Bowel preparation with polyethylene glycol was performed before each examination to achieve a high rate of SRH identification. In patients who were hemodynamically unstable under intravenous fluid resuscitation, colonoscopy to identify the source of active bleeding was done without bowel preparation. Colonoscopy was performed with a water-jet scope (PCF-Q260AZI, PCF-Q260JI, or GIF-Q260J; Olympus, Tokyo, Japan). When a diverticulum with SRH was identified, hemoclips (HX-610-135; Olympus) were applied as markers near the diverticulum (Fig. 2 a, Fig. 2 b). The endoscope was removed, and a band ligator device (MD-48710 EVL Device; Sumitomo Bakelite, Tokyo, Japan) was attached to its tip (Fig. 2 c). The endoscope was then reinserted to the identified diverticulum. The diverticulum was aspirated into the transparent hood of the band ligator device, and an elastic O-ring was deployed ( Fig. 2 d) 13 (link)
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20 (link). Other endoscopic treatments, such as diluted epinephrine (1 : 20 000) injection and endoscopic clipping, were considered for refractory bleeding when several EBL attempts by experts had been unsuccessful. Patients were followed on an outpatient basis at our institution for at least 30 days after EBL.