Iatrogenic papillary bleeding (IPB) is a relatively common (1-2% post-sphyncterotomy -PS- and 10% post-ampullectomy) and potentially a life-threatening endoscopic complication. Despite many endoscopic treatments available, literature is scarce about the best and more efficient option.

Hemostatic bipolar forceps (HBF) Hemostat^TM, a common third-space endoscopy device for vessel precoagulation and/or bleeding treatment, is a new kid on the block in the setting of IPB with first 2 case reports published in 2024. Nevertheless, HBP presents some attractive features for this scenario: 1) good functionality through duodenoscope elevator, 2) possibility of clamping the bleeding point to properly define it, 3) bipolar current with fewer surrounding energy application and 4) costs.

Twenty two cases of IPB (81.8% intraprocedural and 18.2% delayed) were treated by HBF in 21 patients by 2 experienced endoscopists in a 2-year period from June-2023 to June-2025. Patients were 82.7% female, mean age 76.4±12.71 and ASA III-IV: 52.4%. Initial procedure was ERCP + ES and/or precut in 81.8% and ampullectomy in 18.2%. Severity of IPB was classified as AGREE III in 95.5% and AGREE V in 4.5%. Procedural and technical data are presented in table 1.

BHF seems to be a safe and effective treatment for IPB.

These results, its functionality through the duodenoscope and its electrophysical properties made the BHF appear as an attractive tool for IPB.