The use of the cap and underwater technique as an aid in endoscopic diagnosis and treatment of upper gastrointestinal bleeding: case series

BACKGROUND AND AIMS: Upper GI bleeding (UGIB) is a medical emergency associated with elevated mortality and significant costs to the health care system. EGD is currently the method of choice for the diagnosis and management of these conditions. However, the location of bleeding lesions and technical difficulties in achieving endoscope stability may challenge even the most experienced endoscopists. Herein, we demonstrate the use of the cap and underwater technique as a helpful aid in these situations. METHODS: We present a case series of 4 patients with acute UGIB who underwent EGD with suboptimal endoscopic visualization or technical difficulties in identifying the source of bleeding. A transparent plastic cap was attached to the distal tip of the gastroscope, and the water immersion technique (underwater) was used for endoscopic re-evaluation of the bleeding site. RESULTS: Three patients presented with duodenal bleeding, and 1 was diagnosed with diffuse bleeding from the esophagus. The clear and accurate identification of the source of bleeding and effective hemostasis were possible after cap and underwater technique evaluation in all patients. CONCLUSION: The use of the cap and underwater technique is a simple, safe, and low-cost strategy that improves the identification and control of UGIB in locations with poor visibility and technical challenges during endoscopic evaluation.