A method using a combination of multiple hemoclips and an endoloop
was introduced for treating peptic ulcer bleeding and the large mucosal defects
after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection
(ESD) [1]
[2]
[3]
[4]. We report the combined use of
multiple hemoclips and an endoloop in patients with uncontrolled peptic ulcer
bleeding. The endoscopic examination and therapy were performed using a
one-channel endoscope. In contrast to a two-channel endoscope, a one-channel
endoscope permits separating one catheter containing a clip from the other
catheter containing an endoloop, and it also provides a wide range of
therapeutic actions during combination therapy. The combination therapy was
conducted using the step-by-step method ([Figs. 1]
and [2]).
Fig. 1 Illustration of
endoscopic hemostasis with a combination of multiple hemoclips and an
endoloop.
Fig. 2 Upper gastrointestinal
endoscopic pictures of two patients. a Large, oozing
ulcers at the angle of the stomach. b An endoloop and
hemoclip were placed at the edge of the ulcer margin at the distal side.
c The endoloop was attached at the ulcer margin and
caught and fixed with multiple hemoclips. d Tightening
of the endoloop closed the bleeding ulcer.
Before insertion of the endoscope into the patient, alligator
forceps were inserted into the working channel of the endoscope. We slightly
released the catheter equipped with an endoloop, and the alligator forceps
caught the tip of the endoloop. Next, the alligator forceps were pulled back
into the working channel as much as possible to prevent contact injury to the
patient. We then grasped the tip of the endoscope along with the tip of the
endoloop containing the catheter, and we inserted all this into the patient.
The endoscope and the catheter containing the endoloop were placed near the
bleeding ulcer. The alligator forceps were opened for detaching the catheter
with the endoloop. Then the endoloop was fully released and shaped. After
insertion of the clipping catheter equipped with a hemoclip into the working
channel, we caught the tip of the endoloop with the hemoclip and started
attaching the clips from the distal margin; several hemoclips were sequentially
attached with the endoloop around the margin of the ulcer. Finally, we
tightened the endoloop and this closed the bleeding ulcer. The ulcer margins
were almost perfectly joined and they covered the ulcer’s base.
Endoscopy_UCTN_Code_TTT_1AO_2AD
