Endoscopic double-layer nylon rope ligation for rescue of gastric ulcer bleeding after failed OTSC treatment: A case report (with video).

rationaleThe over-the-scope clip (OTSC) system is a potent endoscopic hemostatic tool. Endoscopic nylon rope ligation, a mature, minimally invasive technique for treating colonic polyps, has rarely been reported for gastrointestinal bleeding or as a rescue therapy after OTSC failure. The use of endoscopic double-layer nylon rope ligation as a rescue treatment for peptic ulcer bleeding following OTSC failure in this case is the first such report. PATIENT CONCERNS: A 61-year-old man was admitted to the emergency department with "hematemesis and melena for 3 days," accompanied by dizziness and fatigue. DIAGNOSES: Bleeding gastric ulcer (Forrest IIa type).

interventionsHemostatic clip application for the vascular stump at the center of the ulcer, submucosal injection-OTSC-double-layer nylon rope ligation. OUTCOMES: Immediate hemostasis was achieved after double-layer nylon rope ligation, with no recurrence of hematemesis or melena. The patient's vital signs stabilized, and hemoglobin concentration increased to 72 g/L at 24 hours postoperatively. Gastroscopic reexamination at 2 weeks revealed shedding of the OTSC and nylon ropes, with a clean ulcer surface. At 8 weeks after endoscopic treatment, the ulcer presented new red mucosa with slight mucosal convergence. At the 4-month follow-up, the patient was asymptomatic, and the ulcer had completely healed. LESSONS: Double-layer nylon rope ligation is a safe, effective, and easy-to-perform rescue therapy for gastric ulcer bleeding after OTSC failure.The core advantages of this method include enhanced compression stability, minimal tissue damage, and high operational efficiency. It is particularly suitable for bleeding scenarios with endoscopically accessible lesions, large-caliber blood vessels, or significant tissue edema, providing a new clinical option for such high-risk bleeding cases.