Clips for the prevention and treatment of postpolypectomy bleeding (hemoclips in polypectomy)
The most accurate method for the prevention and treatment of complications after polypectomy has not been well defined. The prophylactic use of hemoclips may reduce the risk of bleeding, mainly in pedunculated big polyps.
To evaluate the accuracy of hemoclips in the prophylaxis and treatment of bleeding after endoscopic polypectomy.
Retrospective study of 223 consecutive endoscopic polypectomies performed in our Endoscopy Unit between january and october 2001. Hemoclips were routinely used only for large polyps (15 to 40 mm); all of them were located in the colon except one, a gastric polyp.
From a total of 223 polypectomies (215 patients), hemoclips were used for 34 (15.2%), in 30 of them just before and in 4 just after polypectomy. When used prophylactically no complication was observed, except one mild bleeding episode (3.3%) that stopped with the placing of a second hemoclip. The therapeutic clipping (4 polypectomies) induced immediate haemostasis in all cases.
The prophylactic use of hemoclips is associated with a very low risk of bleeding after endoscopic resection of big polyps. Therapeutic clipping is an effective measure for polypectomy-related bleeding.
Available from: PubMed Central
- "Indeed, some have even advocated doing nothing for asymptomatic polyps . Although novel endoscopic techniques for polypectomy including the use of hemoclips , detachable snares , and saline-solution-epinephrine injection plus band ligation  have been reported to minimize the risk of bleeding from polypectomy, no alternative low-risk strategy catering for both the diagnosis and treatment of large-sized gastric polyps has been proposed. "
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ABSTRACT: Although gastric polyp is usually an incidental endoscopic finding, large-sized polyps can cause symptoms ranging from epigastralgia to bleeding from ulcerated polyps and gastric outlet obstruction. Although the gold standard of treatment is removal of the polyp either through endoscopic polypectomy or surgical excision, complications associated with these procedures cannot be ignored. The risk becomes a major concern for patients at high risk for surgery when complications arise. We describe a debilitated 74-year-old woman who presented with early satiety, intermittent postprandial nausea and vomiting for three months. Upper endoscopy revealed a 2.5 cm pedunculated polyp over the gastric antrum causing intermittent obstruction. Considering her high risk for polypectomy, detachable snaring was performed without polypectomy in an outpatient setting. The patient was complication-free with complete relief of obstructive symptoms one week after the procedure. Subsequent follow-ups showed satisfactory healing without signs of mucosal disruption or recurrence. The results suggest that detachable snaring without polypectomy may be a therapeutic option for high-risk patients with benign symptomatic gastric polyps.
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ABSTRACT: Lower gastrointestinal bleeding is defined as blood loss that originates from a source distal to the ligament of Treitz and results in hemodynamic instability or symptomatic anemia. Although approximately 10% to 15% of patients presenting with acute severe hematochezia have an upper gastrointestinal source of bleeding identified on upper endoscopy, the most common causes of lower gastrointestinal bleeding are diverticulosis, hemorrhoids, ischemic colitis, and angiodysplasia. As with upper gastrointestinal bleeding, lower gastrointestinal bleeding ceases spontaneously in most cases.
Available from: Lawrence S Friedman
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ABSTRACT: Several recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding.
The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower gastrointestinal bleeding, based on this literature review.
Publications pertaining to lower gastrointestinal bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed.
Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower gastrointestinal bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower gastrointestinal bleeding after localization by either colonoscopy or angiography.
There is limited high-quality research in the area of lower gastrointestinal bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper gastrointestinal bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower gastrointestinal bleeding.
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