Endoscopic Hemoclip Placement Research Articles

Endoscopic band ligation versus endoscopic hemoclip placement for Dieulafoy's lesion: a meta-analysis.

Dieulafoy lesions (DL) are abnormally large arterial lesions that fail to decrease in size as they emerge from the submucosa to the mucosal surface. Endoscopic treatment has become the mainstay of therapy for actively bleeding DL lesions. In this meta-analysis, we aim to assess the efficacy of both techniques in achieving primary hemostasis of actively bleeding DL lesions and their rates of rebleeding. Our search included the Pubmed, Scopus and CINAHL electronic databases. The initial search yielded 440 articles and after appropriate review by 2 individual reviewers, 5 studies met inclusion criteria. Review manager version 5.3 was used for statistical analysis. There were 75 patients treated with EBL and 87 patients treated with EHC. The success rate of primary hemostasis of EBL for bleeding DL lesions was 0.96 [95% confidence interval (CI): 0.88-0.99]. The success rate of primary hemostasis of EHC for bleeding DL lesions was 0.91 (95% CI: 0.83-0.96). The recurrence of bleeding for patients treated with EBL was 0.06 (95% CI: 0.02-0.15). The recurrence of bleeding for patients treated with EHC was 0.17 (95% CI: 0.10-0.28). There was no statistical significance in primary hemostasis or rebleeding in patients treated with EBL or EHC. There was no significant heterogeneity between studies included in the analysis. Endoscopic band ligation and endoscopic hemoclip placement are efficacious procedures for the treatment of NVUGIB secondary to DL with similar rates of primary hemostasis and rebleeding.

Solitary Rectal Ulcer Syndrome with a Visible Vessel: An Uncommon Cause of Lower GI Bleeding

Solitary Rectal Ulcer Syndrome with a Visible Vessel: an Uncommon Cause of Lower GI Bleeding Introduction: Solitary rectal ulcer syndrome (SRUS) is a rare condition affecting both healthy and immunocompromised patients. Presenting symptoms are diverse but can include rectal bleeding in up to 25% of patients. Case: A 51 year old man with PMH including HIV on HAART, HCV cirrhosis, c.difficile colitis and solitary rectal ulcer syndrome (SRUS) presented to the emergency room with new onset hematochezia and clot passage for 3 days. He reported associated tenesmus and constant left lower quadrant abdominal pain. His medical history was notable for diverticulosis and left hemicolectomy with renanastamosis 15 years prior. He reported recent anal intercourse with 1 partner and had used an enema for constipation prior to symptom onset. On evaluation, the patient was tachcardic and hypotensive. Physical exam was significant for left lower quadrant tenderness without rebound, guarding, or masses. Rectal exam showed gross blood, with mild tenderness on inspection and no hemorrhoids or fissures. Lab work demonstrated hemoglobin of 7.7 g/dL, WBC count of 2.1K/mcL, platelets of 57K/mcL and INR of 1.5. He received IV fluid and blood products and was admitted for further workup. Colonoscopy revealed persistent sharp angular ulcerations in the rectum without erythema or colitis. A prominent visible vessel seen in an ulcer bed. A hemoclip was placed successfully. Ulcer histopathology demonstrated mucosal prolapse without architectural distortion. Stains were negative for viral pathogens. The patient's hemoglobin stabilized and he was advised to avoid rectal trauma.Figure 1Figure 2Discussion: Symptoms of SRUS can include bleeding, mucoid discharge, perineal and abdominal pain, feeling of incomplete defecation, constipation and overt rectal prolapse. The pathogenesis is poorly understood but may be related to trauma or shear forces during defecation in combination with mucosal ischemia. Treatment options include bulking agents, topical therapies, biofeedback, and surgery. Bleeding from SRUS has been reported, but visualization of a visible vessel is rare. Dieulafoy-like lesions have been described in the context of stercoral ulcers but to our knowledge, no case of a visible vessel has been reported in SRUS. Endoscopic hemoclip placement was successful for acute treatment in this patient with follow up colonoscopy showing ulcer improvement after 6 weeks.

Clinical outcome of endoscopic management of duodenal Dieulafoy's lesions: endoscopic band ligation versus endoscopic hemoclip placement.

The most appropriate type of endoscopic hemostasis for bleeding due to duodenal Dieulafoy's lesions (DLs) is not yet established. The aim of this study was to assess the efficacy of mechanical endoscopic hemostasis for duodenal DLs and long-term outcome after successful hemostasis, as well as to compare the efficacy and safety of endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP). Patients admitted to the emergency unit with acute upper gastrointestinal bleeding from duodenal DLs were enrolled in this study. The data were collected prospectively, but data analysis was performed retrospectively. Twenty-four patients with duodenal DLs were treated with EBL (n=11) or EHP (n=13). There were no significant differences between groups with respect to clinical or endoscopic characteristics, apart from the number of epinephrine (three cases with EBL vs. 11 cases with EHP; p=0.011). Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient (9.1%) from the EBL group and in five patients (38.5%) from the EHP group (p=0.166). The recurrent bleeding in the patient from the EBL group was treated by EHP. In the EHP group, all five patients achieved successful secondary hemostasis by endoscopic treatment (EBL in two patients and EHP in three patients). There were no differences in secondary outcomes between the two groups, including the number of endoscopic sessions required, need for angiographic embolization or emergent surgery, transfusion requirements, or length of hospital stay. No complications occurred, and there was no recurrence of bleeding in either group during the follow-up period. Mechanical endoscopic treatments are effective and safe for the treatment of bleeding duodenal DLs. A large-scale, randomized, controlled study is required to confirm the efficacy and safety of EBL and EHP for the management of bleeding duodenal DLs.

Endoscopic Management of Rectal Dieulafoy's Lesion: A Case Series and Optimal Treatment.

Rectal Dieulafoy's lesion (DL) is rare cause of lower gastrointestinal bleeding. Because of its rarity, there is no consensus on the optimal endoscopic hemostasis technique for rectal DL. We analyzed six patients who underwent endoscopic management for rectal DL after presenting with hematochezia at a single institute over 10 years. Of the six patients, three underwent endoscopic band ligation (EBL) and three underwent endoscopic hemoclip placement (EHP). Only one patient was treated with thermocoagulation. There were no immediate complications in any of the patients. None of the patients required a procedure or surgery for the treatment of rebleeding. Mean procedure times of EBL and EHP were 5.25 minutes and 7 minutes, respectively. Both EHP and EBL are shown to be effective in the treatment of bleeding rectal DL. We suggest that EBL may have potential as the preferred therapy owing to its superiority in technical and economic aspects, especially in elderly and high-risk patients.

Lower GI Bleed due to Dieulafoy Lesion in Ascending Colon with Histopathological Confirmation

Figure: No Caption available.Purpose: Dieulafoy disease is a rare cause of upper gastrointestinal bleeding and even rarer for colonic bleed. The dieulafoy lesion of the colon was first described by Barbier in 1985.We present a patient who had multiple dieulafoy lesions in the ascending colon, underwent endoscopic therapy and finally surgical resection with histopathologic confirmation of the dieulafoy lesion underneath endoscopically applied hemoclips. Patient is a 71-year-old male with past medical history of coronary artery disease, stroke, and pulmonary embolism on Coumadin presented with symptomatic anemia due to lower GI bleed in December 2011. His Hb was 9 with normal MCV. At that time he was found to have a Dieulafoy lesion of the ascending colon and underwent endoscopic ablation with endoscopic hemoclip placement. He presented with recurrent lower GI bleeding three times in next 8 months needing colonoscopy each visit and underwent endoscopic placement of hemoclips and epinephrine injection of dieulafoy lesions with successful hemostasis. Videos and still images of the bleeding lesion were obtained as well as images of endoscopic metallic clip placement and injection therapy. Due to his history of pulmonary embolism requiring anticoagulation therapy, coronary artery disease and need for multiple blood transfusions of each episodes of GI bleeding, surgical consultation for colonic resection was obtained. Following resection of the ascending colon, the pathologist was able to perform cuts on gross specimen between the two endoclips applied during his last endoscopy and histopathologic evaluation confirmed the presence of a colonic Dieulafoy lesion. The patient has remained clinically stable without the further signs of GI bleeding since his colon resection. Colonic Dieulafoy lesions are uncommon source for gi bleeding but confirmation with histopathologic proof of the clinical impression is exceedingly rare.

Hemostatic efficacy and clinical outcome of endoscopic treatment of Dieulafoy's lesions: comparison of endoscopic hemoclip placement and endoscopic band ligation

The most suitable mechanical endoscopic hemostasis for a bleeding Dieulafoy's lesion (DL) is not yet well established. To compare the hemostatic efficacy and clinical outcome of endoscopic hemoclip placement (EHP) and endoscopic band ligation (EBL). Retrospective, single-center study. A tertiary-care referral university hospital. Sixty-six patients who received mechanical endoscopic hemostasis for bleeding DLs. Endoscopic hemostasis. Primary hemostasis and rebleeding rates. DLs accounted for 3.8% of cases of acute nonvariceal upper GI bleeding during the study period. Active bleeding from DLs was noted in 34 patients (51.5%). EHP and EBL were performed as a method of endoscopic hemostasis in 34 and 32 patients, respectively. There were no significant differences between the 2 groups with respect to baseline characteristics (except comorbidities) and endoscopic features of DLs. Primary hemostasis was achieved in all 66 patients (100%). There were 6 cases of recurrent bleeding: 5 (14.7%) and 1 (3.1%) in the EHP and EBL groups, respectively. Secondary hemostasis was achieved with endoscopic treatment and angiographic embolization in 5 patients and 1 patient, respectively, and no patients required surgery. The mean procedure time of endoscopic hemostasis was significantly longer in the EHP group (19.1 vs 11.5 minutes, P = .015). There was no bleeding-related mortality. Retrospective analysis. Both EHP and EBL are suitable for the treatment of bleeding DLs. EBL can be used as an initial hemostatic method for bleeding DLs because of a favorable clinical outcome comparable to that with EHP and a shorter procedure time.

235 Hemostatic Efficacy and Clinical Outcome of Endoscopic Treatment for Dieulafoy's Lesions: Comparison Between Endoscopic Hemoclip Placement and Endoscopic Band Ligation

235 Hemostatic Efficacy and Clinical Outcome of Endoscopic Treatment for Dieulafoy's Lesions: Comparison Between Endoscopic Hemoclip Placement and Endoscopic Band Ligation

Small Bowel Perforation Attributed to Endoscopic Hemoclip Placement: A Case Report

Purpose: Endoscopic hemoclips are used routinely to stop gastrointestinal bleeding. Perforation after hemoclip placement is a very rarely reported complication. We report here on a perforation after use of hemoclips on a bleeding vessel within a jejunal diverticulum. Case Report: A 79-year-old woman with a reported history of Crohn's and coronary disease was admitted to an outside hospital with bilateral pneumonia and blue-tinged fingers. After developing atrial fibrillation, she was transferred to our institution where she was diagnosed with a small-vessel vasculitis, likely lupus, based on antibody testing. GI was consulted to assess her history of Crohn's and its possible relation to the vasculitis. Colonoscopy and ileoscopy with random biopsies were normal. MRI enterography showed an ileal linear ulcer concerning for Crohn's versus lymphoma. While on heparin for the atrial fibrillation and vasculitis, she developed melenic stools. During an extended EGD, an exposed vessel in a proximal jejunum diverticulum with active bleeding was noted; and two hemoclips were successfully deployed on the vessel. There were no acute changes in the patient's condition over the next few days. However, a CT scan was done six days after hemoclip placement to further elucidate the ileal lesion, with the unexpected finding of oral contrast spilling into the peritoneum near the jejunum. A perforated duodenal diverticulum was found at surgery with hemoclips protruding through the perforation. Despite a segmental resection with primary jejuno-jejunal anastomosis, she developed free abdominal air, likely related to another perforation, two weeks later, by which time she was requiring pressor support, ventilation support, and dialysis. Given the patient's deteriorating medical condition, her family withdrew care. Discussion: Multiple reports suggest that hemoclips can be used safely to stop bleeding in both the upper and lower GI tracts. In a previous report, a hemoclip placed on a Dieulafoy's lesion in a peri-ampullary duodenal diverticulum led to a perforation. Perforation has also occurred after hemoclip placement in a post-polypectomy ulcer in the colon. These cases suggest that care should be taken when placing hemoclips in thin-walled areas of the GI tract. Whereas the earlier patients improved with conservative therapy and surgical repair, respectively, our patient eventually succumbed to multi-organ failure related to her multiple comorbidities.

Bleeding Duodenal Diverticulum – Hemostasis after Endoscopic Hemoclip Placement

Purpose: To highlight a rare cause of overt upper gastrointestinal bleeding successfully controlled with endoscopic hemoclip placement. Methods: N/A Results: Patient: A 90 year old woman presented to an outside hospital with one day of melena and hematemesis. She had no previous history of gastrointestinal disease. Her medical history was significant for hypertension, diabetes, and end-stage renal disease on hemodialysis. At initial presentation to the outside hospital she was hemodynamically stable with a hemoglobin of 9.8. Endoscopy revealed a bleeding duodenal diverticulum which was injected with epinephrine, though hemostasis was not confirmed. She was transferred to our institution for either selective arterial embolization or surgical intervention. On arrival, she was orthostatic with a 20 mmHg drop in blood pressure. She was mildly lethargic with normal cardiopulmonary exam and a soft, nontender abdomen. Several hours after arrival, she had an episode of hematochezia and bright red blood was lavaged from her nasogastric tube. Laboratory data revealed a hemoglobin drop of 4 grams (from 11 to 7.2). Emergent endoscopy was performed which revealed a large wide-mouthed diverticulum in the third portion of the duodenum. There was an actively bleeding arterial vessel within the diverticular sac, though no associated mucosal defect was identified. Complete hemostasis was achieved with injection of 9 cc of 1:10,000 epinephrine followed by placement of two hemostatic clips across the bleeding vessel. Afterwards the area was irrigated with saline with removal of residual clot and without evidence of further bleeding. The remainder of her hospital stay was uneventful and she was discharged home after a 5 day hospital course. Conclusion: Discussion: Duodenal diverticula are commonly discovered on routine evaluation of the upper gastrointestinal tract. Though typically asymptomatic, these diverticula have been associated with duodenal or biliary obstruction and diverticulitis. Additionally they represent a rare and often overlooked source of gastrointestinal hemorrhage. No consensus currently exists to guide management of bleeding duodenal diverticula. Traditional methods have included surgical diverticulectomy or selective arterial embolization. In this elderly patient with multiple comorbidities, rapid endoscopic diagnosis with successful hemostatic clipping offered a less invasive and safer alternative. This case highlights an atypical source of overt gastrointestinal hemorrhage managed effectively with therapeutic endoscopy.

Endoscopic band ligation and endoscopic hemoclip placement for patients with Mallory-Weiss syndrome and active bleeding

To compare the hemostatic efficacy and safety of two mechanical endoscopic methods: endoscopic band ligation (EBL) and endoscopic hemoclip placement (EHP) in patients with actively bleeding Mallory-Weiss syndrome (MWS). A prospective randomized study to compare the efficacy and safety of EHP with EBL was performed from January 2002 to August 2005. Forty-one patients with active bleeding from MWS were treated with EHP (n = 21) or EBL (n = 20). There were no significant differences between groups with respect to clinical and endoscopic characteristics. The mean number of hemoclips applied was 3.2 +/- 1.5 and the mean number of bands applied was 1.2 +/- 0.4. Primary hemostasis was achieved in all patients. Recurrent bleeding was observed in one patient from the EHP group and two from the EBL group. Patients with recurrent bleeding were treated by the same modality as at randomization and secondary hemostasis was achieved in all. There were no significant differences between the two groups in total transfusion amount or duration of hospital stay. No complications or bleeding-related death resulted. EHP and EBL are equally effective and safe for the management of active bleeding in patients with Mallory-Weiss syndrome, even in those with shock or comorbid diseases.

Urgent Colonoscopy for the Diagnosis and Treatment of Severe Lower GI Bleeding and Acute Colorectal Obstruction

Background and Aim: Although urgent colonoscopy is often used to diagnose and treat severe lower gastrointestinal (GI) bleeding, its role in the management of acute colorectal obstruction is uncertain. Regardless of the site of colorectal obstruction, the development of a new device and techniques for its use have made it possible to endoscopically decompress acute colorectal obstruction (GI Endoscopy 2001;54:229-32). The aim of this study was to clarify the role of urgent colonoscopy in the diagnosis and treatment of acute colorectal obstruction in addition to severe lower GI bleeding. Method: From January 2001 to November 2004, 106 patients (64 males and 42 females, age 46 to 94, mean = 68.7) were identified in a colorectal database, and their cases were reviewed. All patients were hospitalized because of severe hematochezia or acute colorectal obstruction based upon abdominal CT findings. Urgent colonoscopy was performed within 24 hours for the purpose of the definite diagnosis of active lower GI bleeding or acute colorectal obstruction. After the diagnosis was confirmed, endoscopic hemoclip placement or endoscopic decompression using a transanal drainage tube was attempted. Results: In 49 (92.5%) of 53 patients who had severe lower GI bleeding, endoscopic hemoclip placement was successful. The etiology of lower GI bleeding was post-polypectomy bleeding (17), diverticulosis (14), postoperative bleeding (8), anorectal bleeding (5) or other (5). In 4 patients, bleeding sources were not identified. Endoscopic decompression by means of a transanal drainage tube was technically successful in 50 of 53 patients (94.3%). Two patients had colonic perforation. The site of obstruction was cecum in 3, ascending colon in 4, transverse colon in 5, descending colon in 11, sigmoid colon in 18, and rectum in 12. Following adequate cleansing of the colon, 42 patients underwent surgery after 7 days ± 3.2 (SD; range, 4-10 days). Stent placement was used as final palliative treatment in 4 patients. Conclusions: Urgent colonoscopy is very useful for the treatment and management of acute colorectal obstruction as well as severe lower GI bleeding. Since endoscopic decompression using a transanal drainage tube seems to be effective, acute colorectal obstruction should be considered as another indication for urgent colonoscopy to prevent emergency surgery in addition to severe lower GI bleeding. Background and Aim: Although urgent colonoscopy is often used to diagnose and treat severe lower gastrointestinal (GI) bleeding, its role in the management of acute colorectal obstruction is uncertain. Regardless of the site of colorectal obstruction, the development of a new device and techniques for its use have made it possible to endoscopically decompress acute colorectal obstruction (GI Endoscopy 2001;54:229-32). The aim of this study was to clarify the role of urgent colonoscopy in the diagnosis and treatment of acute colorectal obstruction in addition to severe lower GI bleeding. Method: From January 2001 to November 2004, 106 patients (64 males and 42 females, age 46 to 94, mean = 68.7) were identified in a colorectal database, and their cases were reviewed. All patients were hospitalized because of severe hematochezia or acute colorectal obstruction based upon abdominal CT findings. Urgent colonoscopy was performed within 24 hours for the purpose of the definite diagnosis of active lower GI bleeding or acute colorectal obstruction. After the diagnosis was confirmed, endoscopic hemoclip placement or endoscopic decompression using a transanal drainage tube was attempted. Results: In 49 (92.5%) of 53 patients who had severe lower GI bleeding, endoscopic hemoclip placement was successful. The etiology of lower GI bleeding was post-polypectomy bleeding (17), diverticulosis (14), postoperative bleeding (8), anorectal bleeding (5) or other (5). In 4 patients, bleeding sources were not identified. Endoscopic decompression by means of a transanal drainage tube was technically successful in 50 of 53 patients (94.3%). Two patients had colonic perforation. The site of obstruction was cecum in 3, ascending colon in 4, transverse colon in 5, descending colon in 11, sigmoid colon in 18, and rectum in 12. Following adequate cleansing of the colon, 42 patients underwent surgery after 7 days ± 3.2 (SD; range, 4-10 days). Stent placement was used as final palliative treatment in 4 patients. Conclusions: Urgent colonoscopy is very useful for the treatment and management of acute colorectal obstruction as well as severe lower GI bleeding. Since endoscopic decompression using a transanal drainage tube seems to be effective, acute colorectal obstruction should be considered as another indication for urgent colonoscopy to prevent emergency surgery in addition to severe lower GI bleeding.

A new type of hemoclip device

Background: There are many endoscopic techniques for hemostasis of non‐variceal upper GI bleeding. Endoscopic hemoclip placement is one of the most important techniques. A rotatable clip‐fixing device developed by Olympus Co. (Tokyo, Japan) has come into widespread use in Japan. However, it involves a number of problems, such as requirement of skill for attachment and it is time‐consuming.Materials: We developed a new type of hemoclip device with collaboration with Olympus Co.Results: We explain the new type of hemoclip device and how to use it. Finally, we examine the convenience of the new type of hemoclip compared with previous devices.Conclusion: Hemoclip placement for bleeding of GI tract seems to be very convenient now and may become common in the world in the future.

The Usefulness of Endoscopic Treatment Compared Hemoclipping with Band Ligation on Active Bleeding of Mallory-Weiss Syndrome

Background : Mallory-Weiss Syndrome (MWS) is considered to be the cause of 4.5% to 11% of all UGI bleedings. In most cases, MWS bleeding stops spontaneously. However, when the bleeding is active, it persists in 50% of the cases. The recent studies also shows that endoscopic methods are effective for the treatment of active bleeding caused by MWS. Nonetheless, the debate continues over what to use for endoscopic treatment. The aim of this study is to investigate the respective efficacy and safety of endoscopic hemoclip placement and endoscopic band ligation (EBL) in MWS. Method : A randomized, open-labelled study to compare the efficacy and safety of hemoclipping with those of EBL was performed from December 2001 to August 2003. 30 patients with active bleeding from MWS were treated with endoscopic hemoclipping (n=17) or band ligation (n=13). Efficacy was resulted by primary hemostasis, rebleeding rate, secondary hemostasis, permanent hemostsis after primary or secondary hemostasis, total transfusion amount, or the length of hospital stay. Safety was also assessed by observing the complication during procedure. Result : There were no significant differences between the two groups with respect to age, gender, hemoglobin level, shock rate, stigmata of bleeding, or locations of laceration. The mean number of hemoclips applied was 2.9±1.2 and the mean number of bands applied was 1.2±0.4. Primary hemostasis was achieved in all 30 patients. Recurrent bleeding was observed in 3 patients from hemoclipping group (n=1) and band ligation group (n=2). However, no significant difference was found (p=0.565). The patients with recurrent bleeding were treated by the same endoscopic procedure performed at primary hemostasis, and secondary hemostasis was achieved in all recurrent bleeding patients. Moreover, for the total transfusion amount and length of hospital stay, there was no significant difference between the two groups. No complications or bleeding related death resulted. Conclusion : Endoscopic hemoclip placement and endoscopic band ligation are equally effective and safe for the management of active bleeding in Mallory-Weiss syndrome, even in patients with shock or comorbid disease.

A prospective, randomized trial of endoscopic hemoclip placement and distilled water injection for treatment of high-risk bleeding ulcers

Background: Although endoscopic hemoclip therapy is widely used in the treatment of GI bleeding, there are few prospective trials that assess its efficacy. This study evaluated the efficacy and safety of hemoclip placement and distilled water injection for the treatment of high-risk bleeding ulcers. Methods: Seventy-nine patients with major stigmata of ulcer hemorrhage were randomly assigned to either endoscopic hemoclip placement (n = 39) or injection with distilled water (n = 40). Results: Initial hemostasis was achieved in all patients treated with hemoclips and 39 treated by distilled water injection (respectively, 100.0% vs. 97.5%; p = 1.00). Bleeding recurred in 4 and 11 of patients, respectively, in the hemoclip and water injection groups. It occurred significantly more frequently in the injection group (hemoclip, 10.3%; injection, 28.2%; p = 0.04). No major procedure-related complication occurred in either group. Emergency operations were performed in 5.1% of patients treated with hemoclips versus 12.5% of those in the water injection group (p = 0.43). Hospital days and mortality rate were similar in both groups. Conclusion: Endoscopic hemoclip placement is a safe and effective hemostatic method that is superior to distilled water injection for treatment of bleeding peptic ulcer. (Gastrointest Endosc 2003;57:324-8.)

Endoscopic hemoclip placement and epinephrine injection for Mallory-Weiss syndrome with active bleeding

Background: Mallory-Weiss syndrome with active bleeding requires effective hemostasis. This is an investigation of the respective efficacy and safety of endoscopic hemoclip placement and endoscopic epinephrine injection in Mallory-Weiss syndrome. Methods: Thirty-five patients with Mallory-Weiss syndrome with spurting vessels or oozing in a university hospital were enrolled prospectively and randomly assigned to endoscopic hemoclip placement (18 patients) or endoscopic epinephrine injection (17 patients) performed by 4 endoscopists with similar clinical experiences. Demographic characteristics, endoscopic variables, and outcome parameters as well as rates of hemostasis and recurrent bleeding were analyzed. Results: The mean (SD) number of hemoclips applied was 2.5 (1.2) and the mean volume of injection was 7.9 (4.3) mL. Primary hemostasis was achieved in all 35 patients. In each group there was 1 case of recurrent bleeding. Secondary hemostasis was achieved by repeating the same procedures as at randomization in both cases. There were no significant differences in age, gender, prior ingestion of alcohol, presenting symptoms, hemoglobin level, shock, comorbid diseases, bleeding stigmata, tear location, blood transfusion, or hospitalization between the groups. There were no procedure-related complications in either group; surgery was not required in any patient. For both groups, there were no second episodes of recurrent bleeding, procedure-related complication, or need of operation. Conclusion: Endoscopic hemoclip placement and endoscopic epinephrine injection are equally effective and safe for the management of active bleeding in Mallory-Weiss syndrome, even in patients with shock or comorbid diseases. (Gastrointest Endosc 2002;55:842-6.)

Endoscopic hemoclip placement for post-sphincterotomy bleeding

Endoscopic hemoclip placement for post-sphincterotomy bleeding

Endoscopic hemoclip treatment for bleeding peptic ulcer.

AIM:To evaluate the efficacy of endoscopic hemoclip in the treatment of bleeding peptic ulcer.METHODS:Totally, 40 patients with F1a and F1b hemorrhagic activity of peptic ulcers were enrolled in this uncontrolled prospective study for endoscopic hemoclip treatment.We used a newly developed rotatable clip-device for the application of hemoclip (MD850) to stop bleeding. Endoscopy was repeated if there was any sign or suspicion of rebleeding, and re-clipping was performed if necessary and feasible.RESULTS:Initial hemostatic rate by clipping was 95%, and rebleeding rate was only 8%.Ultimate hemostatic rates were 87%, 96%, and 93% in the F1a and F1b subgroups, and total cases, respectively.In patients with shock on admission, hemoclipping achieved ultimate hemostasis of 71% and 83% in F1a and F1b subgroups, respectively.Hemostasis reached 100% in patients without shock regar-dless of hemorrhagic activity being F1a or F1b. The average number of clips used per case was 3.0 (range 2-5). Spurting bleeders required more clips on average than did oozing bleeders (3.4 versus 2.8). We observed no obvious complications, no tissue injury, or impairment of ulcer healing related to hemoclipping.CONCLUSION: Endoscopic hemoclip placement is an effective and safe method. With the improvement of the clip and application device, the procedure has become easier and much more efficient. Endoscopic hemoclipping deserves further study in the treatment of bleeding peptic ulcers.

Endoscopic hemoclip treatment for gastrointestinal bleeding.

We conducted an uncontrolled study to evaluate an improved metallic clip (Olympus hemoclip) for the endoscopic treatment of nonvariceal gastrointestinal bleeding. A total of 88 patients (mean age 63 +/- 14, 60 males) with bleeding from a wide range of sources were treated. Seventy-eight patients had active bleeding (spurting in 50, oozing in 28) and 10 patients had a nonbleeding visible vessel. Initial hemostasis was achieved in all patients with active bleeding. A total of 255 clips were placed (average of 2.9 clips per patient, range of 1-10 clips). Spurting arterial bleeders required more clips on average than oozing bleeders (3.2 versus 2.7); active bleeders required more clips than cases with nonbleeding visible vessels (3.0 versus 2.2). Mean follow-up was 397 +/- 148 days. Recurrent bleeding was observed in 5 patients, all of whom had active bleeding on initial presentation. Re-bleeding was successfully treated with hemoclips in 4 patients and one patient underwent surgery. Clips appeared to be retained well; early clip dislodgement resulted in rebleeding in only 1 patient. No complications resulted from this treatment. Clips did not impair healing of peptic ulcers. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating nonvariceal gastrointestinal bleeding and deserves comparative studies with other methods of endoscopic hemostasis.