What is the role of hemostatic clips in the treatment of upper gastrointestinal bleeding (UGIB)?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Hemostatic clips are widely available and used in the United States.

With careful placement of the clip, closing the defect in the vessel is possible. Often, depending on the lesion and progress to affect hemostasis, multiple clips are applied. Typically, they become detached and pass from the GI tract within 2 weeks. Hemostatic clips are considered magnetic resonance imaging (MRI)-conditional because they are metallic, and they can serve as radiopaque markers to direct the interventional radiologist during angiography to the relevant area if endoscopy fails to achieve adequate hemostasis. These clips vary in their size and strength. Numerous manufacturers have produced hemostatic clips, with the most significant advancements being the ability to rotate for accurate placement and the ability to reopen and reapply when necessary.

There are substantial data documenting the efficacy of hemoclips, which is similar to that of thermal coagulation methods. [19, 141]

One report, concerning 113 patients with major stigmata of ulcer hemorrhage, found no difference between the use of hemoclips and photocoagulation with regard to hemostasis, 30-day mortality, and the need for emergency surgery. [56] Patients randomized to the endoclip group had significantly lower rebleeding rates (2% vs 21%). However, only 60% of active bleeders were successfully treated with the heater probe, a rate much lower than in previous reports.

A study of 80 patients found a higher rate of control of initial bleeding with the heater probe compared with the Olympus endoclip (100% vs 85%). [57] Rebleeding rates were not significantly different.

No significant differences in procedure duration, initial hemostasis, or rebleeding rates were found in a study of 47 patients comparing combination therapy with epinephrine injection plus monopolar electrocoagulation versus hemoclips. [58]


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