Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany.
Med Sci Monit. 2011 Jan;17(1):MT1-6. doi: 10.12659/msm.881313.
Hemoclip application in GI-hemorrhage has proven to be effective. Clinical experience shows that multiple clips are frequently necessary. In 2005, an easily reloadable clip-applicator was introduced. We evaluated the hemodynamic efficacy of this new device.
MATERIAL/METHODS: We prospectively compared the new clipping device (Olympus HX 110/610) in a validated experimental setting using the compactEASIE®-simulator for GI bleeding. The artificial blood circulation system in the simulator was connected to a pressure transducer. Four investigators of different endoscopic experience (1000-6000 endoscopies) treated 12 bleeding sources each, with up to 6 clips for each bleeding location. Pressures were recorded to objectify the additive effects of sequential clip application on the reduction in vessel diameter. The intervention was abandoned if a maximum measurable pressure of 300 mmHg was achieved.
Hemoclip application led to a significant increase of peak pressure (91±100 mmHg, p<0.001) and mean pressure (95±99 mmHg, p<0.001), representing a significant reduction in vessel diameter. Pooled data showed a significant stepwise increase in mean and maximum system pressure, resulting in reduction of vessel diameter up to the fifth hemoclip. On average, 5 clips (range 1-6) were used. More experienced endoscopists achieved a higher increase in mean pressure (167 and 118 mmHg vs 72 and 23 mmHg, p<0.05). Mean reloading time was 39 seconds (19-49 sec).
Sequential application of multiple hemoclips led to an increasing effect, comparable to the results of previous clinical trials. The number of hemoclips applied correlated inversely, but not significantly, with the endoscopist´s experience. Expensive single-use clips appear dispensable in view of the short reloading time.
在胃肠道出血中应用止血夹已被证明是有效的。临床经验表明，通常需要多次夹闭。2005 年，一种易于重新加载的夹闭器问世。我们评估了这种新设备的血流动力学效果。
材料/方法：我们在一个经过验证的实验环境中使用紧凑 EASIE®-模拟器对新的夹闭装置（奥林巴斯 HX 110/610）进行了前瞻性比较，该模拟器用于胃肠道出血。模拟器中的人工血液循环系统与压力传感器相连。4 位不同内镜经验的研究人员（1000-6000 次内镜检查）分别对 12 个出血源进行了治疗，每个出血部位最多使用 6 个止血夹。记录压力以客观地反映顺序夹闭对血管直径缩小的附加效果。如果达到可测量的最大压力 300mmHg，则停止干预。
应用止血夹可显著增加峰值压力（91±100mmHg，p<0.001）和平均压力（95±99mmHg，p<0.001），表明血管直径显著缩小。汇总数据显示平均和最大系统压力呈显著阶梯式增加，导致第五个止血夹夹闭后血管直径减小。平均使用 5 个夹子（范围 1-6 个）。经验更丰富的内镜医生平均压力增加更高（167 和 118mmHg 与 72 和 23mmHg，p<0.05）。平均重新加载时间为 39 秒（19-49 秒）。
多次顺序应用止血夹可产生递增效果，与以往临床试验结果相当。应用止血夹的数量与内镜医生的经验呈负相关，但无统计学意义。鉴于较短的重新加载时间，昂贵的一次性使用止血夹似乎可以省略。
