The Use of Endoscopic Hemoclips for Postoperative Anastomotic Bleeding

Abstract

With the availability of endoscopy and its inherent use as a diagnostic and therapeutic modality, many surgeons and gastroenterologists are able to use this tool to remedy a wide range of gastrointestinal pathologies. The literature is replete with anecdotal endoscopic therapeutic strategies ranging from epinephrine injection, to use of cautery or argon plasma coagulation. This case report highlights the use of endoscopic hemoclips which were successfully applied in the acute postoperative period for a bleeding vessel at a fresh anastomotic site. The article allows for a brief discussion of plausible endoscopic treatment strategies available to the surgeon faced with a similar situation.

Efficacy and Safety of Endoscopic Clipping for Acute Anastomotic Bleeding After Colorectal Surgery

“…Blood perfusion to the anastomosis and the anastomotic tension are believed to be the most important factors for proper healing. Factors affecting these in our patient, including the duration of surgery, hypovolemic shock, and high ligation of the inferior mesenteric artery, could have been relevant [7,9,10]; this patient underwent a right hemihepatectomy for liver metastasis at the time of colorectal anastomosis, with a total When luminal bleeding occurs, endoscopic treatment options include injection therapy, thermal coagulation, and clipping [11]. Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [6,11].…”

“…Factors affecting these in our patient, including the duration of surgery, hypovolemic shock, and high ligation of the inferior mesenteric artery, could have been relevant [7,9,10]; this patient underwent a right hemihepatectomy for liver metastasis at the time of colorectal anastomosis, with a total When luminal bleeding occurs, endoscopic treatment options include injection therapy, thermal coagulation, and clipping [11]. Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [6,11]. APC allows noncontact endoscopic thermal coagulation by delivering a high-frequency electrical current through emitted argon gas; however, its cost is higher than the other modalities, and its use for larger vessels is still controversial [11].…”

“…When luminal bleeding occurs, endoscopic treatment options include injection therapy, thermal coagulation, and clipping [ 11 ]. Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [ 6 , 11 ].…”

“…When luminal bleeding occurs, endoscopic treatment options include injection therapy, thermal coagulation, and clipping [ 11 ]. Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [ 6 , 11 ]. APC allows noncontact endoscopic thermal coagulation by delivering a high-frequency electrical current through emitted argon gas; however, its cost is higher than the other modalities, and its use for larger vessels is still controversial [ 11 ].…”

“…Epinephrine (at a ratio of 1:10,000 or 1:20,000) is the most used injection agent; however, it results in vasoconstriction and enhances platelet aggregation, which might have a negative impact on the anastomotic healing process [ 6 , 11 ]. APC allows noncontact endoscopic thermal coagulation by delivering a high-frequency electrical current through emitted argon gas; however, its cost is higher than the other modalities, and its use for larger vessels is still controversial [ 11 ]. Besides, severe complications of APC, including fistulation, stricture formation, and ischemia, were reported [ 12 ].…”