The Bump Trick for Hemostasis (and Closure of Mucosal Defects)

By Klaus Mönkemüller, MD, PhD, FASGE, FJGES and Joel Joseph, MD

Virginia Tech Carilion School of Medicine, Virginia, USA

image via endocollab.com

Often, bleeding lesions are located on the right (Panel A), as in this case of gastric ulcer located in the distal antrum. Many gastroscopes have the working channel on the LEFT (Panel B, green arrow), which makes a targeted delivery of the clip or injection difficult. What are our options to overcome this problem?

One, change to a pediatric colonoscope, with working channel on the right.

Two, use over the scope clip (which allows for en-face approach).

Three, use a transparent distal cap, which may allow for a more targeted approach by "expending" the scope tip and thus angulation capabilities.

Four, use hemospray or hemostatic gels.

Five, as in this case, use the "bump trick". The initial clip is used to create a mucosal “bump” (pink arrow). The second (or hemostatic) clip can now be better targeted to the lesion, as the bump has lifted some folds (D, pink arrow) on the left side and allows for better capture of the ulcer on the right E, light blue arrow).

The bump trick is also useful when closing mucosal defects. The first clip is used to create a mucosal bump, which then allows for easier application of the second clip, and secure closure of the defect (see picture below).

No COI by KM with any of the companies/utensils or products mentioned in this article.

About the authors

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE

Editor-in-Chief, The Practicing Endoscopist

Professor of Medicine, Carilion Memorial Hospital / Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA

Klaus Mönkemüller, MD, PhD, FASGE, FJGES, FESGE, is the editor-in-chief of The Practicing Endoscopist and the founder of EndoCollab. He is Professor of Medicine at Virginia Tech Carilion School of Medicine and a practicing endoscopist at Carilion Memorial Hospital in Roanoke, Virginia.

Dr. Mönkemüller has published extensively on endoscopic techniques and devices, with a particular focus on therapeutic endoscopy, foreign body removal, GI bleeding, and the use of caps and accessories in everyday practice. He lectures internationally and has contributed to multiple GI endoscopy textbooks and atlases.

Joel Joseph, MD

Gastroenterologist

Lexington Medical Center, West Columbia, South Carolina, USA

Joel Joseph, MD, is a board-certified gastroenterologist practicing in West Columbia, South Carolina, and affiliated with Lexington Medical Center. He earned his medical degree from the Medical College of Georgia at Augusta University in 2018 and completed his gastroenterology fellowship at Carilion Clinic / Virginia Tech Carilion School of Medicine in 2025.

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