Procedure of Endoscopic Hemostasis Using a Distal Attachment and Short Clips Against Upper Gastrointestinal Bleeding

Abstract

BACKGROUND and AIM: Endoscopic hemostasis using hemoclips is useful against upper gastrointestinal bleeding, however it is difficult to perform hemoclipping against tangent view-lesions. A hood which is attached to a distal tip of an endoscope makes hemoclipping more easier, however it is sometimes difficult to observe lesions because clot is put into the hood. The aim of this study is to assess endoscopic hemostasis using a distal attachment and short clips against upper gastrointestinal bleeding. SUBJECTS and METHODS: Subjects were 103 patients with 117 lesions of upper gastrointestinal bleeding. A distal attachment, which was a short hood (4 mm in length) was attached to the distal tip of an endoscope from start of endoscopic examination. If lesions of upper gastrointesitinal bleeding were detected, hemoclipping using short clips was performed against them. This procedure had been performed against 50 lesions, including 20 of gastric ulcer, 14 of duodenal ulcer, 12 of lesion resected endoscopically against early gastric cancer and gastric adenoma, 3 of Mallory-Weiss syndrome and 1 of stomal ulcer. Endoscopic hemostasis by this procedure was analyzed. RESULTS: It was easy to insert the endoscope with the distal attachment into the upper GI in all patients. Appropriate endoscopic view using the distal attachment was achieved without disturbance of clot in all lesions. For tangent view-lesions, this attachment made endoscopic observation and treatment more easier. In addition, the entire short clip was able to be stored into this attachment, and certainly clamped a protruded visible vessel even if the bottom of the lesion was hard. Forty-seven of 50 lesions (94.0%) had temporal hemostasis and forty-six lesions (90.0%) had permanent hemostasis. One patient with multiple gastric ulcers, advanced hepatocellular carcinoma and bleeding tendency associated with DIC had temporal hemostasis, however he died of rebleeding from the ulcers. Two patients with duodenal ulcer and one patient with gastric ulcer underwent interventional radiology because visible vessels were more than 3 mm. One patient with duodenal Dieulafoy's lesion close to papilla of Vater underwent endoscopic hemoclipping using a lateral-viewing endoscope. CONCLUSION: Endoscopic hemostasis with a distal attachment and short clips is useful against upper gastrointestinal bleeding.