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A 13-year-old boy with metastatic rhabdomyosarcoma presented with biliary obstruction requiring ERCP for stent placement. Re-evaluation after recurrence of symptoms revealed external migration of the stent with formation of a contralateral wall bleeding duodenal ulcer. Endoscopic therapy was not feasible and bleeding persisted despite medical therapy and embolization. Given his life-threatening condition, approval for the use of Hemospray (Cook Medical, Winston-Salem, NC, USA) was obtained. Hemospray was applied to the visualized bleeding sites with subsequent hemostasis. Patient tolerated the procedure well. This is the first use of Hemospray in the United States outside of a clinical trial.

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