Clinical Endoscopy

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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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

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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Adverse Events of Endoscopic Clip Placement
Daryl Ramai, Smit S. Deliwala, Daniel Mozell, Antonio Facciorusso, Saurabh Chandan, Alana Persaud, Kelita Singh, Andrea Anderloni, Monique T. Barakat
Journal of Clinical Gastroenterology.2024; 58(1): 76. CrossRef
Right tool for the right bleeder
Ding Ek Toh, Sheng Wei Lo, Andrew Tsoi, Jonathan P Segal, Joshua Butt
Gut.2024; 73(1): 206. CrossRef
Could a bleeding-sensor device be established as a new paradigm for detecting upper gastrointestinal bleeding before performing endoscopy?
Sun Gyo Lim
Clinical Endoscopy.2024; 57(2): 191. CrossRef
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
Journal of Investigative Medicine High Impact Case Reports.2024;[Epub] CrossRef
Comparison of mechanical and thermal therapy in upper gastrointestinal bleeding: an analysis of efficacy outcomes
Rahul Karna, Bandhul Hans, Thayer Nasereddin, Dhruv Chaudhary, Manish Dhawan
Baylor University Medical Center Proceedings.2024; 37(5): 734. CrossRef
Turn over the new leaf of the treatment in peptic ulcer bleeding: a review of the literature
Meng-Hsuan Lu, Hsueh-Chien Chiang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef
Current status and clinical outcome of endoscopic hemostatic powder in gastrointestinal bleeding: a retrospective multicenter study
Zie Hae Lim, Seung In Seo, Dae-Seong Myung, Seung Han Kim, Han Hee Lee, Selen Kim, Bo-In Lee
Clinical Endoscopy.2024; 57(5): 620. CrossRef
Evaluating the efficacy of a novel hemostatic powder compared with traditional treatments in nonvariceal upper GI bleeding: a multicenter, randomized, noninferiority study
Da Hyun Jung, Jun Chul Park, Joon Sung Kim, Moon Won Lee, Hyuk Lee, Gwang Ha Kim
Gastrointestinal Endoscopy.2024;[Epub] CrossRef
Sustained Hemostasis With the Padlock™ Over-the-scope Clip for Gastric Fundus Dieulafoy’s Lesion in the Setting of Anticoagulation Following Hemorrhagic Shock From Two Dieulafoy’s Lesions
Jonathan J Cho, Chelsea M Forbes, Benjamin D Fiore, Joshua D McCarron, Leybelis Padilla
Military Medicine.2023; 188(9-10): e3265. CrossRef
Management of complications related to colorectal endoscopic submucosal dissection
Tae-Geun Gweon, Dong-Hoon Yang
Clinical Endoscopy.2023; 56(4): 423. CrossRef
Novel removable endoscopic clip: Usefulness in failure of traction method during endoscopic submucosal dissection
Nobukazu Agatsuma, Takahiro Utsumi, Hirokazu Higuchi, Takahiro Inoue, Yukari Tanaka, Yuki Nakanishi, Hiroshi Seno
Endoscopy.2023; 55(S 01): E1031. CrossRef

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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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The Effect of Tegoprazan on the Treatment of Endoscopic Resection-Induced Artificial Ulcers: A Multicenter, Randomized, Active-Controlled Study
Byung-Wook Kim, Jong Jae Park, Hee Seok Moon, Wan Sik Lee, Ki-Nam Shim, Gwang Ho Baik, Yun Jeong Lim, Hang Lak Lee, Young Hoon Youn, Jun Chul Park, In-Kyung Sung, Hyunsoo Chung, Jeong Seop Moon, Gwang Ha Kim, Su Jin Hong, Hyuk Soon Choi
Gut and Liver.2024; 18(2): 257. CrossRef
Endoscopic diagnosis and treatment of superficial non-ampullary duodenal epithelial tumors: A review
Zheng Zhao, Yue Jiao, Shuyue Yang, Anni Zhou, Guiping Zhao, Shuilong Guo, Peng Li, Shutian Zhang
Journal of Translational Internal Medicine.2023; 11(3): 206. CrossRef
Long-term outcomes of endoscopic resection for duodenal neuroendocrine tumors
Kiyoun Yi, Gwang Ha Kim, Su Jin Kim, Cheol Woong Choi, Moon Won Lee, Bong Eun Lee, Geun Am Song
Scientific Reports.2023;[Epub] CrossRef
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
Clinical Endoscopy.2022; 55(3): 339. CrossRef
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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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

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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.

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UEG Week 2016 Poster Presentations

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

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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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New sights in ectopic varices in portal hypertension
K He, K Pang, X Yan, Q Wang, D Wu
QJM: An International Journal of Medicine.2024; 117(6): 397. CrossRef
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Gemaine Kar Mun Chan, Yi Yuan Tan, Tze Tong Tey, Rajneesh Kumar, Farah Gillan Irani
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Monica Dzwonkowski, Umair Iqbal, Seth W Kaufer, Yakub I Khan, Kishore Kumar
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Justin Robbins, Ihab El Hassan, Christa Siebenburgen
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Hyun Woo Kim, Jun Sik Yoon, Seung Jung Yu, Tae Heon Kim, Jae Heon Seol, Dan Kim, Jun Young Jung, Pyeong Hwa Jeong, Hoon Kwon, Hong Sub Lee, Sang Heon Lee, Jung Sik Choi, Sung Jae Park, Sam Ryong Jee, Youn Jae Lee, Sang Yong Seol
The Korean Journal of Gastroenterology.2020; 76(6): 331. CrossRef
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Tyler House, Patrick Webb, Chad Baarson
Case Reports in Gastroenterology.2017; 11(1): 36. CrossRef
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Duk Hwan Kim
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Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make
Shradha Bhagani, Conchubhair Winters, Sulleman Moreea
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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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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 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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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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Endoscopic Resection of a Large Colonic Lipoma: Hye Suk Son, M.D., Young Seok Cho, M.D., Jin Soo Kim, M.D., Hyung Keun Kim, M.D., Chang Hyuk Ahn, M.D.*, Sung Soo Kim, M.D., Hiun Suk Chae, M.D. and Kyu Yong Choi, M.D.; Korean J Gastrointest Endosc 2008;37(2):122-126. Published online August 30, 2008

Abstract PDF: Although colonic lipomas constitute the most common nonepithelial neoplasms of the gastrointestinal tract, colonic lipomas are rare benign tumors. Most colonic lipomas are asymptomatic and are incidentally identified at the time of endoscopy or surgery. Lipomas may cause symptoms such as bleeding, obstruction or intussusception when the size of a tumor exceeds 2 cm. Surgical resection is recommended for larger lipomas to relieve symptoms or exclude a malignancy. There are few published reports on the endoscopic removal of colonic lipomas. Endoscopic snare polypectomy has been used to treat clinically symptomatic colonic lipomas. However, removal of lipomas 2 cm or greater in diameter has been associated with a greater risk of perforation. Using a detachable snare or hemoclipping may reduce the risk of complications after a polypectomy. We report a case of a large colonic lipoma that was treated with endoscopic polypectomy using a detachable snare and hemoclipping. (Korean J Gastrointest Endosc 2008;37:122-126)

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A Case of a Bleeding Dieulafoy's Lesion in a Duodenal Diverticulum Treated by Endoscopic Hemoclipping: Nang Hee Kim, M.D., Kyu-Jong Kim, M.D., Seo Ryong Han, M.D., Ji Eun Park, M.D., Ji Hyeon Nam, M.D., Sung Hoon Kim, M.D., Eun Kyung Shin, M.D., Do Hyun Kim, M.D., Jun Young Song, M.D., Sung Eun Kim, M.D., Won Moon, M.D., Moo In Park, M.D. and Seun Ja Park,; Korean J Gastrointest Endosc 2007;35(4):258-261. Published online October 30, 2007

Abstract PDF: A duodenal diverticulum is common and usually originates in the second portion of the duodenum. The majority of diverticula are asymptomatic; however, they may sometimes present with symptoms such as obstruction, hemorrhage, perforation, jaundice and pancreatitis. Active bleeding from a duodenal diverticulum is rare, and moreover, Dieulafoy's lesion as a cause is quite rare with very few cases reported so far. The use of endoscopic methods instead of surgery in achieving hemostasis has been on the increase with the widespread use and improvement in endoscope instrumentation and accessories. Of these methods, the use of endoscopic hemoclipping for Dieulafoy's lesion is considered more effective and safe than the use of other methods, such as injection and thermal methods. We report here a case of a bleeding Dieulafoy's lesion in a duodenal diverticulum treated by endoscopic hemoclipping. (Korean J Gastrointest Endosc 2007;35:258-261)

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A Case of Foreign Body Induced Esophageal Perforation Repaired by Endoscopic Clipping: Woo Sik Han, M.D., Jong-Jae Park, M.D., Beom Jae Lee, M.D., Joo Yeon Oh, M.D., Youn Ho Kim, M.D., Sung Woo Jung, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.; Korean J Gastrointest Endosc 2007;35(1):28-32. Published online July 30, 2007

Abstract PDF: An esophageal perforation is a potentially life threatening condition with a high mortality rate. Although primary surgical repair is the mainstay of treatment, non-surgical management can be attempted in selected patients. The successful endoscopic closure of an esophageal perforation with metallic clips was recently reported. We report a case of an esophageal perforation caused by a dog bone and mediastinitis treated by non-surgical management consisting of parenteral nutrition, antibiotics therapy and endoscopic clipping.

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A Case of Endoscopic Hemoclip Management of Dieulafoy-like Lesion on the Hyperplastic Polyp in the Duodenum: Nam Seon Park, M.D., Jung Hoon Song, M.D., Eun Bin Lee, M.D., Byung Kook Kang, M.D., Dae Ho Jin, M.D., Tae Hong Ahn, M.D., Yoon Ju Han, M.D. and Hyung Suk Lee, M.D.; Korean J Gastrointest Endosc 2007;34(6):329-333. Published online June 30, 2007

Abstract PDF: Dieulafoy's lesion (DL) is an uncommon but important cause of massive upper gastrointestinal bleeding that has been reported to be involved in 0.3∼6.7% of cases of major gastrointestinal bleeding. The lesion usually occurs in the lesser curvature of the stomach within 6 cm of the gastroesophageal junction. Similar lesions have also been observed in the esophagus, duodenum, small intestine, colon, and rectum. Most DLs encountered in the duodenum occur in the bulb. Recently, with the advances in endoscopic techniques, the successful management of DL has been achieved through the application of a hemoclip or elastic band ligation. In particular, the application of a hemoclip is considered to be a safe and effective treatment for DL located on a relatively narrow and thin walled canal such as the duodenum. We report the successful application of endoscopic hemoclipping for the treatment of a rare Dieulafoy-like lesion on a hyperplastic polyp in the 2nd portion of the duodenum.

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Appendiceal Stump Bleeding That was Treated by Endoscopic Hemoclipping: Se In Kim, M.D., Sang Kyoon Kim, M.D., Chang Woo You, M.D., Hyeok Jin Kwon, M.D., Sang Wook Kim, M.D. and Soo Teik Lee, M.D.; Korean J Gastrointest Endosc 2007;34(2):108-110. Published online March 2, 2007

Abstract PDF: Appendiceal stump bleeding is a rare, but occasionally life-threatening complication. Significant lower gastrointestinal hemorrhage from an ulcerated appendiceal stump may occur after uncomplicated appendectomy. The common management includes ligation of the bleeding vessel or cecal resection by either emergency laparotomy or laparoscopy. Angiographic embolization of the bleeding vessel is an alternative therapeutic option. We report here on a case of gastrointestinal hemorrhage from an appendiceal stump, and this occurred six days after appendectomy. The bleeding was controlled endoscopically by placing hemoclips on the distinct vessel. The patient recovered thereafter without further intervention. Endoscopic hemoclipping is an effective and safe procedure, and it can replace emergency laparotomy, laparoscopy or angiographic embolization for treating appendiceal stump bleeding.

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Clinical Usefulness of Proton Pump Inhibitor Intravenous Treatment in Bleeding Peptic Ulcer: Hang Lak Lee, M.D., Dong Soo Han, M.D., Byoung Kwan Son, M.D., Oh Young Lee, M.D., Yong Chul Jeon, M.D., Ju Hyun Sohn, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D. and Jin Bae Kim, M.D.*; Korean J Gastrointest Endosc 2007;34(2):71-75. Published online March 2, 2007

Abstract PDF: Background
/Aims: Recently, high dose PPI intravenous (IV) infusion after endoscopic hemostasis was found to decrease the recurrent bleeding rate. Therefore, we conducted this study to define the effect of endoscopic hemoclipping with PPI IV infusion on the recurrent bleeding rate. Methods: We conducted a double-blinded prospective randomized control study. A total of 35 patients were endoscopically diagnosed with bleeding peptic ulcer of Forrest classification Ia, Ib, IIa between Jan. 2003 and Sep. 2003 in our hospital. We carried out epinephrine injection therapy around the ulcer, followed by hemoclipping at the exposed vessel. After controlling for endoscopic bleeding, we randomly divided the patients into two groups. One group received a PPI IV infusion (pantoprazole 80 mg/day) and the other group received a placebo for three days. Results: Only one PPI IV-infused patient and one patient receiving placebo showed recurrent bleeding at two days after endoscopic therapy. The PPI IV infusion group showed 100% (17/17) initial hemostatic rate, 5.8% (1/17) recurrent bleeding rate within 3 days, 0% (0/17) recurrent bleeding rate after 3 days, and 0% (0/17) complication rate. For these same values, the placebo group showed 100% (18/18), 5.5% (1/18), 0% (0/18), and 0% (0/18), respectively. Conclusions: PPI IV infusion showed no addictive hemostatic effect. We think hemoclipping is a very effective hemostatic method, and PPI IV infusion may not be required after appropriate endoscopic management.

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Two Cases of Successful Clipping Closure of Iatrogenic Duodenal Perforation Occurred during Endoscopic Procedure: Young Jae Lee, M.D., Sin Un Lee, M.D., In O Sun, M.D., Jin Hwa Choi, M.D., Hea Un Choi, M.D., Eun Young Ko, M.D., In Suk Seo, M.D., Young Keun Cho, M.D., Seung Min Park, M.D., Yang Ho Kim, M.D., Jin Woong Cho, M.D. and Yong Ung Lee, M.D.; Korean J Gastrointest Endosc 2006;32(3):210-214. Published online March 30, 2006

Abstract PDF: The risk of complications associated with endoscopic procedures, including bleeding and perforation, tends to increase due to the magnification of the therapeutic endoscopic spectrum. In cases of duodenal perforation, surgical closure is the treatment of choice; however, there have been some cases in which the nonsurgical treatment of an iatrogenic duodenal perforation during an endoscopic procedure was effected via endoscopic clipping closure. Here, we report two cases of successful endoscopic clipping closure of an iatrogenic duodenal perforation occur ring during a duodenoscopy insertion for ERCP and endoscopic mucosal resection for the treatment of duodenal adenoma. (Korean J Gastrointest Endosc 2006;32:210⁣214)

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A Case of Iatrogenic Colonic Perforation Repaired by Endoscopic Clipping: Hee Jung Lee, M.D., Tae Hee Lee, M.D., Sun Moon Kim, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D. and Young Woo Kang, M.D.; Korean J Gastrointest Endosc 2005;30(3):168-172. Published online March 31, 2005

Abstract PDF: As colonoscopy is widely used as a diagnostic tool in Korea, it produces many complications such as colonic bleeding and perforation. These are considered to be an usual event, not as a concept of complication. Therefore, the adverse events are given the term of incidental events, not as the complications in the recent days. Medical treatment may be offered as an alternative to surgical method for immediate management of these complications. Colonic perforation usually results in fatal and emergent condition requiring surgical intervention. Others described the application of endoclip as a therapeutic endoscopic maneuver twenty years ago, and in 1997, Yoshikane et al. used clips to close a colonic perforation after performing the endoscopic mucosal resection of an early cancer. Since then, endoscopic repairs of iatrogenic perforation have frequently been used in many cases. We report a 69 year-old man who was successfully treated by endoscopic clipping of iatrogenic colonic perforation site during polypectomy without complications. (Korean J Gastrointest Endosc 2005;30:168⁣172)

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A Case of Lower Gastrointestinal Bleeding due to Angiodysplasia in the Terminal Ileum: Anna Kim, M.D., Jong Min Lee, M.D., Jane Oh, M.D. and Gye Sung Lee, M.D.; Korean J Gastrointest Endosc 2004;28(4):197-201. Published online April 30, 2004

Abstract PDF: Angiodysplasia has been recognized as an important cause of lower gastrointestinal bleeding, but it is difficult to confirm the lesions. Angiodysplasia in the small bowel could be the most probable cause of bleeding particularly in the elderly patients when usual methods fail to document the focus. Small bowel angiodysplasias have been diagnosed by angiography and/or surgery at the sites where usual endoscope could not reach, and treated by medical therapy, angiographic embolization or surgery. We experienced a case of a bleeding angiodysplasia in the terminal ileum in a 51-year-old man who was taking anti-platelet agents. The lesion was diagnosed by colonoscopy, and bleeding was easily controlled with hemoclipping. (Korean J Gastrointest Endosc 2004;28:197⁣201)

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Endoscopic Band Ligation for Rebleeding Esophageal Dieulafoy's Lesion after Hemoclipping: Korean J Gastrointest Endosc 2003;27(5):454-454. Published online November 20, 2003

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A Clinical Trial of Mechanical Method Plus Epinephrine and Epinephrine Alone in Bleeding Ulcers: Korean J Gastrointest Endosc 2003;27(5):390-390. Published online November 20, 2003

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70세 여자, 복부 불쾌감: Korean J Gastrointest Endosc 2003;26(5):307-308. Published online May 30, 2003

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A Case of Iatrogenic Rectal Perforation Repaired by Endoscopic Clipping: Hyun Phil Shin, M.D., Seok Ho Dong, M.D., Jang Ha Kim, M.D., Yo Seb Han, M.D.,; Korean J Gastrointest Endosc 2003;26(4):232-235. Published online April 30, 2003

Abstract PDF: Although colonoscopy is commonly performed, it is an invasive procedure that might produce complications such as hemorrhage and perforation. Colonic perforation is an abdominal emergency with high mortality requiring surgical intervention. Sometimes non-surgical teatment can be applied when perforation is small sized, located in the retoperitoneal spaces or surgical approach is impossible. We are reporting a case of colon perforation in 64-year-old female patient. The patient visited our hospital with symptoms of dizziness and dyspnea. She was anemic and we planned to find the possible cause of anemia. Rectal perforation was developed during the diagnostic colonoscopy. However the operation was not applicable due to arrhythmia and cardiogenic shock. Therefore endoscopic clipping was done at the perforation site. Afterwards nasogastric decompression, intravenous antibiotics and total parenteral nutrition were applied. She was treated successfully without any complications. (Korean J Gastrointest Endosc 2003;26:232⁣235)

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Endoscopic Hemoclipping in a Terminal Ileal Dieulafoy's Lesion: Man Jo Kim, M.D., Jung Sup Eum, M.D., Hae Dong Park, M.D., Soo Hyun Kim, M.D., Sung Min Kim, M.D., Mi Ae Jo, M.D., Dong Ju Song, M.D., Se Lim Choi, M.D., Hee Seung Park, M.D. and Seong Ho Choi, M.D.; Korean J Gastrointest Endosc 2003;26(2):106-109. Published online February 28, 2003

Abstract PDF: Dieulafoy's lesion is an uncommon source of massive gastrointestinal hemorrhage. The lesion predominantly occurs in the proximal stomach, but may occur in all parts of the gastrointestinal tract including small bowel, colon and rectum. We herein report a case of a patient who presented with hematochezia from Dieulafoy's lesion of the terminal ileum with adherent blood clots. Bleeding was successfully controlled with endoscopic treatment by utilizing hemoclipping. (Korean J Gastrointest Endosc 2003;26:106⁣109)

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십이지장 Dieulafoy 병변에서 관찰된 출혈 1 예: Korean J Gastrointest Endosc 2001;23(5):370-370. Published online November 30, 2000

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Dieulafoy 병변의 치료에 있어서 내시경적 교액법의 유용성: Korean J Gastrointest Endosc 2001;23(5):299-299. Published online November 30, 2000

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직장 혈관이형성증: Korean J Gastrointest Endosc 2000;20(5):423-423. Published online November 30, 1999

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대장 게실 출혈: Korean J Gastrointest Endosc 2000;20(5):402-402. Published online November 30, 1999

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이물에 의한 십이지장 제3분의 천공: Korean J Gastrointest Endosc 2000;20(5):395-395. Published online November 30, 1999

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증례 : 식도 위장관 ; 점막절제술 후 절제면에 대한 지혈용클립을 이용한 봉합 ( Case Reports : Esophagus , Stomach & Intestine ; Endoscopic Clip Ligation on Mucosal Defect after Endoscopic Mucosal Resection ): Korean J Gastrointest Endosc 1996;16(1):77-81. Published online November 30, 1995

Abstract PDF: The main complications associated endoscopic mucosal resection are bleeding and perforation and the rate of complication is increasing in larger size of mucosal resection. We used a new method of endoscopic clipping technique for ligation on the large mucosal defect after endoscopic mucosal resection. A 53-year-old female patient visited our hospital because of epigastric pain. Endoscopic examination revealed a type IIa EGC(early gastric cancer) below angle. The endoscopic mucosal resection was performed and the size of resected specimen was 2.7x2.5cm. The mucosal defect was ligated with 6 hemoclips(Olympus, MD-850) after approximation of both resected margins by grasping forceps(Olympus, FG-4L). Follow up endoscopic examination revealed good quality of ulcer healing. The Endoscopic clipping technique might also be useful for treatment of minor perforation.(Kor J Gastrointest Endosc 16: 77~81, 1996)

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