Anchor clip–assisted detachable loop ligation for definitive hemostasis and closure of a high-risk bleeding gastric ulcer

A 75-year-old man was admitted with a 2-week history of melena. Despite conservative medical treatment, including proton pump inhibitor therapy, he had ongoing evidence of active gastrointestinal bleeding and was referred for emergency endoscopic hemostasis. Endoscopy identified a 2.0×2.0 cm ulcer on the lesser curvature of the gastric body ([ Fig. 1a ]). A red, adherent thrombotic plug with active oozing was observed at the center of the ulcer base, consistent with a high-risk stigmata lesion.[ 1​ ] Initial hemostasis was achieved by thermal coagulation using hot biopsy forceps. Given the substantial risk of rebleeding, definitive mechanical closure and vessel control were pursued. Conventional through-the-scope clips may be limited by a relatively small opening angle and insufficient bite depth, which can hinder secure grasping of a broad, fibrotic ulcer base ([ Fig. 1b ]). Therefore, an anchor clip–assisted loop ligation technique was performed ([ Video 1 ]). Three hemoclips were deployed circumferentially along the ulcer margin to serve as anchor points ([ Fig. 1c ]). A nylon loop was then positioned around the anchors and progressively tightened, drawing the ulcer edges together to achieve complete defect closure and simultaneous mechanical ligation of the presumed culprit vessel ([ Fig.1d–f ]). Post-procedurally, the patient had no recurrent melena or signs of ongoing bleeding. He remained hemodynamically stable, required no further endoscopic intervention, and was discharged after clinical improvement. Fig. 1 Anchor clip–assisted detachable loop ligation for a high-risk bleeding gastric ulcer. ( a ) An endoscopic view of a 2.0×2.0 cm ulcer on the lesser curvature of the gastric body with a red, adherent thrombotic plug and active oozing (high-risk stigmata). ( b ) The first anchor point established by deploying a hemoclip along the ulcer margin as preparation for anchor clip–assisted detachable loop ligation. ( c ) Three clips deployed circumferentially along the ulcer margin as anchor points. ( d ) A detachable loop placed around the anchors and progressively tightened, approximating the ulcer edges to achieve complete defect closure and mechanical ligation of the presumed culprit vessel. ( e ) Schematic illustration of three hemoclips deployed circumferentially along the ulcer margin as anchor points, with a detachable loop placed around the anchors. ( f ) Progressively tightened to approximate the ulcer margins, resulting in complete defect closure. Video. 1 Anchor clip–assisted detachable loop ligation for definitive hemostasis and closure of a high-risk bleeding gastric ulcer. Download Video Endoscopy_UCTN_Code_TTT_1AO_2AD Publication History Received: 08 May 2026 Accepted after revision: 14 June 2026 Article published online: 30 June 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany