Where next with endoscopic ulcer hemostasis?

Jensen, Dennis M.

doi:10.1111/j.1572-0241.2002.05966.x

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…Ideally, a hemoclip would be retained on the stigmata of hemorrhage until the ulcer heals. If the hemoclip grasps and stays on the underlying vessel, rebleeding should be markedly reduced compared to ulcers with hemoclips which came off early (1). Hemoclip retention until ulcers healed could promote permanent endoscopic hemostasis of both severe ulcer hemorrhage (that started as an outpatient) and even more severe hemorrhage related to inpatient ulcer bleeding (1,17).…”

Section: Discussionmentioning

confidence: 99%

“…Based upon our initial clinical studies of chronic ulcers in patients with severe hemorrhage, RC hemoclips have been seen up to 3-4 weeks after initial hemostasis (D. Jensen, personal communications). This may particularly be important in reducing rebleeding for high risk patients with slow ulcer healing or those who require anticoagulants, non-steroidal anti-inflammatory drugs (NSAIDs), or anti-platelet medications, because of severe co-morbidities (1,17). …”

Section: Discussionmentioning

confidence: 99%

“…Several endoscopically deployable hemoclips are currently marketed for clinical endoscopic hemostasis (1). The mechanical closure of a bleeding vessel makes sense surgically and may be less traumatic to the tissues than endoscopic coagulation (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…The mechanical closure of a bleeding vessel makes sense surgically and may be less traumatic to the tissues than endoscopic coagulation (1,2). Whether current hemoclips can successfully grasp the vessel underlying stigmata and be retained on chronic ulcer bases is uncertain.…”

Section: Introductionmentioning

confidence: 99%

“…There are no comparative studies yet reported about different types of current endoscopic hemoclips for clinical endoscopic hemostasis of chronic upper GI (UGI) ulcers and their deployment success rates, retention rates, or potential effects on ulcer healing. These factors may all influence initial and definitive hemostasis of ulcers (1,2). …”

Section: Introductionmentioning

confidence: 99%

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Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing

Jensen

Machicado

2009

Gastrointestinal Endoscopy

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Background Several different hemoclips are marketed for endoscopic hemostasis of non-variceal upper GI bleeding. No prior reports have compared success rates of clip deployment onto bases of chronic gastric ulcers (GU's), clip retention rates, or their influence on ulcer healing. Objectives For treatment of chronic GU's, to compare 3 different hemoclips with multipolar coagulation (MPEC) and control. Design Randomized controlled study. Subjects 7 adult dogs with prehepatic portal hypertension had GU's created by rubber band ligation. Animals had oral proton pump inhibitors daily and weekly endoscopies to quantitate clip retention and ulcer healing. Interventions 1 week after banding, 10 chronic ulcers were randomized in pairs to control (no endoscopic treatment), MPEC, or different hemoclips (Olympus-“QuickClip2”-QC; Wilson Cook-“TriClip”-TC; or Boston Scientific Corp-“Resolution Clip”-RC). Main Outcome Measurements Times and success of hemoclip deployment, clip retention rates, and ulcer healing rates on weekly endoscopies. Results Success rates of clip deployment were 100% for RC, 93.1% for TC to 83.3% for QC. Clip retention rates were significantly higher with RC clips than QC or TC at 1 to 3 weeks. Retained clips did not delay GU healing compared with MPEC or control. Conclusions 1) Hemoclipping time was similar with all three, 2) RC clips were retained significantly longer than QC or TC, 3) Hemoclips did not delay ulcer healing compared to control or MPEC, and 4) All 3 hemoclips were safe and no complications such as bleeding or weight loss were noted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing

Jensen

Machicado

2009

Gastrointestinal Endoscopy

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Gastrointestinal Bleeding

Corbett¹

Learning Surgery

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Endoscopic treatment of ulcer bleeding

Kovacs

Jensen²

2007

Curr Treat Options Gastro

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Upper gastrointestinal (UGI) bleeding secondary to ulcer disease occurs commonly and results in significant patient morbidity and medical expense. After initial resuscitation, carefully performed endoscopy provides an accurate diagnosis of the source of the UGI hemorrhage and can reliably identify those high-risk subgroups that may benefit most from endoscopic hemostasis. Large-channel therapeutic endoscopes are recommended. Endoscopists should be very experienced in management of patients with UGI hemorrhage, including the use of various hemostatic devices. 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 coaptive coagulation (with multipolar or heater probe) or endoclips is recommended. High-dose intravenous proton-pump inhibitors are recommended as concomitant therapy with endoscopic hemostasis of major stigmata. Patients with minor stigmata or clean-based ulcers will not benefit from endoscopic therapy and should be triaged to less intensive care and be considered for early discharge. Effective endoscopic hemostasis of ulcer bleeding can significantly improve outcomes by reducing rebleeding, transfusion requirement, and need for surgery, as well as reduce cost of medical care.

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Where next with endoscopic ulcer hemostasis?

Cited by 9 publications

References 25 publications

Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing

Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing

Gastrointestinal Bleeding

Endoscopic treatment of ulcer bleeding

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