Bleeding Ulcers Hemoclip Application and Thermal Methods

■ Hemoclip Application

Principle and Key Characteristics

► Principle: compression of the lesion or bleeding vessel with a metal clip

► Safe, appears as effective as injection therapy, causes no tissue damage, relatively low cost

► Excellent for treating "visible vessels" and arterial hemorrhages, Dieulafoy ulcer, and bleeding after polypectomies

Materials

► Suction pumps

► Hemoclips with applicator

Thermal Methods

Key Characteristics

Several options: electrocoagulation, laser, argon plasma coagulation

No more effective than injection methods, rarely used alone Argon plasma coagulation: shallow penetration, very effective for oozing (Fig. 4.24)

Technique

► Load the hemoclip onto the applicator and insert.

► Apply the hemoclip to the bleeding vessel.

Fig. 4.22 Clipping of a bleeding gastric ulcer a The bleeding site is identified

Fig. 4.22 Clipping of a bleeding gastric ulcer a The bleeding site is identified

The applicator is advanced to the bleeding site. The open clip is visible on the left side of the image b

The applicator is advanced to the bleeding site. The open clip is visible on the left side of the image

c The clip is applied, largely controlling the hemorrhage

Fig. 4.23 Clipping of a bleeding biopsy b Appearance after irrigation c After hemoclip application site a Brisk bleeding after a tissue biopsy

Fig. 4.23 Clipping of a bleeding biopsy b Appearance after irrigation c After hemoclip application site a Brisk bleeding after a tissue biopsy

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