Hemodynamic Efficacy of Sequential Endoscopic Clip Application Using the New Olympus HX-110/610 Reloadable Clipping Device in the Treatment of Spurting Bleedings

Abstract

Background: Clip therapy has proven to be effective in ulcer hemostasis. Clinical experience shows that multiple clips are often necessary. In 2005 a new easily reloadable clip-applicator (Olympus) was presented. We evaluated the hemodynamic efficacy of this new clip-device in an established model for upper GI bleeding with endoscopists of different expertise. Methods: In a prospective trial, we compared the new reloadable clip device (Olympus HX 110/610) in an established experimental setting using the compact EASIEÒ-simulator (Maiss et al. Endoscopy 2006) equipped with an upper GI-organ package for bleeding simulation. The artificial blood circulation system in the simulator was connected with a bloody arterial pressure monitoring system. Four investigators with different endoscopic experience (1000, 1000, 4000 and 6000 endoscopies) participated. Each investigator treated 12 defined bleeding sources in the simulator up to a with a maximum of 6 clips for each bleeding source. Clip-application was stopped earlier if the maximum measurable mean arterial pressure of 300 mmHg was reached. System pressure was recorded one minute before, during and one minute after clip application to objectify the additive effects of sequential clip application on the reduction in vessel diameter. Results: Clip-application significantly increased the peak (91 ± 99 mmHg p < 0.001) and mean system pressure (95 ± 100 mmHg p < 0.001) representing significant relative maximum and mean reduction of vessel diameter. Pooled data for all endoscopists showed a significant stepwise increase in mean and maximum system pressure resulting in reduction of vessel diameter up to fifth clip. A mean number of 5 (1-6) clips was used. More experienced endoscopists achieved higher mean pressure increase (167 and 113 mmHg vs. 72 and 23 mmHg; p < 0.05). Mean reloading time (remounting and repositioning) was very short (39 sec, 19 - 49 sec). Conclusions: In summary, we could prove that multiple clipping led to increasing hemostatic effects as it was observed in clinical trials. The experience of the endoscopist plays also a major role. Single use clips appear dispensable in view of the short reloading time.