title: Prospective, randomized comparison of 3 different hemoclips for the treatment of acute upper GI hemorrhage in an established experimental setting.
abstract: BACKGROUND
  Recently, endoscopic clip application devices have undergone redesign and improvements to optimize their clinical use and effectiveness. Initially designed for the treatment of bleeding nonvariceal lesions, these devices are also increasingly used for the closure of perforations, fistulas, and anastomotic leaks. Several clinical studies, both randomized and nonrandomized, have used endoscopic hemoclips for hemostasis. However, no comparative studies have yet been reported in the literature comparing the latest endoscopic clip devices for usability and effectiveness for hemostasis of acute upper GI hemorrhage.
  
  
  OBJECTIVE
  We aimed to compare the usability and efficacy of 3 different types of endoscopic clip application devices in an established experimental setting by using a porcine ex-vivo simulator of upper GI hemorrhage.
  
  
  METHODS
  Randomized, controlled, ex-vivo study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Spurting vessels were created within ex-vivo porcine stomachs as published in prior studies. The vessels were attached to a pressure transducer to record the pressure of the circulating blood replacement. Before the initiation of bleeding, each vessel was randomized to 1 of 3 endoscopic clipping devices: 2 different commonly used hemoclips deployed through the working channel and 1 novel clip deployed via an over-the-scope applications device. Two investigators treated 45 bleeding sites (15 bleeding sites for each device at various randomized locations in the stomach: fundus, body, and antrum).
  
  
  METHODS
  Usability was measured via the endpoints of procedure time and quantity of clips required to achieve hemostasis. Efficacy was measured via the endpoint of pressure increase (Δp) from baseline to after treatment.
  
  
  RESULTS
  All of the 45 hemostasis treatments were carried out successfully. The mean procedure times were significantly different among the hemoclips, with the clip deployed in an over-the-scope fashion requiring significantly less time to attain hemostasis compared with the other 2 clips. For number of clips needed to attain hemostasis, the clip deployed in an over-the-scope fashion was significantly superior to the others. There were also significant differences among the changes in pressure (Δp ± SD) among the different hemoclips tested.
  
  
  CONCLUSIONS
  Ex-vivo study.
  
  
  CONCLUSIONS
  In this prospective, randomized ex-vivo study, we observed significant differences in the usability (time to achieve hemostasis and number of clips required) and the efficacy (change in pressure achieved by the hemoclips) among the 3 clips. The clip applied in the over-the-scope fashion was superior to the other 2 tested clips with regard to time to achieve hemostasis and number of clips required.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.forename: Yunho
authors.initials: Y
authors.lastname: Jung
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gromski
authors.forename: Ram
authors.initials: R
authors.lastname: Chuttani
authors.forename: Kai
authors.initials: K
authors.lastname: Matthes
mesh_terms: D000818:Animals; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D020699:Gastroscopes; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D066298:In Vitro Techniques; D011312:Pressure; D011446:Prospective Studies; D011897:Random Allocation; D018709:Statistics, Nonparametric; D013270:Stomach / Q000601:surgery; D013525:Surgical Instruments; D013552:Swine; D013997:Time Factors