Endoscopic Hemostasis Device, How to CHOOSE

Endoscopic Hemostasis Device:How to CHOOSE

Gastrointestinal bleeding, as regarded clinically, is the emergent, dangerous and severe case. Non-varicose vein gastrointestinal bleeding is one of the most common types with high rate of fatality and disability.

The main types of endoscopic bleeding have their own advantages and disadvantage.In Chinese traditional medicine, we have the treating principle,that is called “BIAN ZHENG SHI ZHI”. Differentiate the syndromes before you choose proper treatments.  This principle could be applied to the treatment of GI bleeding very well.

We shall introduce the below treatments and their applied indications.

1. Spray hemostasis: spray 8% arterenol on the lesions with dosage 20-~40Ml.

Advantage: this method is effective in cleaning the lesion and exposing the blood vessel, not suitable for large spraying bleeding of artery.

2. Endoscopic injection for hemostasis: penetrate the injection needle. Inject the adrenalin into the lesion position. Inject 0.5~1.0 ml on each position and the amount of injection is controlled within 6~10ml.

Advantages: simple operation with good hemostasis effect. Disadvantage is high rate of re-bleeding.

3. Microwave hemostasis: gently “iron” the bleeding point and repeat 2-3 times on each lesion.

The principle of hemostasis is to expand the tissue and compress the vessel cavity.

The vessel cavity is compressed to minimumand even blocked. The largest difficulty lies on the control of thermo coagulationand depth to inactivate the tissue.

If the device is adhesive to the tissue and dragged improperly, it may cause new bleeding point.

4. Titanium clip hemostasis：Connect the endoscope with the clip applicator. Close the clip applicator and seal the vessel. The vessel is closed and the blood flow is blocked. The effectiveness of hemostasis in this method is over 95%. The principle is to make mechanical force on the lesion. It is mainly referred to Forrest Ia, Ib, and IIa.

The below cases are not suitable for clip hemostasis: varicose bleeding of esophagus or gastric fundus, diffuse bleeding, malignant ulcer bleeding with fragile tissue.

The bleeding of artery with lesion diameter larger than 3mm is not suitable to use clip as well.

The endoscopic clip hemostasis has rare complications. The well-known complications include perforation and clip detaining.

After one week of the operation, the granulation tissue shall grow and the clip will fall off.

If the clip is compressed with extraordinary strong force and grab excessive tissue. The clip may retain in the body. After clinical observation, this situation shall not lead to any negative result.

Some tips to use hemoclip with good effect.

1. Keep the vision clearly and clamp the vessel in the correct position.

2. Once you discover the lesion, span the clip on the lesion and include the nearby mucosa into the clip.

3. Pay attention to the complications.

4. Titanium clip shall not bring any injury on the mucosa and shall not affect the heal of the ulcer.（From China’s Naturopathy April2011, Vol.19 No.4）

For ulcer with cicatrix nearby and large area bleeding, combined use of hemoclip and ligation loop together is the effective way in clinical practice.

5．Joint-hemostasis

Combined use of the above methods could be innovative and have extraordinary good hemostasis effect.Combined use of the above methods could be innovative and have extraordinary good hemostasis effect.For example, for emergency gastric bleeding, clip combined with drug spray has extraordinarily good effect in hemostasis. The blooding time and dosage could be reduced to great extent.

Therefore, the life quality of patients is improved.

Combined use of the above methods could be innovative and have extraordinary good hemostasis effect.

For example, for emergency gastric bleeding, clip combined with drug spray has extraordinarily good effect in hemostasis. The blooding time and dosage could be reduced to great extent.

Therefore, the life quality of patients is improved.

Large area bleeding of upper GI could be treated effectively and safely with combined use of transparent cap and hemoclip.

For the cases in which the bleeding lesion is unclear, spray the lesion wit 0.1‰ epinephrine saline and use hemoclip for hemostasis. It is an easy and safe method with good effect.