Clinical Endoscopy

Review

Post-polypectomy colorectal bleeding: current strategies and the way forward: Nilanga Nishad, Mo Hameed Thoufeeq; Received September 3, 2024 Accepted September 23, 2024 Published online November 27, 2024; DOI: https://doi.org/10.5946/ce.2024.241 [Epub ahead of print]

Abstract PDF PubReader ePub: Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.

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Original Article

Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection: Wang Fangjun, Leng Xia, Gao Yi, Shen Xiuyun, Wang Wenping, Liu Huamin, Liu Pengfei; Clin Endosc 2022;55(4):525-531. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.241

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods
From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results
The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p>0.05).
Conclusions
The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

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Review

Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment: Giuseppe Galloro, Angelo Zullo, Gaetano Luglio, Alessia Chini, Donato Alessandro Telesca, Rosa Maione, Matteo Pollastro, Giovanni Domenico De Palma, Raffaele Manta; Clin Endosc 2022;55(3):339-346. Published online April 28, 2022; DOI: https://doi.org/10.5946/ce.2021.249

Abstract PDF PubReader ePub

Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

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Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?

Over-the-Scope Clip in the Treatment of Gastrointestinal Leaks and Perforations: Mike T. Wei, Ji Yong Ahn, Shai Friedland; Clin Endosc 2021;54(6):798-804. Published online November 30, 2021; DOI: https://doi.org/10.5946/ce.2021.250

Abstract PDF PubReader ePub

While perforations, postoperative fistulas, and leaks have traditionally led to surgical or interventional radiology consultation for management, the introduction of the over-the-scope clip has allowed increased therapeutic possibilities for endoscopists. While primarily limited to case reports and series, the over-the-scope clip successfully manages gastrointestinal bleeding, perforations, as well as postoperative leaks and fistulas. Retrospective studies have demonstrated a relatively high success rate and a low complication rate. Given the similarity to variceal banding equipment, the learning curve with the over-the-scope clip is rapid. However, given the higher risk of procedures involving the use of the over-the-scope clip, it is essential to obtain the scope in a stable position and grasp sufficient tissue with the cap using a grasping tool and/or suction. From our experience, while closure may be successful in lesions sized up to 3 cm, successful outcomes are obtained for lesions sized <1 cm. Ultimately, given the limited available data, prospective randomized trials are needed to better evaluate the utility of the over-the-scope clip in various clinical scenarios, including fistula and perforation management.

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Case Report

Endoscopic hemostasis using an over-the-scope clip for massive bleeding after percutaneous endoscopic gastrostomy removal: a case report: Sun Young Moon, Min Kyu Jung, Jun Heo; Clin Endosc 2022;55(3):443-446. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2020.294

Abstract PDF PubReader ePub

Percutaneous endoscopic gastrostomy (PEG) is a common method for providing long-term enteral nutrition to patients. PEG tube placement and removal are relatively safe; generally, a PEG tube can be removed using gentle traction, and excessive bleeding is rare. The over-the-scope clip system is a new device that can be used for gastrointestinal hemostasis and for closing gastrointestinal fistulae. In the present case, a 68-year-old male patient had to remove the PEG tube because of persistent leakage around the PEG tube. Although it was gently removed using traction, incessant bleeding continued, with a Rockall score of 5 points, even after hemocoagulation was attempted. An over-the-scope clip device was used to achieve hemostasis and fistula closure.

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Original Articles

The Use of Endoscopic Clipping in Preventing Delayed Complications after Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors: Jee Young An, Byung-Wook Kim, Joon Sung Kim, Jae-Myung Park, Tae Ho Kim, Jaesin Lee; Clin Endosc 2021;54(4):563-569. Published online November 24, 2020; DOI: https://doi.org/10.5946/ce.2020.109

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic resection (ER) has recently been accepted as the standard treatment modality for superficial nonampullary duodenal tumors (SNADTs). However, the procedure can cause adverse events such as perforation and bleeding. This study aimed to investigate the efficacy of prophylactic clipping in the prevention of delayed complications.
Methods
A retrospective review of the medical records of patients who underwent ER for SNADT from 3 centers was performed. Patients were divided into 2 groups: the immediate clipping group (ICG) and the no clipping group (NCG). Various baseline characteristics and factors associated with the appearance of delayed complications, such as size of the lesion, tumor location, histologic type, and co-morbidities, were compared between the two groups.
Results
A total of 99 lesions from 99 patients were included in this study. Fifty-two patients were allocated into ICG and 47 patients were allocated into NCG. Delayed bleeding occurred in 1 patient from ICG and in 8 patients from NCG. Delayed perforation occurred in 1 patient from ICG and in 3 patients from NCG. There were no procedure-related deaths in both groups.
Conclusions
Although the use of endoscopic clipping seemed to reduce the risk of developing delayed complications, further studies using a prospective design is required.

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Gut and Liver.2024; 18(2): 257. CrossRef
Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review
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Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment
Giuseppe Galloro, Angelo Zullo, Gaetano Luglio, Alessia Chini, Donato Alessandro Telesca, Rosa Maione, Matteo Pollastro, Giovanni Domenico De Palma, Raffaele Manta
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Endoscopic Closure After Endoscopic Resection for Superficial Non-Ampullary Duodenal Tumors
Satoshi Tanabe, Takuya Wada
Clinical Endoscopy.2021; 54(4): 453. CrossRef

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Endoscopic Management with a Novel Over-The-Scope Padlock Clip System: Mahesh Kumar Goenka, Gajanan Ashokrao Rodge, Indrajeet Kumar Tiwary; Clin Endosc 2019;52(6):574-580. Published online November 26, 2019; DOI: https://doi.org/10.5946/ce.2019.122

Abstract PDF PubReader ePub

Background
/Aims: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system.
Methods
Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients.
Results
All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed.
Conclusions
The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

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Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
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Xue Jing Li, Brian M Fung
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Usage of Padlock Over-the-Scope-Clip in Difficult-to-Control Recurrent Gastrointestinal Bleeding Due to a Gastric Dieulafoy Lesion
John Joyce, Vishnu Kumar, Dayana Nasr, Ganesh Aswath, Hafiz M. Khan, Savio John
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Jad P. AbiMansour, Ryan J. Law
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Daniyal Abbas, Mohamed Abdallah, Khalid Ahmed, Abubaker O. Abdalla, Nicholas McDonald, Shifa Umar, Brian J. Hanson, Mohammad Bilal
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(2): 106. CrossRef
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Sneha Annie Sebastian, Edzel Lorraine Co, Venkatesh Panthangi, Radha Bansal, Vaishnavi Narayanan, Shachi Paudel, Rabab Raja, Inderbir Padda, Babu P Mohan
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Natalie Wilson, Moamen Gabr, Mohammad Bilal
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Case Reports

Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management: Nonthalee Pausawasdi, Chotirot Angkurawaranon, Tanyaporn Chantarojanasiri, Arunchai Chang, Wanchai Wongkornrat, Somchai Leelakusolvong, Asada Methasate; Clin Endosc 2020;53(3):361-365. Published online October 28, 2019; DOI: https://doi.org/10.5946/ce.2019.106

Abstract PDF Supplementary Material PubReader ePub

Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.

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Successful Closure of a Tracheoesophageal Fistula Using an Over-The-Scope Clip
Osman Ali, Gurbani Singh, Sindhura Kolachana, Mohammed a Khan, Varun Kesar
Cureus.2023;[Epub] CrossRef
Over-the-Scope Clip Closure of Persistent Gastrocutaneous Fistula After Percutaneous Endoscopic Gastrostomy Tube Removal: A Report of Two Cases
Shigenori Masaki, Keishi Yamada
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Gastroenterology Research and Practice.2021; 2021: 1. CrossRef

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Full-Thickness Resection Device for Complex Colorectal Lesions in High-Risk Patients as a Last-Resort Endoscopic Treatment: Initial Clinical Experience and Review of the Current Literature: Edris Wedi, Beatrice Orlandini, Mark Gromski, Carlo Felix Maria Jung, Irina Tchoumak, Stephanie Boucher, Volker Ellenrieder, Jürgen Hochberger; Clin Endosc 2018;51(1):103-108. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.093

Abstract PDF PubReader ePub

The full-thickness resection device (FTRD) is a novel endoscopic device approved for the resection of colorectal lesions. This case-series describes the device and its use in high-risk patients with colorectal lesions and provides an overview of the potential indications in recently published data.
Between December 2014 and September 2015, 3 patients underwent endoscopic full thickness resection using the FTRD for colorectal lesions: 1 case for a T1 adenocarcinoma in the region of a surgical anastomosis after recto-sigmoidectomy, 1 case for a non-lifting colonic adenoma with low-grade dysplasia in an 89-year old patient and 1 for a recurrent adenoma with high-grade dysplasia in a young patient with ulcerative rectocolitis who was under immunosuppression after renal transplantation. Both technical and clinical success rates were achieved in all cases. The size of removed lesions ranged from 9 to 30 mm.
Overall, the most frequent indication in the literature has been for lifting or non-lifting adenoma, submucosal tumors, neuroendocrin tumors, incomplete endoscopic resection (R1) or T1 carcinoma.
Colorectal FTRD is a feasible technique for the treatment of colorectal lesions and represents a minimally invasive alternative for either surgical or conventional endoscopic resection strategies.

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Original Article

Efficacy of the Over-the-Scope Clip System for Treatment of Gastrointestinal Fistulas, Leaks, and Perforations: A Korean Multi-Center Study: Hang Lak Lee, Joo Young Cho, Jun-Hyung Cho, Jong Jae Park, Chan Gyoo Kim, Seong Hwan Kim, Joung-Ho Han; Clin Endosc 2018;51(1):61-65. Published online August 29, 2017; DOI: https://doi.org/10.5946/ce.2017.027

Abstract PDF PubReader ePub

Background
/Aims: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea.
Methods
This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure.
Results
A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone.
Conclusions
The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.

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Case Report

Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation: Edris Wedi, Mohamed Bounnah, Riccardo Memeo, Carlo Jung; Clin Endosc 2017;50(6):598-601. Published online June 1, 2017; DOI: https://doi.org/10.5946/ce.2017.024

Abstract PDF PubReader ePub: Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.

6,266 View
171 Download

Original Article

Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study: Mahesh Kumar Goenka, Vijay Kumar Rai, Usha Goenka, Indrajit Kumar Tiwary; Clin Endosc 2017;50(1):58-63. Published online October 31, 2016; DOI: https://doi.org/10.5946/ce.2016.028

Abstract PDF PubReader ePub

Background
/Aims: The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC.
Methods
Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip.
Results
All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding.
Conclusions
In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.

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Review

Recent Developments in the Endoscopic Treatment of Patients with Peptic Ulcer Bleeding: Jae-Young Jang; Clin Endosc 2016;49(5):417-420. Published online September 30, 2016; DOI: https://doi.org/10.5946/ce.2016.135

Abstract PDF PubReader ePub

Peptic ulcer bleeding is an internal medical emergency. Endoscopic hemostasis has been shown to improve the survival rate of patients with peptic ulcer bleeding. Although the established hemostatic modalities, including injection, thermal therapy, and mechanical therapy, are effective in controlling peptic ulcer bleeding, hemostasis can be difficult to achieve in some cases. As a result, recent, new endoscopic hemostatic modalities, including over-the-scope clips, topical hemostatic sprays, and endoscopic ultrasonography-guided angiotherapy, have been developed.

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Volodymyr Mamchych, Sergiy Vereshchagin, Volodymyr Maksymchuk, Dmytro Maksymchuk
EUREKA: Health Sciences.2021; (2): 37. CrossRef
Advances in the Treatment of Gastrointestinal Bleeding: Safety and Efficiency of Transnasal Endoscopy
Hiroyuki Abe, Kenya Kamimura, Yoshihisa Arao, Junji Kohisa, Shuji Terai
Medicines.2021; 8(9): 53. CrossRef
Acute upper gastrointestinal bleeding: A review
Elroy Patrick Weledji
Surgery in Practice and Science.2020; 1: 100004. CrossRef
Acute gastroinstinal bleeding: a review
Elroy P. Weledji
International Journal of Surgery: Global Health.2020; 3(3): e18. CrossRef
Upper gastrointestinal bleeding: Is only an injection of epinephrine sufficient? Success rates by Forrest classification
Ahmet Surek, Eyup Gemici, Abdussamet Bozkurt, Mehmet Karabulut
Sanamed.2020; 15(3): 309. CrossRef
Endoscopic closure of iatrogenic colon perforation using dual-channel endoscope with an endoloop and clips: methods and feasibility data (with videos)
Ja Young Ryu, Byung Kwan Park, Won-Seok Kim, Kisung Kim, Jae Young Lee, Young Kim, Jae Yong Park, Beom Jin Kim, Jeong Wook Kim, Chang Hwan Choi
Surgical Endoscopy.2019; 33(4): 1342. CrossRef
Endoscopic Hemostatic Treatment of Peptic Ulcer Bleeding
Yeon Hwa Choe, Jun Chul Park
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2018; 18(4): 235. CrossRef

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Case Reports

Utility of Over-the-Scope Clipping for Closure of a Persistent Post-Percutaneous Endoscopic Gastrostomy Fistula under Long-Term Steroid Therapy: Yoshihisa Arao, Yuichi Sato, Satoru Hashimoto, Hiroki Honda, Kazumi Yoko, Masaaki Takamura, Ken-ichi Mizuno, Masaaki Kobayashi; Clin Endosc 2015;48(6):563-565. Published online November 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.6.563

Abstract PDF PubReader ePub

A 50-year-old woman had a percutaneous endoscopic gastrostomy (PEG) tube placed after surgery for pharyngeal cancer. After 21 months, the PEG tube was removed due to improvement of per-oral ingestion. She had taken prednisolone for 31 years for systemic lupus erythematosus. The post-PEG fistula did not close spontaneously. The cause of the fistula was slow wound healing and gastrostomy site inflammation due to long-term steroid therapy. We were able to close the fistula with an over-the-scope clipping (OTSC) system. This case suggests that OTSC is useful for closing persistent post-PEG fistulas in patients receiving long-term prednisolone therapy.

Citations

Citations to this article as recorded by

UEG Week 2016 Poster Presentations

United European Gastroenterology Journal.2016; 4(5_suppl): A157. CrossRef

10,167 View
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1 Crossref

Treatment of Traumatic Esophagopleural Fistula Using the Over-the-Scope-Clip System: Ji Hyoung Kim, Jong-Jae Park, Il Woo Jung, Sang Hoon Kim, Hee Dong Kim, Jung Wan Choe, Moon Kyung Joo, Hyun Gu Kim; Clin Endosc 2015;48(5):440-443. Published online September 30, 2015; DOI: https://doi.org/10.5946/ce.2015.48.5.440

Abstract PDF PubReader ePub

Esophagopleural fistula (EPF) is a rare condition that is usually accompanied by severe infection and life-threatening morbidity. Here, we report the successful treatment of an EPF by closing an esophageal orifice using the over-the-scope-clip (OTSC) system without postprocedural complications. A 41-year-old man had serious thoracic and abdominal trauma due to a traffic accident. Computed tomography revealed findings suggestive of esophageal rupture due to Boerhaave syndrome. An emergent explorative operation was performed for primary repair with the insertion of a vacuum-assisted closure device. A postoperative upper gastrointestinal series revealed an EPF tract connecting the left pleural space and distal esophagus. We performed an endoscopic procedure using the "traumatic-type"OTSC to seal the EPF, and the esophageal orifice was completely healed 2 weeks postoperatively. The OTSC system might represent a safe and feasible modality for the treatment of EPF.

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Mihajlo Gjeorgjievski, Zaid Imam, Mitchell S. Cappell, Laith H. Jamil, Michel Kahaleh
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Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer
Ting Wang, Asmitananda Thakur, Baoqing Chen
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Justin Chuang, Naveena Luke, Khushbu Patel, Jordan Burlen, Ali Nawras
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Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis
Carlos Tuñon, Juan De Lucas, Jan Cubilla, Rafael Andrade, Miguel Aguirre, Julio Zúñiga Cisneros
BMC Gastroenterology.2021;[Epub] CrossRef
Komplikationsbeherrschung bei Körperhöhlentrauma
H. Vogelsang
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Moon Kyung Joo
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Koji Otsuka, Masahiko Murakami, Tomotake Ariyoshi, Takeshi Yamashita, Satoru Goto, Makoto Watanabe, Takeshi Aoki
International Journal of Surgery Case Reports.2017;[Epub] CrossRef

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Endoscopic Treatment of Various Gastrointestinal Tract Defects with an Over-the-Scope Clip: Case Series from a Tertiary Referral Hospital: Woong Cheul Lee, Weon Jin Ko, Jun-Hyung Cho, Tae Hee Lee, Seong Ran Jeon, Hyun Gun Kim, Joo Young Cho; Clin Endosc 2014;47(2):178-182. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.178

Abstract PDF PubReader ePub

Recently, increasingly invasive therapeutic endoscopic procedures and more complex gastrointestinal surgeries such as endoscopic mucosal resection, endoscopic submucosal dissection, and novel laparoscopic approaches have resulted in endoscopists being confronted more frequently with perforations, fistulas, and anastomotic leakages, for which nonsurgical closure is desired. In this article, we present our experiences with the use of over-the-scope clip (OTSC) for natural orifice transluminal endoscopic surgery (NOTES) closure, prevention of perforation, anastomotic leakages, and fistula closures. The OTSC is a valuable device for closing intestinal perforations and fistulas, for NOTES closure, and for the prevention of perforation after the excision of a tumor from the proper muscle layer. Furthermore, it seems to be quite safe to perform, even by endoscopists with little experience of the technique.

Citations

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Experimental Evaluation of the Optimal Suture Pattern With a Flexible Endoscopic Suturing System
Peter Halvax, Michele Diana, Yoshihiro Nagao, Jacques Marescaux, Lee Swanström
Surgical Innovation.2017; 24(3): 201. CrossRef
Management of non-acute gastrointestinal defects using the over-the-scope clips (OTSCs): a retrospective single-institution experience
Joshua S. Winder, Afif N. Kulaylat, Jane R. Schubart, Hassan M. Hal, Eric M. Pauli
Surgical Endoscopy.2016; 30(6): 2251. CrossRef
Early endoscopic closure of colocutaneous fistula adjacent to unmatured low colorectal anastomosis with the Over-The-Scope Clip (OTSC)
Constantinos Avgoustou, K. Paraskeva
Hellenic Journal of Surgery.2016; 88(3): 193. CrossRef
Endoscopic Closure for Full-Thickness Gastrointestinal Defects: Available Applications and Emerging Innovations
Nobuyoshi Takeshita, Khek Yu Ho
Clinical Endoscopy.2016; 49(5): 438. CrossRef

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Successful Treatment of Duodenal Variceal Bleeding by Endoscopic Clipping: Su Bin Park, Sang Ho Lee, Jin Hee Kim, Hyun Jung Lee, Sung Pil Jang, Jae Nam Lee, Jong Ho Hwang; Clin Endosc 2013;46(4):403-406. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.403

Abstract PDF PubReader ePub

Duodenal varix bleeding is an uncommon cause of gastrointestinal bleeding in patients with portal hypertension but can cause severe and potentially fatal bleeding. However, the incidence is low and a good treatment method has not been well established yet. Duodenal variceal bleeding can be treated surgically or nonsurgically. We have successfully treated a patient with duodenal variceal bleeding secondary to liver cirrhosis using hemoclips to control the bleeding.

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Gemaine Kar Mun Chan, Yi Yuan Tan, Tze Tong Tey, Rajneesh Kumar, Farah Gillan Irani
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Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report
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The Korean Journal of Gastroenterology.2020; 76(6): 331. CrossRef
Massive Hemorrhage from Ectopic Duodenal Varices: Importance of a Multidisciplinary Approach
Tyler House, Patrick Webb, Chad Baarson
Case Reports in Gastroenterology.2017; 11(1): 36. CrossRef
A massive bleeding from a duodenal mass: what treatment option should be chosen?
Duk Hwan Kim
Intestinal Research.2017; 15(4): 548. CrossRef
Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make
Shradha Bhagani, Conchubhair Winters, Sulleman Moreea
BMJ Case Reports.2017; : bcr2016218669. CrossRef
Long-term Successful Treatment of Massive Distal Duodenal Variceal Bleeding with Balloon-occluded Retrograde Transvenous Obliteration
Soon Woo Hwang, Joo Hyun Sohn, Tae Yeob Kim, Ji Yeoun Kim, Jiyoung Yhi, Dong Shin Kwak, Hae Su Kim, Soon-Young Song
The Korean Journal of Gastroenterology.2014; 63(4): 248. CrossRef

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Original Article

Clipping for the Prevention of Immediate Bleeding after Polypectomy of Pedunculated Polyps: A Pilot Study: Sun-Jin Boo, Jeong-Sik Byeon, Seon Young Park, Jong Sun Rew, Da Mi Lee, Sung Jae Shin, Dong Uk Kim, Geum Am Song; Clin Endosc 2012;45(1):84-88. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.84

Abstract PDF PubReader ePub

Background/Aims

Immediate postpolypectomy bleeding (IPPB) increases the procedure time and it may disturb performing a safe polypectomy. The purpose of this study is to investigate whether clipping before snare polypectomy of large pedunculated polyps is useful for the prevention of IPPB.

Methods

This is a single arm, pilot study. We enrolled patients with pedunculated colorectal polyps that were 1 cm in size or more from 4 university hospitals between June 2009 and June 2010. Clips were applied at the stalk and snare polypectomy was then performed. The complications, including IPPB, were investigated.

Results

Fifty six pedunculated polyps in 47 patients (Male:Female=36:11; age, 56±11 years) were included. The size of the polyp heads was 17±8 mm. Tubular adenoma was most common (57%). The number of clips used before snare polypectomy was 2±0.5. The procedure was successful in all cases. IPPB occurred in 2 cases (3.6%), and both of these were managed by additional clipping. Delayed bleeding occurred in another one case (1.8%), which improved with conservative treatment. No perforation occurred.

Conclusions

We suggest that clipping before snare polypectomy of pedunculated polyps may be an easy and effective technique for the prevention of IPPB, and this should be confirmed in large scale, prospective, controlled studies.

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Saudi Journal of Gastroenterology.2021; 27(5): 296. CrossRef
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Vinay Chandrasekhara, Nikhil A. Kumta, Barham K. Abu Dayyeh, Manoop S. Bhutani, Pichamol Jirapinyo, Kumar Krishnan, John T. Maple, Joshua Melson, Rahul Pannala, Mansour A. Parsi, Amrita Sethi, Guru Trikudanathan, Arvind J. Trindade, David R. Lichtenstein
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Jae Seung Soh, Myeongsook Seo, Kyung-Jo Kim
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Management of colonic polyps: an advancing discipline
Amir Klein, Michael J. Bourke
ANZ Journal of Surgery.2017; 87(5): 327. CrossRef
Massive post‐polypectomy hemorrhage: Successful tulip‐bundle technique with endoloop for hemostasis
Hsu‐Heng Yen, Chia‐Wei Yang, Shun‐Sheng Wu, Maw‐Soan Soon
Advances in Digestive Medicine.2016; 3(3): 128. CrossRef
Advanced Polypectomy and Resection Techniques
Amir Klein, Michael J. Bourke
Gastrointestinal Endoscopy Clinics of North America.2015; 25(2): 303. CrossRef
Comparison of clipping with and without epinephrine injection for the prevention of post‐polypectomy bleeding in pedunculated colon polyps
Yehyun Park, Tae Joo Jeon, Ji Young Park, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Sung Pil Hong
Journal of Gastroenterology and Hepatology.2015; 30(10): 1499. CrossRef
Endoscopic haemostasis: An overview of procedures and clinical scenarios
Jérémie Jacques, Romain Legros, Stanislas Chaussade, Denis Sautereau
Digestive and Liver Disease.2014; 46(9): 766. CrossRef
Advanced Endoscopic Resection of Colorectal Lesions
Andres Sanchez-Yague, Tonya Kaltenbach, Gottumukkala Raju, Roy Soetikno
Gastroenterology Clinics of North America.2013; 42(3): 459. CrossRef
A Cost-efficacy Decision Analysis of Prophylactic Clip Placement After Endoscopic Removal of Large Polyps
Neehar D. Parikh, Kyle Zanocco, Rajesh N. Keswani, Andrew J. Gawron
Clinical Gastroenterology and Hepatology.2013; 11(10): 1319. CrossRef
Fat Polyp, Thin Blood: Think Clip!
Laura Borodyansky, John R. Saltzman
Clinical Gastroenterology and Hepatology.2013; 11(10): 1333. CrossRef

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Case Report

A Primary Repair with Hemoclips and Fibrin Glue Injection in Biliary Stent Induced Duodenal Perforation: Ki Won Kim, M.D., Tae Hoon Lee, M.D., Sang-Heum Park, M.D., Bum Suk Son, M.D., Sae Hwan Lee, M.D., Suck-Ho Lee, M.D., Il-Kwun Chung, M.D. and Sun-Joo Kim, M.D.; Korean J Gastrointest Endosc 2011;42(6):437-441. Published online May 25, 2011

Abstract PDF: Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.

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Three Cases of Successful Treatment of Iatrogenic Duodenal Perforation: Choong Heon Ryu, M.D., Do Hyun Park, M.D., Myung-Hwan Kim, M.D., Dong Wan Seo, M.D., Sang Soo Lee, M.D., Sung Koo Lee, M.D. and Hong Jun Kim, M.D.; Korean J Gastrointest Endosc 2011;42(1):57-61. Published online January 30, 2011

Abstract PDF: Endoscopic retrograde cholangiopancreatography has become a standard procedure for the diagnosis and treatment of pancreatobiliary disease. Like any invasive procedure, it carries a small, but significant rate of serious complications such as duodenal perforation. Primary surgical closure is the treatment of choice for the cases of duodenal perforation. However, there have been some case reports in which endoscopic metal clip closure of an iatrogenic duodenal perforation was successful. We experienced three cases of successful treatment of the iatrogenic duodenal perforation using endoscopic clipping and fibrin glue injections during a duodenoscope insertion. (Korean J Gastrointest Endosc 2011;42:57-61)

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A Case of Fishbone-induced Esophageal Perforation Closed by Endoscopic Clipping: Joung Muk Leem, M.D., Joung-Ho Han, M.D.*, Byeong Seong Ko, M.D.*, Mi Sung Kim, M.D.*, Ji Young Park, M.D.*, Woo Hyung Choi, M.D.*, Sei Jin Youn, M.D. and Seon Mee Park, M.D.; Korean J Gastrointest Endosc 2010;41(3):151-154. Published online September 30, 2010

Abstract PDF: Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature. (Korean J Gastrointest Endosc 2010; 41:151-154)

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A Case of Successful Embolization with Superselection by Endoscopic Hemoclipping for Pseudoaneurysmal Bleeding in a Patient with Pylorus Preserving Pancreaticoduodenectomy: Yong Hun Kim, M.D., Chang-Il Kwon, M.D., Sae Kyung Joo, M.D., Won Hee Kim, M.D., Hong Gern Bin, M.D., Man Deuk Kim, M.D. and Seong Gyu Hwang, M.D.; Korean J Gastrointest Endosc 2010;41(1):31-35. Published online July 31, 2010

Abstract PDF: Arterial bleeding after pancreaticoduodenectomy is a very serious complication with high mortality. Therefore, early diagnosis and treatment is essential. In particular, early detection and immediate embolization can be effectively used for the delayed massive bleeding that occurs from a pseudoaneurysmal rupture. However, sometimes intermittent bleeding or a vessel spasm can cause the bleeding focus to remain unidentified in spite of repeated angiography. We experienced a case of successful embolization with superselection by endoscopic hemoclipping in a patient who underwent pylorus preserving pancreaticoduodenectomy, and the patient's bleeding focus was not found after repeated angiography. Endoscopic hemoclip application can be useful for localizing a pseudoaneurysmal rupture in patients with pancreaticoduodenectomy. (Korean J Gastrointest Endosc 2010;41:31-35)

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Two Cases of Foreign Body-induced Esophageal Perforation That Were Treated by Endoscopic Clipping and Non-surgical Management: Jung Bok Park, M.D., Won Ki Bae, M.D., Hyoung Don Lee, M.D., Jung Hoon Kim, M.D., Nam-Hoon Kim, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Young Soo Moon, M.D.; Korean J Gastrointest Endosc 2010;40(5):316-320. Published online May 30, 2010

Abstract PDF: Perforation of the esophagus is a deadly injury that requires careful management if the patient is to survive. Prompt recognition and proper treatment of esophageal perforation may avert death or minimize complications. Esophageal perforation might be followed by mediastinitis, broncho-esophageal fistula, pneumomediastinum, peritonitis and empyema. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. Endoscopic closure of an esophageal perforation with metallic clips and conservative therapy has recently been reported. We describe here two patients with esophageal perforation and pneumomediastinum that were caused by fish bones. One was completely closed by endoscopic clipping and the other was not. Non-surgical management that was made up of parenteral nutrition and antibiotic therapy produced the same successful outcomes in these two cases. (Korean J Gastrointest Endosc 2010;40:316-320)

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Extensive Gastric Mucosal Laceration During Endoscopic Examination: Han Byul Chun, M.D., Il Hyun Baek, M.D., Su Rin Shin, M.D., Hyo Jung Kim, M.D., Jin Bae Kim, M.D. and Myung Seok Lee, M.D.; Korean J Gastrointest Endosc 2010;40(5):321-324. Published online May 30, 2010

Abstract PDF: Gastric mucosal lacerations occurring during the course of upper gastroduodenal endoscopy are apparently rare. The location and extent of the lesion are little different from the usual one found in the Mallory-Weiss tear. But the pathogenesis of the gastric mucosal tear is similar to that of Mallory-Weiss tear. Hiatal hernia, atrophic gastritis, and old age are predisposing factors for Mallory-Weiss tear. There is currently only one report about extensive gastric mucosal laceration during performance of endoscopy in an elderly patient. During a standard diagnostic endoscopic procedure, we experienced extensive gastric mucosal laceration that ranged from the gastroesophageal junction to the gastric angle in an elderly woman Furthermore, her body surface area and stomach size were very small. The patient was treated successfully with hemoclip application for the laceration. We report on the case along with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;40:321-324)

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A Case of Transparent Cap-fitted Endoscopic Hemoclipping on a Bleeding Dieulafoy's Lesion in the Ampulla of Vater: Hoon Sup Koo, M.D., Yong Seok Kim, M.D., Gwang Il Kim, M.D., Jung Kyung Yang, M.D., Seung Min Kim, M.D., Sang Yeol Cheon, M.D., Je Hyung Sun, M.D. and Sun Moon Kim, M.D.; Korean J Gastrointest Endosc 2010;40(1):45-48. Published online January 30, 2010

Abstract PDF: Dieulafoy's lesion is a rare cause of repetitive and massive gastrointestinal bleeding, and this is characterized by an isolated arteriole protruding through a small mucosal defect. Dieulafoy's lesion is generally found in the stomach within 6 cm of the gastroesophageal junction, and usually on the lesser curvature, but many lesions have been reported in extragastric locations, including the esophagus, small bowel and rectum. A Dieulafoy's lesion in the ampulla of Vater is extremely rare, and only one such case has been reported in the Korean population. We experienced a rare case of Dieulafoy's lesion in the ampulla of Vater with massive pulsatile bleeding, and this was successfully treated by transparent cap-assisted endoscopic hemoclipping. We report here on this case with a review of the relevant literature. (Korean J Gastrointest Endosc 2010;40:45-48)

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Two Cases of Boerhaave's Syndrome Treated by Endoscopic Hemoclipping: Hyun Jeong Jang, M.D., Tae Hyo Kim, M.D., Chang Min Lee, M.D., Kang Ju, M.D., Chang Yoon Ha, M.D., Hyun Ju Min, M.D., Woon Tae Jung, M.D. and Ok Jae Lee, M.D.; Korean J Gastrointest Endosc 2009;39(6):359-363. Published online December 30, 2009

Abstract PDF: Boerhaave's syndrome is a spontaneous esophageal perforation due to severe nausea and vomiting after hyperphagia or drinking, and it is not due to trauma, medical instrumentation or a foreign body. Untreated esophageal perforation is associated with high mortality, and the traditional treatment has been surgical drainage and primary repair of the perforation. However, non-surgical primary repair with an endoscopic procedure has recently been attempted in some selected patients with a small sized perforation, limited contamination of the mediastinum and no evidence of sepsis. We report here on 2 patients with Boerhaave's syndrome and who were successfully treated via primary repair with endoscopic hemoclips, and we review the other cases of the Boerhaave's syndrome that were treated with a endoscopic procedure. (Korean J Gastrointest Endosc 2009;39: 359-363)

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A Case of Brunner's Gland Adenoma Causing a Ball-valve Obstruction: Endoscopic Treatment with a Simple Method of Endoclip-assisted Direct Resection with Using an IT-knife: Do Won Choi, M.D., Jin Ki Hwang, M.D., Jong Jae Park, M.D., Jae-Won Yun, M.D., Min-Jung Kwon, M.D., Hyejin Noh, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2009;39(1):38-41. Published online July 30, 2009

Abstract PDF: Brunner's gland adenoma is a rare benign tumor that is usually asymptomatic and it the result of a benign proliferation of the Brunner's glands of the duodenum. In symptomatic patients, the common clinical presentation is gastrointestinal bleeding and obstructive symptoms. A 48-year-old man presented with abdominal discomfort and vomiting. The endoscopic examination revealed a large pedunculated polypoid mass arising in the bulb and it was prolapsing through the pylorus into the antrum, and this all resulted in a ball-valve obstruction. After endoclips were applied at the peduncle of the mass, this polyp was simply and successfully cut with using an IT-knife without bleeding or perforation. We report here on a case of Brunner's gland adenoma that caused a ball-valve obstruction, and the tumor was removed by a simple and easy method with using endoclips and an IT-knife. (Korean J Gastrointest Endosc 2009;39:38-41)

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The Usefulness of Applying an Additional Clip When Using a Double-layered Pyloric Stent to Treat Gastric Outlet Obstruction: Woo Jin Jung, M.D., Dae Hwan Kang, M.D., Cheol Woong Choi, M.D., Hyung Wook Kim, M.D., Gwang Ha Kim, M.D., Jeong Heo, M.D., Geun Am Song, M.D., Mong Cho, M.D., Kyung Sik Jung, M.D., Yong Wuk Kim, M.D., Dong Uk Kim, M.D., Pyo Jun Kim, M.D. and Il Du Kim, M; Korean J Gastrointest Endosc 2009;38(4):193-198. Published online April 30, 2009

Abstract PDF: Background
/Aims: It has been reported the placement of a double-layered pyloric combination stent can overcome the disadvantage of the increased ingrowth observed for an uncovered stent and the increased migration for a covered stent. But this did not satisfactorily prevent stent migration and it caused stent migration more frequently than with using the uncovered stent. This study evaluated the usefulness of applying a clip in an effort to reduce stent migration. Methods: Fifteen patients with malignant gastric outlet obstruction were treated with endoscopic placement of a double-layered combination pyloric stent. Three endoscopic clips were then applied to fix the proximal end of the enteral stent to the gastric or duodenal mucosa. The clinical efficacy and especially the rate of migration were analyzed. Results: The technical and clinical success rate was 100% (15/15) and 93.3% (14/15), respectively. No stent migration was observed in any of the patients. Three patients (20%) experienced complications such as stent collapse. The median stent patency period was 83.4 days. Conclusions: Endoscopic clipping for enteral stent placement is effective for preventing stent migration in patients with malignant gastric outlet obstruction. (Korean J Gastrointest Endosc 2009;38:193-198)

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Non-surgical Treatment with Endoscopic Clipping in a Patient with Boerhaave's Syndrome: Yun-Kyung Kim, M.D., Chang Nyol Paik, M.D., U-Im Chang, M.D., Sung Hoon Jung, M.D., Jeong Rok Lee, M.D., Woo Chul Chung, M.D., Kang-Moon Lee, M.D. and Jin-Mo Yang, M.D.; Korean J Gastrointest Endosc 2008;37(6):409-412. Published online December 30, 2008

Abstract PDF: Boerhaave's syndrome is difficult to diagnosis because of the esophageal rupture, which is caused by nausea and vomiting, and Boerhaave's syndrome is known to have a high mortality rate. The mortality increases with a delayed diagnosis; therefore, an early diagnosis and surgical treatment are critical for a good prognosis. Yet some recent cases have shown that non-surgical treatments are successful in some classified patient groups. These groups should be considered according to their symptoms and their laboratory and radiological findings. Sepsis and multi-organ failure should be continuously checked for to see if they occurred and/or progressed. We report here on a 51 year old woman who had Boerhaave's syndrome, and this was caused by heavy drinking, nausea and vomiting, and she improved with just non-surgical treatment such as fasting, antibiotics and endoscopic clipping. (Korean J Gastrointest Endosc 2008;37:409-412)

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Predictors of Rebleeding after Hemoclip Therapy for Treating High-risk Bleeding Ulcers: Hemoclip Therapy Alone was Comparable to Combination Treatmentwith Epinephrine Injection: Hyo Jeong Oh, M.D., Tae Hyeon Kim, M.D., Geom Seog Seo, M.D., Chang Soo Choi, M.D., Eun Young Cho, M.D., Ki Hoon Kim, M.D., Sung O Seo, M.D., Ji Hye Kweon, M.D., Han Seung Ryu, M.D.,Suck Chei Choi, M.D., Haak Cheoul Kim, M.D. and Sae Ron Shin, M.D.*; Korean J Gastrointest Endosc 2008;37(2):83-89. Published online August 30, 2008

Abstract PDF: Background/Aims: Active bleeding and non-bleeding visible vessels in patients with bleeding peptic ulcer are associated with a high risk of rebleeding. The aim of our study was to define the risk factors associated with failure of endoscopic hemostasis and rebleeding in patients with active peptic ulcer bleeding. Methods: We retrospectively reviewed 119 patients (90 men and 29 women; mean age, 60.14±14.67 years) with active peptic ulcer bleeding (spurting, oozing and/or non-bleeding visible vessel) and who were treated in Wonkwang Medical Center from January 2002 to January 2007. They were classified to endoscopic hemoclipping alone group (n=75) or endoscopic hemoclipping combined with epinephrine injection group (n=44), according to the therapeutic modality. Results: Initial hemostasis was achieved in the two groups (100%), and permanent hemostasis was achieved 71.4% in all the patients. Operation was done in eight patients (6.7%), and six patients (5%) in the two groups, respectively, died within 1 month after initial hemostasis because of bleeding related complications. Recurrent bleeding, the duration of the hospital stay, blood transfusion requirements, complications and the operation and mortality rates were not statistically different between the hemoclip alone and combination groups. Univariate analysis showed that rebleeding was related to the presence of shock on admission (p=0.01), complication (p=0.00), the pulse rate (＞100/min) on admission (p=0.04), single ulcer (p=0.032), the level of hemoglobin (＜8 g/dL) (p=0.02) and the volume of transfusion (＞3 units) after the procedure (p=0.005) in all the patients. On the multivariate analysis that was adjusted for age and gender, the hemoglobin level (＜8 g/dL) (odds ratio = 10.5) was the only significant predictor for early rebleeding. Conclusions: This result may suggest that the combination method does not provide a substantial advantage over hemoclipping alone for the hemostatic management of active peptic ulcers bleeding. A low hemoglobin level on admission may be useful to predict rebleeding after initial endoscopic hemostasis in patients with active peptic ulcer. However, this study was designed retrospectively, so the comparison between these two groups should be re-evaluated prospectively in a large, multicenter trial. (Korean J Gastrointest Endosc 2008;37:83-89)

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