Rex Douglas K
Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
Gastroenterol Hepatol (N Y). 2021 Oct;17(10):464-468.
Delayed hemorrhage is the most common complication of endoscopic mucosal resection (EMR). Studies have shown that prophylactic placement of hemostatic clips on certain EMR scars reduces the risk of delayed hemorrhage. During endoscopic follow-up, mucosal distortions induced by clip closure known as clip artifact can be visualized. Clip artifact can be confused with residual neoplastic polyp, potentially leading to unnecessary treatment and complications. Clip artifact can be classified into 3 different types: Type 1: the presence of inflammation associated with continued clip attachment; Type 2: the presence of inflammation that persists after clip detachment; and Type 3: the presence of noninflamed mucosal distortions after clip detachment. Differentiation of clip artifact from residual neoplasia relies on careful analysis of colonic pit patterns. Management varies greatly; clip artifact requires no treatment, whereas residual polyp requires resection. This article reviews clip artifact and introduces a classification scheme to help endoscopists with diagnosis and management.
迟发性出血是内镜黏膜切除术（EMR）最常见的并发症。研究表明，在内镜黏膜切除术的某些创面预防性放置止血夹可降低迟发性出血的风险。在内镜随访过程中，可以观察到由夹子闭合引起的黏膜扭曲，即夹子伪像。夹子伪像可能与残留的肿瘤性息肉相混淆，从而可能导致不必要的治疗和并发症。夹子伪像可分为3种不同类型：1型：与夹子持续附着相关的炎症存在；2型：夹子脱落后持续存在的炎症；3型：夹子脱落后无炎症的黏膜扭曲。将夹子伪像与残留肿瘤区分开来依赖于对结肠小凹形态的仔细分析。处理方法差异很大；夹子伪像无需治疗，而残留息肉则需要切除。本文回顾了夹子伪像，并介绍了一种分类方案，以帮助内镜医师进行诊断和处理。
