostasis, but placement inside a diverticulum is rarely attempted due to technical difficulty. We present a case of successful clip deployment inside a diverticulum harboring an actively bleeding angioectasia.
Case Description/
Methods: A 74-year-old male with COPD, hypertension, atrial fibrillation on apixaban, and chronic anemia presented with dyspnea and was diagnosed with COPD exacerbation and type 2 NSTEMI. Hemoglobin was 6.3 g/dL, improving to 7.1 after transfusion. He had a one-year history of intermittent hematochezia. A prior colonoscopy in 2023 showed non-bleeding diverticulosis and internal hemorrhoids.
Apixaban was held. Esophagogastroduodenoscopy was unremarkable. Colonoscopy revealed grade 2 internal hemorrhoids and extensive diverticulosis. In the proximal ascending colon, an actively bleeding angioectasia was seen within a diverticulum. Argon plasma coagulation (0.8 L/min, 20 W) provided partial hemostasis. A single hemostatic clip was then skillfully deployed inside the diverticulum, achieving complete hemostasis. A tattoo was placed 2 cm distal to the site. Discussion: Diverticular bleeding typically arises from rupture of the vasa recta at the dome of the diverticulum. Clipping offers effective control of bleeding, but placing a clip within a diverticulum is rare due to technical limitations. In this case, APC alone was inadequate. Definitive control was achieved with intracavitary clip placement, an advanced technique that prevented the need for radiologic or surgical intervention.This case highlights a rare, skillful, and effective approach to diverticular bleeding. In select cases, clip placement inside a diverticulum can achieve successful hemostasis when performed by experienced endoscopists
Figure: Intra Diverticular Clip
Figure: Diverticular bleed
Disclosures: Shamayel Safdar indicated no relevant financial relationships. Joseph Soucy indicated no relevant financial relationships. Aaron Yam indicated no relevant financial relationships. Rabbia Irfan indicated no relevant financial relationships. Mohsin Chundrigar indicated no relevant financial relationships. Jad Moumen indicated no relevant financial relationships. Zarbakht Nisar indicated no relevant financial relationships. Robert Gianotti indicated no relevant financial relationships.
Shamayel Safdar, MBBS, Joseph Soucy, MD, Aaron Yam, , Rabbia Irfan, MBBS, Mohsin Chundrigar, MBBS, Jad Moumen, MD, Zarbakht Nisar, MBBS, Robert Gianotti, MD. P3022 - Direct Clip Deployment into a Bleeding Diverticulum: A High-Skill Solution for a High-Stakes Problem, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
