In cooperation with Olympus Optical Co. (Tokyo, Japan) the author developed a detachable snare that enables the endoscopic ligation of the base of an elevated lesion. This apparatus surrounds the base of a large polyp or other elevated lesions with a specially manufactured loop, which is then tightened. This detachable snare enables the removal of large polyps and other elevated lesions without bleeding. The loop is made of nylon because the removal of an elevated lesion required high-frequency current. At Sakura National Hospital between May 1989 and October 1990, the detachable snare was used in 11 patients, including 4 with elevated gastric lesions, 2 with elevated duodenal lesions, and 5 with elevated colonic lesions. All of these elevated lesions were pedunculated or semi-pedunculated and measured greater than or equal to 20 mm in maximal diameter. In all cases, the lesions were removed effectively, resulting in a temporary, residual shallow ulcer.

Endoscopic clipping hemostasis (ECH) is an effective method to control bleeding. However, ordinary clipping apparatuses have not been widely adopted because of several disadvantages. Accordingly, we developed an improved ECH apparatus that can be used during a general endoscopic examination without requiring an assistant. It is not only easy to operate but also ensures safe and effective hemostasis. The ECH apparatus was employed in 80 patients between February 1983 and August 1987 at the Sakura National Hospital. Fifty-one of the patients had upper gastrointestinal bleeding; in 29, preventive clipping was performed after polypectomy. Permanent hemostasis was maintained in 43 (84.3%) of the patients with upper gastrointestinal bleeding, and no bleeding was recognized in any of the 29 patients treated with prophylactic clipping following polypectomy.

Injection of India ink and clipping are relatively well-known methods for marking lesions of the gastrointestinal tract. The use of metal clips provides a radiologically recognizable mark, which is also palpable at surgery. In addition, clips can be extremely useful as landmarks in comparing endoscopic findings with the resected specimen. Previous reports of clip-marking have concentrated on the Olympus (Tokyo, Japan) HX-2L clip, but this clip has the disadvantages of having too wide a diameter to be used through most conventional endoscopes and also a relatively low clip-retention rate, as the depth of its bite is limited. Recently, Olympus has marketed a new clip (HX-3L) designed by the author for hemostasis in cases of gastrointestinal bleeding. This new clip is an improved version of the cassette-type J-clip that was previously reported by the author in this journal. The prime advantage of the HX-3L is that the endoscopist can use it via a panendoscope without any assistance. In addition, it has an excellent bite and a very high level of safety. In terms of function and application, it is completely different from the HX-2L. In addition, the tip (the portion that actually grasps tissue) of the HX-3L is longer and thinner than the HX-2L, thus permitting a firm grasp of the muscularis mucosae layer even when approaching from an upper oblique angle and this, in turn, improves the performance of the clip as a marker.(ABSTRACT TRUNCATED AT 250 WORDS)

We developed a rotatable, highly durable clipping device (rotatable clip‐device) and a long clip which can be used to effectively grasp a large bite of tissue. However, application of the long clip required a special reinforced clipping device. The new rotatable clip‐device can be appropriately used in combination with the long clip because of its improved strength and rotatability. The rotatable clip‐device was used for endoscopic treatment of 133 patients, including 43 requiring hemostasis of gastrointestinal bleeding, 43 with prophylactic clipping following polypectomy, 39 with mucosal closure following endoscopic mucosal resection (EMR), and 10 undergoing prophylactic ligation of esophageal varices. The long clips were used mainly for mucosal closure after EMR. The rotatable clip‐device was found to be especially useful for hemostasis of soft bleeding lesions. Prophylactic clipping following polypectomy prevented complications in 40 out of 41 patients. Mucosal closure by means of clipping following EMR prevented complications in all 39 patients, and the rotatability of the rotatable clip‐device and the large bite capacity of the long clip greatly facilitated closing mucosal defects, especially large defects. In the 10 patients who underwent prophylactic clipping of esophageal varices, the rotatable clip‐device allowed the varices to be grasped securely and ligated effectively. During endoscopic treatment, three of the four clip‐devices functioned normally despite frequent auto‐claving and clipping procedures.

A new detachable snare for hemostasis in the removal of large polyps or other elevated lesion was developed by the author (Olympus Ligating Device). It allows ligation to be performed through the channel of an endoscope using a nonconductive loop that can be detached from the ligator. At Sakura National Hospital, endoscopic ligation with this device was performed in 80 patients from May 1989 to January 1994. The purpose of the procedure was preventive hemostasis prior to the endoscopic resection of large elevated lesions in 71 patients and for control of hemorrhage in 9 patients. The elevated lesions were polyps in 69 patients and submucosal tumor in 2, being pedunculated in 36 and semipedunculated in 35. The maximum diameter of these lesions ranged from 15 to 40 mm (mean: 23 mm), being greater than 20 mm in 57 cases. The 9 patients undergoing endoscopic ligation for hemorrhage had bleeding polypectomy stumps (n = 5), bleeding polyps (n = 3), and a bleeding esophageal varix (n = 1). Endoscopic ligation achieved the complete prevention of hemorrhage following the resection of elevated lesion in 63/71 patients (88.7%) and, in combination with a HX-3L clip, allowed endoscopic resection to be performed in 70/71 patients (98.6%). In the 9 patients with bleeding lesions, complete hemostasis was achieved without complications.