The risk factors for prolonged hemostatic clip retention after endoscopic submucosal dissection for gastric neoplasm
- 24 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 36 (2), 1-8
- https://doi.org/10.1007/s00464-021-08379-0
Abstract
Background Endoscopic hemostatic clipping is a safe and efficient treatment used to manage bleeding or perforation during endoscopic submucosal dissection (ESD) for gastric neoplasm. However, the natural history of applied hemoclips during ESD has not been elucidated. As prolonged clip retention limits the use of magnetic resonance imaging and may impede the ulcer healing process, we investigated the factors associated with prolonged hemoclip retention during gastric ESD. Methods We retrospectively reviewed 199 patients who underwent gastric ESD with hemoclip application from January 2006 to January 2019. The primary outcome was the prolonged hemoclip retention rate 3 months after ESD. We examined the records of subjects followed at 3, 6, and 12 months and then annually after ESD to monitor clip retention. Results The prolonged hemoclip retention rate at 3 months was 27.1% (54/199). The risk of hemoclip retention was significantly lower at the antrum (19.6%, P = 0.03). Hemoclips at the angle tended to remain longer than other locations in the stomach (40.6%, P = 0.081) while there was no difference in the number of applied clips depending upon the location of the lesion. By Kaplan–Meier survival analysis, clips at the antrum detached significantly earlier than those at other locations (P = 0.011). Conclusions Most of the hemostatic clips attached during ESD were spontaneously removed by 3 months after gastric ESD. However, clips positioned at angle are suspected to have a high probability of prolonged retention. With this in mind, more attention is needed when using hemoclips on angle.Keywords
Funding Information
- Dongguk University (Dongguk University Research Fund of 2020)
This publication has 32 references indexed in Scilit:
- ACR guidance document on MR safe practices: 2013Journal of Magnetic Resonance Imaging, 2013
- Management of bleeding and artificial gastric ulcers associated with endoscopic submucosal dissectionWorld Journal of Gastrointestinal Endoscopy, 2012
- Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 expertsGastrointestinal Endoscopy, 2011
- Management of complications following endoscopic submucosal dissection for gastric cancerWorld Journal of Gastrointestinal Endoscopy, 2011
- Evaluating long-term attachment of two different endoclips in the human gastrointestinal tractWorld Journal of Gastrointestinal Endoscopy, 2010
- Predictors of immediate bleeding during endoscopic submucosal dissection in gastric lesionsSurgical Endoscopy, 2008
- Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcersGastrointestinal Endoscopy, 2006
- Endoscopic clip application devicesGastrointestinal Endoscopy, 2006
- Complete endoscopic closure of gastric perforation induced by endoscopic resection of early gastric cancer using endoclips can prevent surgery (with video)Gastrointestinal Endoscopy, 2006
- Endoscopic clip-assisted placement of enteral feeding tubesGastrointestinal Endoscopy, 1994