What is the role of endoclips 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

There are some clinical settings in which endoclips may be preferred over other hemostatic methods. These include the treatment of ulcers in patients who are coagulopathic or who require ongoing anticoagulation; in such patients, electrocoagulation will increase the size, depth, and healing time of treated lesions. Endoclips may also be preferable in the retreatment of lesions that rebleed after initial thermal hemostasis. Finally, some endoscopists, including this author, may choose endoclips as their method of choice for hemostasis to avoid the potential for tissue destruction altogether, thus allowing a potentially safer setting to use any method of choice if repeat endoscopy for hemostasis is required.

Ulcers on the lesser curvature, the posterior duodenum, or the cardia increase the difficulty of clip deployment and clip failure rates.

Larger endoclips, such as the over-the-scope clips, have advantages over smaller hemoclips for the hemostasis of chronic ulcers, fibrotic lesions, and the closure of larger lesions. However, the use of the over-the-scope clips can be cumbersome in upper GI bleeding and, therefore, these clips have been more commonly used in refractory bleeding or as a salvage maneuver, but there are data showing efficacy of these clips as a primary modality. [142, 143]


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