There are a number of reasons which make metal clips an attractive alternative to the more common methods of hemostasis. First, clips allow definitive and secure closure of bleeding vessels (3) and the endoscopist can immediately recognize whether a vessel has been occluded. Another important aspect is that no complications have been reported so far. In a comparative study by Chung et al. (5) on patients with Dieulafoy lesions, some of which were in the colon, the initial hemostasis effect of hemo-clipping was clearly superior to injection therapy and rebleeding was less frequent. Hemoclips are manufactured by Olympus and are comprised of stainless steel ribbons. The clips do not interfere with magnetic resonance imaging (MRI). The delivery catheter (Fig. 20.23) is available in various lengths (165,195, and 230 cm) and diameters (2.8 and 3.2 mm) allowing placement in the working channels of most flexible endoscopes. The catheter can also be rotated which allows optimal orientation of the clip delivery position. Clips are available in different versions with various angles of the jaws (90°/135°) and lengths (4, 6, and 8 mm).
The clips are loaded onto the clip application device and retracted into the device sheath before it is placed in the endoscope. The sheath is then advanced through the working channel. When the tip of the application device is protruding from the end of the endoscope, the hemoclip can be advanced and opened. The clip should be pressed gently against the bleeding source and then closed (Fig. 20.24, 0 20.2). Afterward, it is released from the application device. Procedures for clipping a vessel can vary (Fig. 20.25). It may be possible to stop bleeding, i. e., to occlude a visible vessel with a single hemoclip, (Figs. 20.26,20.27). However, it may also be necessary to use several clips to achieve optimal hemostasis (Fig. 20.28). Important requirements for hemoclip application are good visibility of the bleeding source and accuracy. Tangential application is also possible.
ices has proved itself. Although it has been recommended that the injection needle be flushed with distilled water prior to Histacryl, in our own experience we found the use of Lipiodol more appropriate. Generally, 0.5 mL of Lipiodol is required to fill the injection needle. Lipiodol is then mixed 1:1 with Histacryl and this mixture is injected, in several portions if necessary. Afterward, the injection needle is again filled with Lipidiol, in the previously determined amount, and injected, thereby transporting any remaining Histacryl into the vessel (varix).
The hemoclip usually falls off after some time. This does not cause tissue damage or ulceration. The only disadvantage is that hemoclips that have fallen off and are suctioned with an endoscope can clog the working channel of the instrument and lead to costly repairs.
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