Abstract
Background
Bleeding is a major complication of endoscopic mucosal resection (EMR). This study investigated whether the use of metal hemoclips to close EMR-induced ulcers after gastric EMR was effective in preventing delayed bleeding.
Methods
This single-center study retrospectively examined the records for 150 lesions of 140 consecutive patients (107 men and 33 women) with a mean age of 61 years (range, 38–81 years) who underwent EMR. For 60 patients, moderate to severe immediate bleeding occurred during the procedure, and the ulcers had been closed using metal hemoclips (clip group). In the remaining 90 cases, the immediate bleeding was absent or mild, and hemoclips were not used (nonclip group). Postprocedure bleeding (delayed bleeding) was analyzed.
Results
Overall, delayed bleeding occurred with 14 (9.3%) of the 150 lesions. Delayed bleeding occurred less frequently in the clip group (2 of 60 lesions; 3.3%) than in the nonclip group (12 of 90 lesions; 13.3%; p = 0.04). Of the 60 clip group ulcers, 37 (62%) were completely closed, and none showed delayed bleeding. The median number of hemoclips used for ulcer closure was 10 (range, 4–22), and the median time for ulcer closure was 14 min (range, 4–40 min).
Conclusions
Prophylactic closure of gastric EMR-induced ulcers with hemoclips reduced delayed bleeding.
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References
Kojima T, Parra-Blanco A, Takahashi H, Fujita R (1998) Outcome of endoscopic mucosal resection for early gastric cancer: review of the Japanese literature. Gastrointest Endosc 48:550–554, discussion 554–555
Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229
Soetikno RM, Gotoda T, Nakanishi Y, Soehendra N (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567–579
Tanabe S, Koizumi W, Mitomi H, Nakai H, Murakami S, Nagaba S, Kida M, Oida M, Saigenji K (2002) Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer. Gastrointest Endosc 56:708–713
Ohkuwa M, Hosokawa K, Boku N, Ohtu A, Tajiri H, Yoshida S (2001) New endoscopic treatment for intramucosal gastric tumors using an insulated-tip diathermic knife. Endoscopy 33:221–226
Rosch T, Sarbia M, Schumacher B, Deinert K, Frimberger E, Toermer T, Stolte M, Neuhaus H (2004) Attempted endoscopic en bloc resection of mucosal and submucosal tumors using insulated-tip knives: a pilot series. Endoscopy 36:788–801
Shioji K, Suzuki Y, Kobayashi M, Nakamura A, Azumaya M, Takeuchi M, Baba Y, Honma T, Narisawa R (2003) Prophylactic clip application does not decrease delayed bleeding after colonoscopic polypectomy. Gastrointest Endosc 57:691–694
Tsunada S, Ogata S, Ohyama T, Ootani H, Oda K, Kikkawa A, Ootani A, Sakata H, Iwakiri R, Fujimoto K (2003) Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips. Gastrointest Endosc 57:948–951
Baron TH, Gostout CJ, Herman L (2000) Hemoclip repair of a sphincterotomy-induced duodenal perforation. Gastrointest Endosc 52:566–568
Hachisu T (1988) Evaluation of endoscopic hemostasis using an improved clipping apparatus. Surg Endosc 2:13–17
Lee SY, Kim JJ, Lee JH, Kim YH, Rhee PL, Paik SW, Rhee JC (2004) Healing rate of EMR-induced ulcer in relation to the duration of treatment with omeprazole. Gastrointest Endosc 60:213–217
Miyamoto S, Muto M, Hamamoto Y, Boku N, Ohtsu A, Baba S, Yoshida M, Ohkuwa M, Hosokawa K, Tajiri H et al (2002) A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms. Gastrointest Endosc 55:576–581
Larghi A, Waxman I (2005) Endoscopic mucosal resection: treatment of neoplasia. Gastrointest Endosc Clin North Am 15:431–454, viii
Okano A, Hajiro K, Takakuwa H, Nishio A, Matsushita M (2003) Predictors of bleeding after endoscopic mucosal resection of gastric tumors. Gastrointest Endosc 57:687–690
Takeshita K, Tani M, Inoue H, Saeki I, Hayashi S, Honda T, Kando F, Saito N, Endo M (1997) Endoscopic treatment of early oesophageal or gastric cancer. Gut 40:123–127
Sorbi D, Norton I, Conio M, Balm R, Zinsmeister A, Gostout CJ (2000) Postpolypectomy lower GI bleeding: descriptive analysis. Gastrointest Endosc 51:690–696
Hirasaki S, Tanimizu M, Moriwaki T, Hyodo I, Shinji T, Koide N, Shiratori Y (2004) Efficacy of clinical pathway for the management of mucosal gastric carcinoma treated with endoscopic submucosal dissection using an insulated-tip diathermic knife. Intern Med 43:1120–1125
Parra-Blanco A, Kaminaga N, Kojima T, Endo Y, Uragami N, Okawa N, Hattori T, Takahashi H, Fujita R (2000) Hemoclipping for postpolypectomy and postbiopsy colonic bleeding. Gastrointest Endosc 51:37–41
Matsuda T, Fujii T, Emura F, Kozu T, Saito Y, Ikematsu H, Saito D (2004) Complete closure of a large defect after EMR of a lateral spreading colorectal tumor when using a two-channel colonoscope. Gastrointest Endosc 60:836–838
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Choi, K.D., Jung, HY., Lee, G.H. et al. Application of metal hemoclips for closure of endoscopic mucosal resection–induced ulcers of the stomach to prevent delayed bleeding. Surg Endosc 22, 1882–1886 (2008). https://doi.org/10.1007/s00464-008-9743-0
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DOI: https://doi.org/10.1007/s00464-008-9743-0