Single-Center Experience of a New Endoscopic Clip in Managing Non-Variceal Upper Gastrointestinal Bleeding

Abstract

Introduction: To assess the safety and efficacy of a new endoscopic clip in the acute endoscopic treatment of upper gastrointestinal bleeding. This is the first large series reporting this clip for achieving hemostasis. Methods: A retrospective study of patients presenting with hematemesis, melena or anemia with recent overt gastrointestinal bleeding at a tertiary care center between May 2013 and January 2016 who received clips as therapy. Demographics, pre-procedure symptoms, laboratory values, type of lesion, duration of the procedure, length of hospital stay, incidence of re-bleeding and need for additional procedures were collected. Data are expressed in absolute numbers and percentages. Results: 178 consecutive patients with upper gastrointestinal bleeding were included. Source of bleeding was identified as duodenal ulcer 29.2%, gastric ulcer 22.5%, gastro-esophageal junction tear 8.4 %, anastomosis 5.6%, erosive gastropathy 5.6%, Dieulafoy 5.1%, gastric polyp 4.5%, post endoscopic procedure 3.9%, angioectasia 3.4%, esophageal ulcer 2.8%, benign duodenal mass 2.8%, peg tube site 2.3%, gastric neoplasm 1.7%, esophagitis 1.1%, and small bowel ulcer 1.1%. Lesions demonstrated active bleeding in 47.5% (11.3% spurting and 36.2% oozing) and non-bleeding lesions in 52.5% (25.0% visible vessel, 11.9% hematin in an ulcer base, 10.0% adherent clot, 5.6% flat spot). Initial hemostasis was achieved in 96.6%. Additional methods were used in 24.1% (argon plasma coagulation and epinephrine injection in 21.3% at the index endoscopy, surgery in 0.6% and interventional radiology in 2.2%). There were no adverse events. In-hospital re-bleeding was 7.3% and 3.9% presented with re-bleeding within 30 days. Average procedure duration was 22.9 minutes and average length of hospital stay was 11.3 days. Conclusion: The new endoscopic Clip when used for upper gastrointestinal bleeding appears to be safe and effective. The re-bleeding rates are similar to other modalities of endoscopic hemostasis.Figure 1Figure 2