title: Hemodynamic efficacy of sequential hemoclip application using the Olympus HX-110/610 reloadable clipping device in spurting bleedings.
abstract: BACKGROUND
  Hemoclip application in GI-hemorrhage has proven to be effective. Clinical experience shows that multiple clips are frequently necessary. In 2005, an easily reloadable clip-applicator was introduced. We evaluated the hemodynamic efficacy of this new device.
  
  
  METHODS
  We prospectively compared the new clipping device (Olympus HX 110/610) in a validated experimental setting using the compactEASIE®-simulator for GI bleeding. The artificial blood circulation system in the simulator was connected to a pressure transducer. Four investigators of different endoscopic experience (1000-6000 endoscopies) treated 12 bleeding sources each, with up to 6 clips for each bleeding location. Pressures were recorded to objectify the additive effects of sequential clip application on the reduction in vessel diameter. The intervention was abandoned if a maximum measurable pressure of 300 mmHg was achieved.
  
  
  RESULTS
  Hemoclip application led to a significant increase of peak pressure (91±100 mmHg, p<0.001) and mean pressure (95±99 mmHg, p<0.001), representing a significant reduction in vessel diameter. Pooled data showed a significant stepwise increase in mean and maximum system pressure, resulting in reduction of vessel diameter up to the fifth hemoclip. On average, 5 clips (range 1-6) were used. More experienced endoscopists achieved a higher increase in mean pressure (167 and 118 mmHg vs 72 and 23 mmHg, p<0.05). Mean reloading time was 39 seconds (19-49 sec).
  
  
  CONCLUSIONS
  Sequential application of multiple hemoclips led to an increasing effect, comparable to the results of previous clinical trials. The number of hemoclips applied correlated inversely, but not significantly, with the endoscopist´s experience. Expensive single-use clips appear dispensable in view of the short reloading time.
authors.affiliation: Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Ende
authors.forename: Yurdaguel
authors.initials: Y
authors.lastname: Zopf
authors.forename: Roland
authors.initials: R
authors.lastname: Heide
authors.forename: Thomas
authors.initials: T
authors.lastname: Bernatik
authors.forename: Markus
authors.initials: M
authors.lastname: Wehler
authors.forename: Dieter
authors.initials: D
authors.lastname: Schwab
authors.forename: Eckhart G
authors.initials: EG
authors.lastname: Hahn
authors.forename: Juergen
authors.initials: J
authors.lastname: Maiss
mesh_terms: D000818:Animals; D001794:Blood Pressure; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D011446:Prospective Studies; D034421:Sus scrofa