CASE REPORT: The Hemoclip: A Novel Approach to Endoscopic Therapy for Esophageal Perforation

Blocksom, Jason M.; Sugawa, Choichi; Tokioka, Satoshi; Williams, Mallory

doi:10.1023/b:ddas.0000037800.78510.0d

Cited by 23 publications

(25 citation statements)

References 7 publications

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“…Currently there are three basic categories of hemostatic agents or procedures: chemical, thermal, and mechanical [1,3,6,8,[10][11][12][13][14][15]. Chemical agents are those that change the clotting activity of the blood or act as vasoconstrictors, such as thromboxane A2 [16], which causes vessels to contract thus reducing blood flow and promoting clotting [7,16,17].…”

mentioning

confidence: 99%

“…There are also agents that react exothermically upon application that may create an effect similar to a standard two probe cautery device [1,14]. Mechanical methods use pressure or ligature to slow the blood flow [3]. A combination therapy might use both chemical and mechanical means to produce a hemostat that adsorbs fluid and swells [18], producing pressure to slow the blood flow and allow clotting, or it may involve the introduction of fibrinogen, thrombin, and calcium to produce fibrin glue, which acts as an artificial clot [1,2,5,6,8,10,14,19].…”

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confidence: 99%

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Nano hemostat solution: immediate hemostasis at the nanoscale

Ellis-Behnke

Liang

Tay

et al. 2006

Nanomedicine: Nanotechnology, Biology and Medicine

234

199

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Hemostasis is a major problem in surgical procedures and after major trauma. There are few effective methods to stop bleeding without causing secondary damage. We used a self-assembling peptide that establishes a nanofiber barrier to achieve complete hemostasis immediately when applied directly to a wound in the brain, spinal cord, femoral artery, liver, or skin of mammals. This novel therapy stops bleeding without the use of pressure, cauterization, vasoconstriction, coagulation, or cross-linked adhesives. The self-assembling solution is nontoxic and nonimmunogenic, and the breakdown products are amino acids, which are tissue building blocks that can be used to repair the site of injury. Here we report the first use of nanotechnology to achieve complete hemostasis in less than 15 seconds, which could fundamentally change how much blood is needed during surgery of the future.

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mentioning

confidence: 99%

mentioning

confidence: 99%

Nano hemostat solution: immediate hemostasis at the nanoscale

Ellis-Behnke

Liang

Tay

et al. 2006

Nanomedicine: Nanotechnology, Biology and Medicine

234

199

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“…Reports in the lit− erature describe the use of the clips to treat post−esophagectomy leaks [5], spontaneous perforations [6], leaks following hydro− static balloon dilation for esophageal achalasia [7], and submu− cosal resection of tumors in the esophagus [8]. Most endosco− pists [4 ± 8] have used two to four clips, and only a single session has been required in most cases, but Rodella et al [5] reported two applications in one patient and three in another.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Clip Application for Postoperative Residual Esophageal Duplication Cyst

Kochhar

Saluja²,

Singh³

et al. 2006

Endoscopy

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A 35−year−old woman presented with coughing, left−sided chest pain, and high−grade intermittent fever that had persisted for 3 weeks. She had received a course of antibiotics for a week, with− out any response. At admission, the clinical examination was un− remarkable except for toxemia. The chest examination did not reveal any abnormality. A chest radiograph showed mediastinal widening and chest computed tomography revealed a cyst 8 10 4 cm in size communicating with the mid−esophagus, with an air±fluid level. An infected esophageal duplication cyst was diagnosed and the patient underwent surgery. Due to exten− sive adhesions, however, only partial excision of the cyst was achieved, and only a partially successful attempt could be made to suture the defect in the esophageal wall. Ten days after sur− gery, the patient developed chest pain, with a spiking fever. A contrast study revealed an esophageal leak into the posterior mediastinum (Figures 1 a). An upper endoscopic examination re− vealed a tear 7 ± 8 mm long in the mid−esophagus (Figures 2 a).After the patient had provided informed consent, metallic clips (Olympus, Tokyo, Japan) were applied to close the leak (Fig− ures 2 b). The first clip was only able to catch one wall of the leak− age site, but the use of two more clips led to successful approxi− mation of the edges of the leak. The patient was kept nil per os for 72 h and given broad−spectrum antibiotics. A repeat contrast study on day 15 (Figures 1 b) and endoscopic examinations on days 7 and 21 revealed complete healing of the leak. The histolo− gy of the excised cyst showed features of a congenital duplication cyst. DiscussionEsophageal duplication cysts generally present in childhood [1,2]. Patients with duplication cysts in the upper third of the esophagus, as in the case described here, rarely reach adult life without experiencing any symptoms [3]. Mediastinitis occurs rarely in these patients [2]. The present patient presented for the first time with a mediastinal fluid collection at 35 years of age. Due to adhesions around the cyst, complete excision was not possible, and an attempt was made to close the esophageal defect, which failed. In these circumstances, a repeat exploration can be fraught with complications, and it was therefore decided to use Hemoclips to close the esophageal defect.

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“…Böylece hastane yatış süre-si ve morbidite artar. Bu dezavantajlar nedeniyle son zamanlarda özofagial perforasyonlarda cerrahisiz tedaviye yönelen otörler olmuştur (73)(74)(75)(76)(77)(78)(79). Tedavi prensiplerinde fibrin glue enjeksiyonu, klips kullanı-mı ve kendiliğinden genişleyebilen kaplı stentler gibi endoskopik işlemlere doğru meyil olmaya başlamıştır.…”

Section: Minimal İnvaziv Tekniklerunclassified

“…Tedavi prensiplerinde fibrin glue enjeksiyonu, klips kullanı-mı ve kendiliğinden genişleyebilen kaplı stentler gibi endoskopik işlemlere doğru meyil olmaya başlamıştır. Endoskopik işlemler ağrının az olması, hastane yatış süresinin ve maliyetin azalması gibi ek faydalara sahiptir (75,76).…”

Section: Minimal İnvaziv Tekniklerunclassified