After removing the metal clips of mucosal entry, a large number of blood clots were discovered inside the submucosal tunnel, and were removed. In two cases, the active bleeding points were identified and coagulated with hemostatic forceps; in one case of them, a Sengstaken–Blakemore tube was immediately placed into the stomach and lower part of the esophagus to compress the bleeding spot, while in other case, a Sengstaken–Blakemore tube was placed on the third day after first endoscopic hemostasis because of major blood drainage from nasogastric tube. In another patient, the bleeding source could not be Selleckchem Palbociclib identified and a Sengstaken–Blakemore tube was

placed directly. Proton pump inhibitor, antibiotics, and hemocoagulase were applied in all patients. Intermittence deflation of the balloons was done every 24 hours. The gastric balloon of Sengstaken–Blakemore tube was finally deflated on the first day after placement, and the esophageal balloon was finally released on the second day. Successful hemostasis was achieved in all cases and no blood transfusion was necessary. Two ulcers at the esophagogastric junction appeared in one patient before discharge but a satisfactorily healing was seen at 3-month follow-up endoscopy. Conclusion: Vomiting of fresh blood and progressive serious retrosternal pain are the

major early manifestations in patients with delayed bleeding in the submucosal tunnel after POEM. Emergency endoscopic diagnosis Bay 11-7085 and hemostasis should be performed immediately

after symptom emergence. It should be worth mentioning that a Sengstaken–Blakemore tube is particularly effective for providing selleck chemicals llc compressive hemostasis to staunch post-POEM bleeding. Key Word(s): 1. Delayed bleeding; 2. POEM; 3. Submucosal tunnel; Presenting Author: XIAODAN HUANG Additional Authors: LIN MIAO, YUANLIN XIA, ZHINING FAN, GUOZHONG JI Corresponding Author: GUOZHONG JI Affiliations: Second Affiliated Hospital of Nanjing Medical University; The people’s hospital of Hexian Objective: Pyogenic liver abscesses remain an important and life-threatening clinical problem. The formation of a communication between liver abscesses and intrahepatic bile ducts is an uncommon cause of bile leak. Percutaneous drainage with systemic antibiotics is the initial treatment for these conditions. However, the presence of a biliary communication is associated with significant longer periods of catheter drainage, because continuous bile flow into the abscess cavity through the communicating tract hindered the natural healing course, resulting in prolonged healing time. We report a case of an intrahepatic abscess communicating with bile ducts successfully treated by endoscopic management who had a poor response to continuous percutaneous drainage. Methods: A 73-year-old women was hospitalized for fever, right upper quadrant pain. A 9.6 cm *3.