Evaluating long-term attachment of two different endoclips in the human gastrointestinal tract

Abstract

AIM:To evaluate the long-term attachment of two types of endoclips in the human gastrointestinal tract. METHODS:In this prospective observational study, endoclips were placed and followed-up during endoscopies or using fluoroscopic images as part of a pro spective feasibility study evaluating external beam radiotherapy (EBRT, wk 1-3) followed by high dose rate brachytherapy (HDRBT with an endoluminal app licator once a week for 3 wk, wk 9-11) in medically inoperable rectal cancer patients. Initially, the type and number of endoclips were chosen randomly and later refined to 1 Resolution ® clip (Microvasive) proximal and 2 Quickclips ® (Olympus) distal to the tumor. Nine consecutive patients, included between September 2007 and August 2008 were analyzed. Retention rates were evaluated over three different observational periods [period 1: pre-HDRBT (wk -2-8), period 2: during HD RBT (wk 9-11) and period 3: post-HDRBT (wk 12-16)]. RESULTS:In this study, a total of 44 clips were placed during endoscopy, either at the beginning or at the end of period 1. The Resolution clip had a higher overall retention rate than the Quickclip (P = 0.01). After a median period of 81 d after placement (in period 1), longterm retention rates for the Resolution clip and Quickclip clip were 67% and 35% respectively. CONCLUSION:The Resolution clip has a high retention rate and is useful in situations where long-term attachment to the human gastrointestinal mucosa is warranted.

Mechanical Hemostasis Techniques in Nonvariceal Upper Gastrointestinal Bleeding

“…9 Although hemoclips are generally thought to fall off after approximately 2 weeks, there are reports of clip retention for up to 2 years. [10][11][12] Whether there is a relationship between hemoclips retention and control of bleeding is unknown.…”

Which clip? A prospective comparative study of retention rates of endoscopic clips on normal mucosa and ulcers in a porcine model

“…The duration of attachment at the site of application is particularly important when clips are used for marking gastrointenstinal (GI) tumors for radiotherapy or attachment of endoprosthesis such as enteral feeding tubes. [ 15 16 ] Therefore, establishing retention rates can help determine which clip should be used for various clinical applications. To date, there are no studies comparing the retention rates of the three current clips on ulcers or normal tissue.…”

Clips for managing perforation and bleeding after colorectal endoscopic mucosal resection

“…In summary, the Resolution clip was reported to have a strong adherence to tissue, generally achieving a minimum adherence of 4 weeks. Some small studies have shown that the QuickClip stays in place between one and two weeks [6,7]. Considering that the majority of delayed bleeding cases occur within 48 h after EMR [8], both these adherence rates should be sufficient to prevent bleeding.…”

“…Considering that the majority of delayed bleeding cases occur within 48 h after EMR [8], both these adherence rates should be sufficient to prevent bleeding. However, when the clip needs to stay attached to the mucosa for a longer time, for example, for marking purposes, then a preference may be given to the Resolution clip [6,9,10]. Nonetheless, long-term retention rates of the Resolution clip and the Instinct clip at the first surveillance colonoscopy at 6 months after EMR have been reported to be low for both clips (4.2% after a mean follow up of 7 months vs. 8.6% after a mean follow up of 6 months, respectively), although this difference was found to be statistically significant [11].…”