Management of massive fistula bleeding after endoscopic ultrasound-guided pancreatic pseudocyst drainage using hemostatic forceps: A case report

BACKGROUND Endoscopic ultrasound (EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections (PFCs), and is associated with ease, safety, and efficiency. Bleeding is one of the main procedure-related complications, and often requires surgery or radiologic interventions. Indeed, endoscopic management of this complication is limited. CASE SUMMARY A 42-year-old man presented for evaluation of abdominal pain and distention for approximately 2 wk. Abdominal computed tomography revealed a pancreatic pseudocyst located in the tail of the pancreas. EUS-guided pancreatic pseudocyst was performed. After stent placement, massive bleeding was noted from the fistula. Finally, hemostasis was successfully achieved using hemostatic forceps within the fistula. CONCLUSION Bleeding vessel grasp and coagulation may represent a successful treatment for a fistula hemorrhage during EUS-guided drainage for a PFC, which may be tried before application of balloon or stent compression.