Summary
Injection of India ink and clipping are relatively well-known methods for marking lesions of the gastrointestinal tract. The use of metal clips provides a radiologically recognizable mark, which is also palpable at surgery. In addition, clips can be extremely useful as landmarks in comparing endoscopic findings with the resected specimen. Previous reports of clip-marking have concentrated on the Olympus (Tokyo, Japan) HX-2L clip, but this clip has the disadvantages of having too wide a diameter to be used through most conventional endoscopes and also a relatively low clip-retention rate, as the depth of its bite is limited. Recently, Olympus has marketed a new clip (HX-3L) designed by the author for hemostasis in cases of gastrointestinal bleeding. This new clip is an improved version of the cassette-type J-clip that was previously reported by the author in this journal. The prime advantage of the HX-3L is that the endoscopist can use it via a panendoscope without any assistance. In addition, it has an excellent bite and a very high level of safety. In terms of function and application, it is completely different from the HX-2L. In addition, the tip (the portion that actually grasps tissue) of the HX-3L is longer and thinner than the HX-2L, thus permitting a firm grasp of the muscularis mucosae layer even when approaching from an upper oblique angle and this, in turn, improves the performance of the clip as a marker. We employed this method preoperatively in 27 patients undergoing digestive tract surgery, and the rate of clipping patency was evaluated. The time from clipping to operation varied from 1 to 26 days (average: 10.7) and of the 70 clips, 69 remained in place on the resected specimen (98.6%). In all cases it was possible to palpate the clips during operation.
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References
Endo M, Kobayashi S, Suzuki S, Ide H, Tobita Y, Hanyu F, Yazawa C, Takemoto C, Nakayama K (1972) Esophageal marking by esophagofiberscope. J Jpn Bronchoesophagol Soc 23: 106–108
Fuyuno S, Yao T (1977) Determination of the extent of infiltration in gastric cancer by endoscopic clipping method. Stomach Intestine 12: 1055–1071
Hachisu T (1988) Evaluation of endoscopic hemostasis using an improved clipping apparatus. Surg Endosc 2: 13–17
Hachisu T, Nakao T, Suzuki N (1985) The endoscopic clipping hemostasis against upper gastrointestinal bleeding (a device of the improved clip and its clinical study). Gastroenterol Endosc 27: 276–281
Hachisu T, Nakao T, Nagata M, Ohmori K, Kashiwabara H, Yokoyama T, Nagamine K, Hamaguchi K (1985) A study on endoscopic clipping hemostasis against upper gastrointestinal bleeding. Prog Dig Endosc 27: 115–119
Hachisu T, Awano T, Ohmori K, Kashiwabara H, Yokoyama T, Suzuki N, Tsubura Y, Iwaoka H, Hamaguchi K (1987) Clinical applications of a cassette-type J-clip; its usefulness in marking the lesions. Prog Dig Endosc 31: 80–83
Hachisu T, Miyazaki S, Suzuki N, Sato S, Tsubura Y, Iwaoka H, Ogawa A, Kawashima R (1988) A device of the improved clipping apparatus (HX-3L) and its clinical study. Prog Dig Endosc 33: 62–64
Hayashi T, Yonezawa M, Kuwabara T, Kudoh I (1975) The study on stanch clip for the treatment by endoscopy. Gastroenterol Endosc 17: 92–101
Makuuchi H, Kumagai Y, Kakegawa T, Takahashi H, Nohga K, Sakuma M (1976) Esophageal marking (esophageal clipping under the observation with esophagofiberscope). Gastroenterol Endosc 18: 856–863
Oida M, Igarashi M, Naka H, Nishiyama Y, Katsumata T, Saigenji K, Okabe H, Hayasaka T, Takahashi T, Hiki Y, Mieno H (1981) A comparative study on magnified endoscopic observation and preoperative clip-marking method for the depressive-type of gastric cancer. Gastroenterol Endosc 23: 1043
Yokota H, Nakano S, Yamazaki M, Yamao R, Ito H, Shimoda T (1984) A study on endoscopic clip-marking method for the operation of early cancer of upper stomach. Gastroenterol Endosc 26: 2498
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Hachisu, T., Miyazaki, Si. & Hamaguchi, Ki. Endoscopic clip-marking of lesions using the newly developed HX-3L clip. Surg Endosc 3, 142–147 (1989). https://doi.org/10.1007/BF00591360
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DOI: https://doi.org/10.1007/BF00591360