Top

Surgical Endoscopy

Published in:

01-07-2017

Endoclip therapy of post-sphincterotomy bleeding using a transparent cap-fitted forward-viewing gastroscope

Authors: Hyung Ku Chon, Tae Hyeon Kim

Published in: Surgical Endoscopy | Issue 7/2017

Abstract

Background

The incidence of post-endoscopic sphincterotomy (ES) bleeding is reportedly 2.0–5.0 %. Among various hemostatic methods, endoclip therapy is an effective modality in gastrointestinal bleeding. However, endoclip application for post-ES hemorrhage has not been widely studied, partly because of the difficulty in placing of clips using a duodenoscope. A cap-fitted forward-viewing gastroscope can easily visualize the major papilla and overcome the technical difficulty in applying endoclips. We aimed to determine the efficacy and safety of endoclips for the treatment of post-ES hemorrhage using a cap-fitted forward-viewing gastroscope.

Methods

From January 2011 to December 2015, a total of 1448 endoscopic retrograde cholangiopancreatography procedures with ES were retrospectively assessed and followed-up. Patients with post-ES hemorrhage who did not respond to balloon compression or to spray or injection of a diluted epinephrine solution at the bleeding focus underwent endoclip therapy using a cap-fitted forward-viewing gastroscope. Bleeding patterns (oozing, pulsatile, and exposed vessel) were recorded.

Results

ES-induced uncontrolled hemorrhage occurred in 57 patients (3.93 %). The mean age was 68.9 ± 14.5 years, and the sex ratio (male/female) was 37 (64.9 %):20 (35.1 %) in 57 patients. Of the 57 cases of hemorrhage, early uncontrolled and delayed hemorrhage occurred in 45 (3.1 %) and 12 (0.82 %), respectively. Visible bleeding patterns following ES were: 50 oozing (57.7 %), 6 pulsatile (10.5 %), and 1 exposed vessel (1.8 %). Hemostasis was achieved by endoclipping using a cap-fitted forward-viewing gastroscope in 57 of 57 patients (100 %). The median number of clips used was 1.8 (range 1–3). No evidence of further bleeding or procedure-related complications was seen.

Conclusions

We concluded that endoclip application using a cap-fitted forward-viewing gastroscope is feasible and safe and may be an effective technique for the treatment and/or prevention of post-ES hemorrhage.

Available only for authorised users

Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complication of endoscopic biliary sphincterotomy. N Engl J Med 335(13):909–918CrossRefPubMed

Katsinelos P, Kountouras J, Chatzimavroudis G, Zavos C, Paroutoglou G, Pilpilidis I, Papaziogas B (2007) A novel technique of injection treatment for endoscopic sphincterotomy-induced hemorrhage. Endoscopy 39(7):631–636CrossRefPubMed

Ferreira LE, Baron TH (2007) Post-sphincterotomy bleeding: who, what, when, and how. Am J Gastroenterol 102(12):2850–2858CrossRefPubMed

Kapetanos D, Beltsis A, Chatzimavroudis G, Katsinelos P (2009) The use of endoclips in the treatment of nonvariceal gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech 19(1):2–10CrossRefPubMed

Lai YC, Yang SS, Wu CH, Chen TK (2000) Endoscopic hemoclip treatment for bleeding peptic ulcer. World J Gastroenterol 6(1):53–56CrossRefPubMedPubMedCentral

Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS (2007) Cap-assisted ERCP in patients with a Billroth II gastrectomy. Gastrointest Endosc 66(3):612–615CrossRefPubMed

Geller AJ, al-Kawas FH (1995) Endoscopic injection for the treatment of bleeding ulcers: local tamponade or drug effect. Gastrointest Endosc 41(2):183–185CrossRefPubMed

Wilcox CM, Canakis J, Monkemuller KE, Bondora AW, Geels W (2004) Patterns of bleeding after endoscopic sphincterotomy, the subsequent risk of bleeding, and the role of epinephrine injection. Am J Gastroenterol 99(40):244–248CrossRefPubMed

Tsou YK, Lin CH, Liu NJ, Tang JH, Sung KF, Cheng CL, Lee CS (2009) Treating delayed endoscopic sphincterotomy induced bleeding: epinephrine injection with or without thermotherapy. World J Gastroenterol 15(38):4823–4828CrossRefPubMedPubMedCentral

10.

Dubravcsik Z, Hritz I, Fejes R, Szepes A, Madacsy L (2014) Endoscopic therapy of refractory post-papillotomy bleeding with electrocautery forceps coagulation method combined with prophylactic pancreatic stenting. Video J Encycl GI Endosc 1:628–631CrossRef

11.

Hayashi T, Yonezawa M, Kawabara T (1975) The study on staunch clip for the treatment by endoscopy. Gastroenterol Endosc 17:92

12.

Sung JJ, Tsoi KK, Lai LH, Wu JC, Lau JY (2007) Endoscopic clipping versus injection and thermo-coagulation in the treatment of non-variceal upper gastrointestinal bleeding: a meta-analysis. Gut 56(10):1364–1373CrossRefPubMedPubMedCentral

13.

Lin LF, Siauw CP, Ho KS, Tung JN (2004) Hemoclip treatment for post-endoscopic sphincterotomy bleeding. J Chin Med Assoc 67(10):496–499PubMed

14.

Katsinelos P, Paroutoglou G, Papaziogas B, Beltsis A, Dimiropoulos S, Atmatzidis K (2005) Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips. World J Gastroenterol 11(39):6232–6234CrossRefPubMedPubMedCentral

15.

Choi YR, Han JH, Cho YS, Han HS, Chae HB, Park SM, Youn SJ (2013) Efficacy of cap-assisted endoscopy for routine examining the ampulla of Vater. World J Gastroenterol 19(13):2037–2043CrossRefPubMedPubMedCentral

16.

Kim JI, Kim SS, Park S, Han J, Kim JK, Han SW, Choi KY, Chung IS, Chung KW, Sun HS (2003) Endoscopic hemoclipping using a transparent cap in technically difficult cases. Endoscopy 35(8):659–662CrossRefPubMed

17.

Sherman S, Hawes RH, Nisi R, Ga Lehman (1992) Endoscopic sphincterotomy-induced hemorrhage: treatment with multipolar electrocoagulation. Gastrointest Endosc 38(2):123–126CrossRefPubMed

18.

Leung JW, Chan FK, Sung JJ, Chung S (1995) Endoscopic sphincterotomy-induced hemorrhage: a study of risk factors and the role of epinephrine injection. Gastrointest Endosc 42(6):550–554CrossRef

19.

Kim KO, Kim TN, Kim SB, Lee JY (2010) Characteristic of delayed hemorrhage after endoscopic sphincterotomy. J Gastroenterol Hepatol 25(3):532–538CrossRefPubMed

20.

Nelson DB, Freeman ML (1994) Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol 19(4):283–287CrossRefPubMed

Title: Endoclip therapy of post-sphincterotomy bleeding using a transparent cap-fitted forward-viewing gastroscope
Authors: Hyung Ku Chon
Tae Hyeon Kim
Publication date: 01-07-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5287-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Endoclip therapy of post-sphincterotomy bleeding using a transparent cap-fitted forward-viewing gastroscope

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2017

Functional outcomes after TEM in patients with complete clinical response after neoadjuvant chemoradiotherapy

Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection

Consensus on structured training curriculum for transanal total mesorectal excision (TaTME)

The role of stents in the management of colorectal complications: a systematic review

A novel method of self-pulling and latter transected reconstruction in totally laparoscopic total gastrectomy: feasibility and short-term safety

Radiofrequency energy delivery to the lower esophageal sphincter improves gastroesophageal reflux patient-reported outcomes in failed laparoscopic Nissen fundoplication cohort