Endoscopic Clipping for Gastric Ulcer
Endoscopic clips are relatively new devices that have been shown to be effective for the control of acute gastrointestinal hemorrhage. Recently, endoscopic clips have been used for a variety of non‐hemorrhagic conditions. Peptic ulcer bleeding is one of the main indications for clip use. The bleeding stops spontaneously in most patients.
Endoscopic intervention has reduced mortality Different technologies have been used to treat peptic ulcers, including injection therapy and thermal ablation. They may be used separately or in combination. Injecting agents include epinephrine, hypertonic saline or alcohol. Thermal ablation is performed by a bicap, heater probe or argon plasma beam coagulation.
Clips were originally designed as an alternative treatment to control bleeding by direct mechanical pressure. The clip is used to grasp and compress a bleeding vessel similar to surgical ligation. The appeal of this method is that it minimizes injury to surrounding tissues as opposed to injection or thermal therapy. This may reduce the risk of necrosis and perforation.
To achieve hemostasis with a clip requires locating the vessel, which may be difficult in patients who are actively bleeding. Therefore, pretreatment with injection therapy to reduce bleeding may be required before clip placement, negating the theoretical advantage of using the clip to cause no tissue injury.
Other sources of bleeding in the GI tract can also be managed with clipping devices. Endoscopic clips have been used on gastric tumors, post‐sphincterotomies, arterio–venous malformations and diverticular bleeds. Endoscopic clips have been used to close a variety of small perforations and fistulas throughout the gastrointestinal tract. Closing anastomotic leaks and fistulas has been demonstrated in various case reports.
clips have been proved to be a valuable alternative method of controlling hemostasis by using mechanical pressure. There is no injury to surrounding tissue with this method, and the clips do not interfere with healing.