Over-the-Scope Endoscopic Clip as Rescue Therapy for Massive Esophageal Variceal Bleeding

Postbanding ulcer bleeding is a challenging complication of endoscopic variceal ligation (EVL), particularly when standard rescue therapies fail or are unavailable. We report a 45-year-old man with decompensated cirrhosis who presented with massive hematemesis 2 weeks after EVL. Endoscopy revealed active bleeding from a deep postbanding ulcer overlying a large esophageal varix. Repeat EVL was unsuccessful, and transjugular intrahepatic portosystemic shunt or stent placement was not accessible. An over-the-scope clip (OTSC) was deployed, achieving immediate hemostasis and stable short-term outcomes. Although the patient later died of unrelated complications, this case highlights OTSC as an effective salvage option for severe postbanding ulcer bleeding.