Application of endoscopic hemoclips for nonvariceal bleeding in the upper gastrointestinal tract

Abstract

Aim: To investigate acute nonvariceal bleeding in the upper gastrointestinal (GI) tract and evaluate the effects of endoscopic hemoclipping.

Methods: Sixty-eight cases of acute nonvariceal bleeding in the upper GI tract were given endoscopic treatment with hemoclip application. Clinical data, endoscopic findings, and the effects of the therapy were evaluated.

Results: The 68 cases (male:female = 42:26, age from 9 to 70 years, average 54.4) presented with hematemesis in 26 cases (38.2%), melena in nine cases (13.3%), and both in 33 cases (48.5%). The causes of the bleeding included gastric ulcer (29 cases), duodenal ulcer (11 cases), Dieulafoy's lesion (11 cases), Mallory-Weiss syndrome (six cases), post-operative (three cases), post-polypectomy bleeding (five cases), and post-sphincterotomy bleeding (three cases); 42 cases had active bleeding. The mean number of hemoclips applied was four. Permanent hemostasis was obtained by hemoclip application in 59 cases; 6 cases required emergent surgery (three cases had peptic ulcers, one had Dieulafoy's lesion, and two were caused by sphincterotomy); three patients died (two had Dieulafoy's lesion and one was caused by sphincterotomy); and one had recurrent bleeding with Dieulafoy's lesion 10 mo later, but in a different location.

Conclusion: Endoscopic hemoclip application was an effective and safe method for acute nonvariceal bleeding in the upper GI tract with satisfactory outcomes.

Figure 1

Endoscopic view of a Dieulafoy’s lesion before and after endoscopic hemoclipping. A: Endoscopic view of a Dieulafoy’s lesion with a protruding vessel in the gastric fundus; B: Endoscopic view showing complete closure of the mucosal defect with a protruding vessel by hemoclips; C: Endoscopic view of the same patient three months later.

Figure 2

Endoscopic view of a Dieulafoy’s lesion before and after endoscopic hemoclipping. A: Endoscopic view of a Dieulafoy’s lesion with active bleeding at the posterior wall of the proximal one third of the stomach. B: View after hemoclips application to bleeding site; bleeding has stopped. C: Endoscopic view of the same patient three months later.

Figure 3

Endoscopic view of a Mallory-Weiss tear at the esophagogastric junction before and after endoscopic hemoclipping. A: Endoscopic view of a Mallory-Weiss tear at the esophagogastric junction with active bleeding; B: View after hemoclips application to bleeding vessel; bleeding has stopped.