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Endoscopic clipping for the management of gastrointestinal bleeding

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 559–568 (2008)Cite this article

Abstract

Endoscopic clipping is a safe and effective technique for the treatment of various bleeding gastrointestinal lesions. Randomized controlled trials and a meta-analysis have shown comparable efficacy between clipping and conventional contact thermal therapy for definitive hemostasis of nonvariceal upper gastrointestinal hemorrhage. Clipping also seems to be efficacious for selected lower gastrointestinal bleeding lesions, such as diverticular bleeding and postpolypectomy bleeding. Proficiency in clip application and endoscopic identification of lesions that are amenable to clipping are key determinants of a successful outcome.

Key Points

  • Clipping is an established technique for endoscopic hemostasis and should be included in the endoscopist's repertoire of hemostatic devices

  • Successful outcome is dependent on operator familiarity with the clipping devices and proper lesion selection

  • The QuickClip2 and Resolution® clip devices are probably of comparable efficacy with regard to hemostasis; the Triclip® device has limited applications owing to its three-pronged design

  • Clipping is comparable in efficacy to standard contact thermal techniques for the management of nonvariceal upper gastrointestinal bleeding lesions, including peptic ulcers and Dieulafoy lesions, as shown by prospective randomized controlled trials and a meta-analysis

  • Clipping seems to be effective for the treatment of diverticular bleeding and postpolypectomy hemorrhage on the basis of results from case series

  • Clipping is considered safer than thermal coagulation techniques owing to the lower risk of perforation

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Figure 1: Endoscopic clipping for the treatment of a Mallory–Weiss tear.
Figure 2: Endoscopic clipping for the treatment of postpolypectomy bleeding.
Figure 3: Endoscopic clipping for the treatment of an actively bleeding colonic diverticulum.

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Author information

Authors and Affiliations

  1. but at the time of writing was a Medical Resident in the Department of Medicine, CP Anastassiades is a Gastroenterology Fellow at the University of Michigan, Mayo Clinic, Rochester, MN.,

    Constantinos P Anastassiades

  2. Division of Gastroenterology and Hepatology, TH Baron is Director of ERCP and Professor of Medicine, and LM Wong Kee Song is Director of the Mayo GI Bleeding Team and Assistant Professor of Medicine, Mayo Clinic, Rochester, MN, USA.,

    Todd H Baron & Louis M Wong Kee Song

Authors
  1. Constantinos P Anastassiades
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  2. Todd H Baron
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  3. Louis M Wong Kee Song
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Corresponding author

Correspondence to Louis M Wong Kee Song.

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The authors declare no competing financial interests.

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Anastassiades, C., Baron, T. & Wong Kee Song, L. Endoscopic clipping for the management of gastrointestinal bleeding. Nat Rev Gastroenterol Hepatol 5, 559–568 (2008). https://doi.org/10.1038/ncpgasthep1233

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