Background Massive intragastric clotting (MIC) makes endoscopic therapy difficult in patients with acute upper gastrointestinal bleeding. We conducted a study of massive stomach bleeding with MIC that was successfully treated endoscopically using a snare and thoracic drainage tube of 32Fr.

Methods 6 patients with acute massive upper gastrointestinal bleeding admitted to the intensive care unit between January 1^st, 2024, and April 30th, 2024, were enrolled in our study. All patients had emergent esophagogastroduodenoscopy, revealing massive blood clots and fresh blood in the stomach with evidence of active bleeding. Bleeding sites could not be observed even by changing the patient’s position and aggressive endoscope suction. First, a snare was used to cut massive blood clots into smaller pieces. And a thoracic drainage tube of 32Fr connected to suction with a pressure of 2 kPa was introduced into the stomach guided by a gastroscope. Then, the snare fixed the front end of the tube through the biopsy forceps channel to aspirate the MIC and fresh blood. The primary outcome was success rates of endoscopic hemostasis. Secondary outcomes included the procedure time, endoscopic diagnosis, treatment strategies, recurrent bleeding rates and mortality events within 7 days post-endoscopic treatment.

Results All bleeding sites of patients were successfully found after suction of the intragastric MIC and fresh blood and performed with appropriate endoscopic hemostasis. Among the cases, four patients (4/6, 66.7%) were diagnosed with ulcers in the fundus or body of the stomach, presenting spray or oozing hemorrhage. And two patients were diagnosed with Dieulafoy’s Lesion with jet bleeding. All bleeding was stopped using hemostatic clips. The mean procedure time was 62.17±20.03min. No recurrent bleeding and mortality events within 7 days post-endoscopic treatment occurred.

Conclusions This technique could be considered when other methods are not available or if they fail to remove massive intragastric blood clots in patients whose bleeding sites could not be observed in emergent esophagogastroduodenoscopy.