Hemoclip application is a test which allows the doctor to look directly at the bleeding source and apply mechanical clips to stop bleeding. Diagnostic hemoclip application is recommended for active gastrointestinal bleeding, bleeding ulcers, post-polypectomy hemorrhage and bleeding vascular malformations. In order to do the test, an endoscope is carefully passed through the mouth into the esophagus, stomach and duodenum or through the anus into the colon. The endoscope is a long flexible tube, about the thickness of your index finger, with a bright light at its tip. The video camera on the endoscope transmits images of the bleeding site to a monitor allowing the physician to visualize the exact location and source of bleeding. If necessary, hemoclips can be applied through the scope during hemoclip application to stop the bleeding. Tissue samples (biopsies) can be taken during the procedure as well.

Diagnosis

Hemoclip application can help doctors diagnose the reasons for

• Active upper gastrointestinal bleeding

• Bleeding gastric and duodenal ulcers

• Post-polypectomy hemorrhage

• Bleeding from vascular malformations or angioectasias

• Dieulafoy lesion bleeding

• Bleeding from gastric or esophageal tears

• Unexplained gastrointestinal bleeding despite other interventions

• Diagnosis and treatment of rebleeding sources

Hemoclip application can also localize the exact bleeding source and assess bleeding severity. The procedure is used to identify the anatomic site of bleeding that requires hemostasis. The doctor can also take samples from the bleeding area during hemoclip application. The procedure allows identification of the bleeding source and application of hemostatic therapy.

High definition endoscopy: High resolution visualization allows precise identification of bleeding vessels and lesions that will help to locate the exact bleeding source especially in difficult cases.

Therapeutic ultrasound: is a modality when applied with hemoclip application can help to assess bleeding vessel size and predict hemostasis success so that therapeutic yield is high.

Treatment

Hemoclip application can help doctors with the following issues

• Control of active bleeding from gastric and duodenal ulcers

• Treatment of post-polypectomy hemorrhage

• Hemostasis of bleeding vascular malformations and angioectasias

• Control of bleeding from Dieulafoy lesions

• Treatment of bleeding from gastric or esophageal tears and lacerations

• Prevention of rebleeding from previously treated bleeding sources

• Mechanical hemostasis for difficult bleeding not responding to injection therapy

• Emergency bleeding control to prevent mortality from massive hemorrhage

Interventions

Hemoclip placement: mechanical clip applied directly to bleeding vessel to stop bleeding

Hemoclip hemostasis: clip applied for the control of active gastrointestinal bleeding

Repeat hemoclip placement: multiple clips applied to achieve complete hemostasis

Hemoclip plus injection: hemoclip combined with epinephrine injection for reinforced hemostasis

Hemoclip removal: previously placed clips removed if they migrate or interfere with healing

Hemoclip repositioning: clip repositioned or additional clips applied if initial hemostasis incomplete

Combined hemostasis: hemoclip combined with thermal coagulation or sclerotherapy for difficult bleeding

Hemoclip monitoring: follow-up endoscopy performed to assess hemoclip efficacy and clip healing

Preventive

Bleeding ulcer surveillance: gastrointestinal bleeding from ulcers is common in high-risk patients. Surveillance is recommended in patients on anticoagulation or with history of ulcer bleeding to detect ulcers in the early stage which may help in endoscopic prevention avoiding surgery.

Surveillance of patients with prior bleeding episodes: Patients with history of gastrointestinal bleeding are prone to develop rebleeding which can be prevented by hemoclip application and appropriate medical therapy combined with monitoring.

Early detection and hemoclip treatment of bleeding sources followed by monitoring: Early detection and hemoclip treatment of bleeding vessels prevents massive hemorrhage and reduces mortality significantly.

Post-polypectomy bleeding prevention: Patients undergoing polypectomy at high risk for post-procedure bleeding can undergo prophylactic hemoclip placement to prevent post-polypectomy hemorrhage.