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Gastrointestinal Bleeding

pper gastrointestinal bleeding is one of the pathologic conditions frequently encountered in daily medical care, and this condition is thought to result from various diseases such as peptic ulcer, acute gastric mucosal lesion (AGML), gastric cancer, Mallry-Weiss syndrome and esophageal or gastric varices. Treatments for these diseases are generally classified into conservative and surgical therapies. The latter is gradually decreasing due to recent development of potent anti-ulcer drugs and advances in endoscopic hemostasis. However, conservative therapies have limitations as well, and therefore it is important to appropriately select cases for conservative therapies and to recognize when surgery is necessary. In this issue, we explain clipping hemostasis which is mainly performed in our clinic.

Clipping hemostasis in which bleeding is physically stopped by grasping the bleeding vessels, is equivalent to surgical ligation with a needle and thread. It is a safe method that usually does not crush the lesion. Moreover, it is highly effective with very little likelihood of rebleeding if the bleeding vessels are clipped at an appropriate depth. However, grasping with a clip is impossible in highly fibrotic bleeding lesion, and at this point, clipping hemostasis is somewhat dissimilar from other methods (local injection of pure ethanol, heater probe, microwave, laser or high frequency coagulation) by which transient hemostasis is comparatively easy. Though, seen from a different perspective, the applicable range of clipping hemostasis is clear, allowing us to easily determine when surgery is necessary. This method is thought to be suitable for non-specialized medical facilities such as our clinic. We present here a case of hemorrhagic gastric ulcer treated by clipping hemostasis.

gigantic ulcer in the gastric angle
There was a gigantic ulcer in the gastric angle and bleeding from the exposed vessels (arrow) was observed.

Gastrointestinal Bleeding
Opening the clip.

Gastrointestinal Bleeding
Deeply grasping the exposed vessels.

Gastrointestinal Bleeding
Four weeks after hemostasis. The ulcer reduced and there was no bleeding observed.