A Pro Tip from Our New Book: The 'Bump Trick' for Hemostasis
How a simple, two-clip technique can solve one of endoscopy's most frustrating problems—the difficult-to-reach bleeding lesion.
We’ve all been there. You’re scoping a patient with a GI bleed and you find the culprit: a peptic ulcer. But it’s in a challenging location, like the distal, posterior antrum. Your endoscope’s working channel is on the left, but the lesion is on the right, making a direct approach with a hemostatic clip seem impossible.
What are your options? You could change scopes or reach for more complex tools. But what if there was a simpler, more elegant solution using the tools you already have?
In chapter 5 of our new book, The EndoCollab Guide for GI Bleeding, we detail a technique called the "Bump Trick." It’s a powerful method for achieving targeted hemostasis in these exact situations.
How the "Bump Trick" Works
(For the full visual guide, please see Figure 1 on page 63 of the book.)
The technique uses two clips to overcome the poor positioning.
Step 1: Create the "Bump"
Instead of trying to target the bleeding vessel with your first clip, you place the initial clip next to the lesion. The goal is not hemostasis. The purpose of this first clip is to purposefully grasp the nearby mucosa and create a mucosal "bump."
Step 2: Achieve Targeted Hemostasis
This newly created "bump" effectively lifts and repositions the surrounding tissue. This subtle change in anatomy now allows your second (hemostatic) clip to be aimed directly at the target ulcer, which was previously inaccessible. You can now easily capture the vessel and achieve secure closure.
Beyond Hemostasis: A Versatile Technique
The "Bump Trick" isn't just for bleeding ulcers. It is also an incredibly useful method for closing large mucosal defects or perforations. By placing the first clip on one edge of the defect, you create a "bump" that serves as an anchor, allowing for easier and more secure placement of subsequent clips to fully approximate the tissue.
The Takeaway
This is just one example of the dozens of practical, real-world techniques shared in The EndoCollab Guide for GI Bleeding. Our goal is to provide you with the expert tips and visual guidance needed to handle challenging cases with confidence and precision.
The full guide is now available on Amazon in eBook, paperback, and hardcover formats.
>> Get Your Copy on Amazon Here <<
All information and techniques described in this post are adapted from Chapter 5: "The Bump Trick for Hemostasis (and Closure of Mucosal Defects)", found on pages 63-65 of The EndoCollab Guide for GI Bleeding.