Application of metal hemoclips for closure of endoscopic mucosal resection-induced ulcers of the stomach to prevent delayed bleeding.
BACKGROUND
Bleeding is a major complication of endoscopic mucosal resection (EMR). This study investigated whether the use of metal hemoclips to close EMR-induced ulcers after gastric EMR was effective in preventing delayed bleeding.


METHODS
This single-center study retrospectively examined the records for 150 lesions of 140 consecutive patients (107 men and 33 women) with a mean age of 61 years (range, 38-81 years) who underwent EMR. For 60 patients, moderate to severe immediate bleeding occurred during the procedure, and the ulcers had been closed using metal hemoclips (clip group). In the remaining 90 cases, the immediate bleeding was absent or mild, and hemoclips were not used (nonclip group). Postprocedure bleeding (delayed bleeding) was analyzed.


RESULTS
Overall, delayed bleeding occurred with 14 (9.3%) of the 150 lesions. Delayed bleeding occurred less frequently in the clip group (2 of 60 lesions; 3.3%) than in the nonclip group (12 of 90 lesions; 13.3%; p = 0.04). Of the 60 clip group ulcers, 37 (62%) were completely closed, and none showed delayed bleeding. The median number of hemoclips used for ulcer closure was 10 (range, 4-22), and the median time for ulcer closure was 14 min (range, 4-40 min).


CONCLUSIONS
Prophylactic closure of gastric EMR-induced ulcers with hemoclips reduced delayed bleeding.
Choi
Kee Don
KD
Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea.
Jung
Hwoon-Yong
HY
Lee
Gin Hyug
GH
Oh
Tae Hoon
TH
Jo
Ji Yun
JY
Song
Ho June
HJ
Hong
Seoung Soo
SS
Kim
Jin-Ho
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000209:etiology / Q000628:therapy*; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome