Comparison of monopolar hemostatic forceps with soft coagulation versus hemoclip for peptic ulcer bleeding: a randomized trial (with video)

Monopolar hemostatic forceps with soft coagulation: earning a place in the endoscopic hemostasis repertoire for peptic ulcer bleeding

“…In another randomized study by Arima et al 14 (sample size Z 96) comparing MHFSC with hemoclips in gastric ulcer bleeding, the hemostasis success rate and recurrent bleeding rate were found to be similar. By contrast, the current study by Toka et al 11 included both gastric ulcers (n Z 53) and duodenal ulcers (n Z 59) and demonstrated better initial hemostasis success and lower risk of 7-day recurrent bleeding in the MHFSC group. How can the difference in clinical outcomes be explained?…”

“…In this study, when compared with patients who received hemoclips, those after MHFSC were found to have a significantly higher initial hemostasis success rate (98.2% in the MHFSC group vs 80.4% in the hemoclip group, P Z .004), lower 7-day recurrent bleeding rate (3.6% in the MHFSC group vs 17.7% in the hemoclip group, P Z .04), shorter duration of endoscopic procedures, and shorter length of hospital stay. 11 No procedure-related adverse event was observed in both groups. The authors concluded that MHFSC is a safe thermal therapy and is more effective than hemoclips in achieving initial hemostasis in peptic ulcer bleeding.…”

“…MHF is in theory associated with a lower risk of perforation because of reduced coagulation effect at the deep tissue level. [11][12][13][14] However, the utility of MHFSC in the treatment of peptic ulcer bleeding has been less well studied.…”

Endoscopic clipping for gastrointestinal bleeding: emergency and prophylactic indications

“…A meta-analysis of prospective RCTs reinforced that epinephrine injection alone results in higher rates of rebleeding and requirement for surgical intervention compared with clipping as monotherapy, and also failed to show a clear benefit of endoclipping compared to thermocoagulation [ 14 , 15 ]. Another RCT showed that monopolar hemostatic forceps with soft coagulation, a relatively new contact thermal method, was associated with a higher hemostasis success rate, lower recurrent bleeding rate and a shorter procedure time compared to endoclip methods [ 16 ]. According to the European Society for Gastrointestinal Endoscopy (ESGE) guidelines, endoclip can be used as monotherapy for ulcers with a non-bleeding visible vessel.…”

Management of arterial bleeding after endoscopic resection of a neuroendocrine gastric tumor

“…Hemostasis could thus be performed by use of a clip or thermal coagulation. However, recent data suggest the superiority of thermal therapy for the treatment of bleeding ulcers 1 . We thus performed hemostasis using the Coagrasper forceps (Olympus Corporation, Tokyo, Japan), a monopolar hemostatic hot forceps (soft coagulation mode, effect 6.5; 80 W).…”