In many endoscopic units, the endocarp is the preferred tool for endoscopic Hemostatic Forceps. However, because of some technical limitations of the endocarp and the success of hemostatic forceps in hemostasis during endoscopic submucosal dissection (ESD), We reviewed the files of patients treated in the Al-ahsa hospital endoscopy unit between 1 January 2018 and 30 November 2018. We enrolled 33 patients who had gastrointestinal bleeding that required endoscopic treatment. During the use of hemostatic forceps, the blood was washed out with a single-channel gastroscope equipped with a water jet. With hemostatic forceps, the bleeding points were pinched and gently retracted. An electrosurgical current generator was used to perform monopolar electrocoagulation.
Hemostatic Forceps in Various Gastrointestinal Tracts
Three patients with post-sphincterotomy bleeding were initially treated with Hemostatic Forceps, with 100% primary hemostasis and no complications. Endoclipping was used on 15 patients, with 100% primary hemostasis, and two patients (13%) rebelled. The procedure took 8.53 3.58 minutes. Hemostatic forceps were used as the primary tool for hemostasis in another 15 patients, with all patients achieving hemostasis without complications. The procedure took 5.27 2.05 minutes (P = 0.005). Finally, hemostatic forceps can be an effective, quick, and safe alternative approach for GI bleeding of various causes.
Therapeutic endoscopy is the first line of treatment for GI bleeding because it reduces recurrent bleeding, surgery, and mortality (Cook et al., Citation 1992). Endoclip has been used to mark gastric lesions by gastroenterologists since its introduction a few decades ago (Hachisu, Miyazaki, & Hamaguchi, Citation1989). The endocarp was used as a primary tool for endoscopic hemostasis in many endoscopy units after its design was refined (Jensen, Machicado, & Hirabayashi, Citation 2009). Hemostatic forceps were successfully used to induce hemostasis during ESD (Enomoto et al., Citation 2007). Endoscopic treatment of bleeding gastric ulcers with hemostatic forceps has been attempted (Enomoto, Yahagi, & Fujishiro et al., Citation2004).
Endoclipping, on the other hand, necessitates highly skilled endoscopists and assistants who collaborate. Any movement, such as intestinal peristalsis, may interfere with the precise catch of the bleeder at the proper angle. Tissue damage or delicate tissue cuts are possible. In fibrotic or hard tissue, such as chronic or malignant ulcers, it is less effective. Dislodgement can occur spontaneously or as a result of subsequent endocarp placement. Kinks or looping of the end clip device, such as those found in lesions of the gastric cardia, lesser curvature, and posterior wall of the duodenum, will obstruct proper endocarp placement (Bhatti, Amoateng-Adjepong, Qamar, Matlock, & Loyd, Citation1998; Cappell, Citation2005; Kovacs, Citation2008; Rudolph, Landsverk, & Freeman, Citation2003). To the best of our knowledge, no one has studied the use of hemostatic forceps in the treatment of various causes of GI bleeding in our region: Saudi Arabia, Egypt, and even the Middle East.
Patients and Procedures:
From 1 January 2018 to 30 November 2018, we enrolled 33 patients (22 men and 11 women) over the age of 18 who needed endoscopic Hemostatic forceps for GI bleeding. Endoscopic examination was performed at the Al-ahsa hospital endoscopy unit in Al-ahsa, Eastern Province, Saudi Arabia. The same endoscopist performed all procedures. The Al-ahsa hospital’s institutional ethical review committees approved this retrospective cohort study. Before any endoscopic examination, all patients provided written informed consent. Three patients with post-sphincterotomy bleeding were treated entirely with hemostatic forceps. Endoclipping was performed on 15 of the 30 patients (Group I), while hemostatic forceps were used on the remaining 15 patients (group II).
This study included 33 patients (22 men and 11 women) with various causes of GI bleeding who met the inclusion criteria. Three of them with post-sphincterotomy bleeding were given hemostatic forceps treatment. They were all men between the ages of 25 and 53. Initial hemostasis was achieved in all of them without rebleeding. The time required for hemostasis ranged between 3 and 8 minutes.
The endoscopist decided on endoscopic therapy based on the feasibility of using either technique in the specific patient. The groups were compared in terms of initial hemostasis, time spent waiting for hemostasis, and rebleeding rate. The amount of time required to achieve hemostasis (measured from the point of time at which the decision was made to start the procedure till hemostasis or change of decision). Overt GI bleeding, shock, and/or a decrease in hemoglobin level of more than 2 g/dl occurred within 24 hours of the initial stabilization of pulse, blood pressure, and hemoglobin level. Endoscopic hemostasis was immediately performed when rebleeding was suspected.