Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers

Jensen, Dennis M.; Machicado, Gustavo A.; Hirabayashi, Ken

doi:10.1016/j.gie.2006.06.031

Cited by 74 publications

(45 citation statements)

References 17 publications

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“…With a grip that theoretically deteriorates due to cell renewal and mechanical pressure of passing stools during defecation, these clips could possibly have been on the verge of dislodgement, leading to the decreased retention rate over periods 2 and 3. Regarding the subgroup of endoscopic clips in our study in which attachment was determined after 1, 2 and 3 wk, retention rates (Table 1) are at least in line with those reported in the abovementioned study by Jensen et al (Quickclip: 74%, 30% and 11% versus the Resolution clip: 65%, 58% and 45% after 1,2 and 4 wk) [13] . Interestingly, when one only looks at the retention of the two clip types during these periods (at 1,2 and 3 wk) in our study, the Quickclip retention rate did Finally, we found the endoscopic clips useful in locating and marking the tumor borders for radiotherapy volume delineation and for optimizing the position of the endorectal brachytherapy applicator.…”

Section: Discussionsupporting

confidence: 91%

“…Similar results were reported in a randomized controlled study of 3 types of endoscopic clips used for haemostasis in bleeding gastric ulcers in 7 canines. In their study, the median clip retention time was 2 wk for the Quickclip (maximum duration of attachment of 3 wk) and 4 wk for the Resolution clip (maximum duration of attachment of 18 wk) [13] . The nature of our study enabled the first report in humans in vivo and is in line with these reports, favoring the Resolution clip when long-term attachment is required.…”

Section: Discussionmentioning

confidence: 94%

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

Swellengrebel

Marijnen²,

Vincent³

et al. 2010

WJGE

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 94%

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

Swellengrebel

Marijnen²,

Vincent³

et al. 2010

WJGE

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“…Variables to consider in assessing the heterogeneous study results include variation among diff erent endoscopists and among diff erent types of clips. Newer clips in current use are easier to apply and vary in size, rigidity, depth of attachment, and duration of retention ( 72,73 ); however, they have not been well studied in randomized trials. Clips also have the theoretical benefi t of not inducing tissue injury, unlike thermal therapies and sclerosantsand therefore may be preferred in patients on antithrombotic therapy and those undergoing retreatment for rebleeding.…”

Section: Routine Second-look Endoscopy In Which Repeat Endoscopy Is mentioning

confidence: 99%

Management of Patients With Ulcer Bleeding

Laine

Jensen

2012

American Journal of Gastroenterology

651

547

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Ulcers are the most common cause of hospitalization for upper gastrointestinal bleeding (UGIB), and the vast majority of clinical trials of therapy for nonvariceal UGIB focus on ulcer disease. Th is guideline provides recommendations for the management of patients with overt UGIB due to gastric or duodenal ulcers. "Overt" indicates that patients present with symptoms of hematemesis, melena, and/or hematochezia. We fi rst discuss the initial management of UGIB in patients without known portal hypertension, including initial assessment and risk stratifi cation, pre-endoscopic use of medications and gastric lavage, and timing of endoscopy. We then focus on the endoscopic and medical management of ulcer disease, including endoscopic fi ndings and their prognostic implications, endoscopic hemostatic therapy, post-endoscopic medical therapy and disposition, and prevention of recurrent ulcer bleeding.Each section of the document presents the key recommendations related to the section topic, followed by a summary of the supporting evidence. A summary of recommendations is provided in Table 1 .A search of MEDLINE via the OVID interface using the MeSH term " gastrointestinal hemorrhage " limited to " all clinical trials " and " meta-analysis " for years 1966 -2010 without language restriction as well as review of clinical trials and reviews known to the authors were performed for preparation of this document. Th e GRADE system was used to grade the strength of recommendations and the quality of evidence ( 1 ). Th e quality of evidence, which infl uences the strength of recommendation, ranges from " high " (further research is very unlikely to change our confi dence in the estimate of eff ect) to " moderate " (further research is likely to have an important impact on our confi dence in the estimate of eff ect and may change the estimate) to " low " (further research is very likely to have an important impact on our confi dence in the estimate of eff ect and is likely to change the estimate), and " very low " (any estimate of eff ect is very uncertain). Th e strength of a recommendation is graded as strong when the desirable eff ects of an intervention clearly outweigh the undesirable eff ects and is graded as conditional when uncertainty exists about the trade-off s ( 1 ). In addition to quality of evidence and balance between desirable and undesirable eff ects, other factors aff ecting the strength of recommendation include variability in values and preferences of patients, and whether an intervention represents a wise use of resources ( 1 ). 2. Blood transfusions should target hemoglobin ≥ 7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation). Management of Patients With Ulcer Bleeding3. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as timing of endoscopy, time of discharge, and level of care (Cond...

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“…Studies have shown that not all clips are equally effective. They differ in size, shape, deployment characteristics, ability to grasp and release a bleeding point and to rotate, and in long-term retention [43], as well as in clinical effi cacy [44]. For example, in one pilot study evaluating a specifi c clip brand, the TriClip (Cook Ireland Ltd., Limerick, Ireland), the overall hemostasis failure rate was 33%, and the clips were dislodged in 41% of patients at the follow-up endoscopy 24 hours after placement [45].…”

Section: Endoclipsmentioning

confidence: 99%

Management of upper gastrointestinal bleeding

Kovacs

2008

Curr Gastroenterol Rep

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Upper gastrointestinal bleeding secondary to ulcer disease is common and results in substantial patient morbidity and medical expense. After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and identifies high-risk ulcer patients who are likely to rebleed with medical therapy alone and will benefit most from endoscopic hemostasis. For patients with major stigmata of ulcer hemorrhage--active arterial bleeding, nonbleeding visible vessel, and adherent clot--combination therapy with epinephrine injection and either thermal coagulation (multipolar or heater probe) or endoclips is recommended. High-dose intravenous proton pump inhibitors are recommended as concomitant therapy after successful endoscopic hemostasis. Patients with minor stigmata or clean-based ulcers will not benefit from endoscopic treatment and should receive high-dose oral proton pump inhibitor therapy. Effective medical and endoscopic management of ulcer hemorrhage can significantly improve outcomes and decrease the cost of medical care by reducing rebleeding, transfusion requirements, and the need for surgery.

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Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers

Cited by 74 publications

References 17 publications

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

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

Management of Patients With Ulcer Bleeding

Management of upper gastrointestinal bleeding

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