Quantification of Hemostatic Clip Usage in Treating Non-Variceal Gastrointestinal Bleeding

Le résumé fourni par la source

Introduction: Gastrointestinal (GI) bleeding accounts for over 300,000 hospitalizations yearly. Upper and lower GI bleeding management includes resuscitation, treatment with proton pump inhibition (for upper GI lesions), and endoscopic intervention for definitive therapy. One method of achieving hemostasis is mechanical tamponade of vessels associated with these lesions. Hemostatic clips and cautery are endoscopic therapies for non-variceal GI bleeds. The number of clips placed to achieve hemostasis has not been quantified. We therefore, analyzed the number of clips placed per lesion type for patients with GI bleeding at an academic teaching hospital. Methods: Data was obtained from the New York-Presbyterian Queens endoscopic electronic medical record (ProVationTM). Endoscopic cases requiring hemostatic clips between March 2016 and January 2018 were assessed. During that time, 230 patients were treated with clips. Baseline patient traits, site of bleeding, types of lesions (angioectasias, ulcers, dieulafoy lesions, Mallory-Weiss tears and diverticula), and number of clips used for each type of lesion was evaluated. Results: Of the 230 patients who underwent procedures requiring hemostatic clipping, 142 were males (62%) and 88 were females (38%) with an average age of 59.5 (range 9-97). 669 total clips were used with an average of 2.91 clips per case. 137/230 (60%) of the patients undergoing clipping had gastric or duodenal ulcers with 435 clips used with an average of 3.18 clips/case (range 1-9 clips). There were a total of 60 cases of angioectasias of the upper and lower GI tract with 159 clips both to complete hemostasis after cautery and to prevent perforation used at an average of 2.65 clips per case (range 1-7 clips). There were 11 cases of dieulafoy lesions with 30 total clips used, averaging 2.72 clips per case (range 1-4 clips). There were 6 cases of Mallory-Weiss tears with 17 total clips, averaging 2.83 clips per case (range 1-6 clips). Finally, there were 10 cases of diverticular bleeding with 28 total clips used, averaging 2.8 clips per case (range 1-6). Conclusion: Hemostatic clips are used in the management of GI bleeding. Their safety and efficacy are well reported, however there is a paucity of literature quantifying the number of clips needed for different types of lesions. In our retrospective review, a similar number of clips were used to achieve hemostasis irrespective of the etiology or location of the target lesion.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.