Home  >  All News  >  The clinical value of nylon ligation and metallic hemoclip in the treatment of peptic ulcer hemorrhage

The clinical value of nylon ligation and metallic hemoclip in the treatment of peptic ulcer hemorrhage

Wednesday 09th May 2018 Back to list

Peptic ulcer hemorrhage is one of the main types in nonvariceal upper gastrointestinal bleeding. The hemostasis methods include local injection of drugs, thermocoagulation and hemostasis, and mechanical hemostasis. Hemoclip is the mostly common used device of mechanical hemostasis, being especially useful for Forrest grade Ia or Ib.

 

There are also some cases in which hemoclips fail to work well in hemostasis, for example, cicatrix around ulcer, large area ulcer and broken end of hemorrhagic vascular on the center of the lesion. In these circumstances, Nylon ligation is ushered in to be used together in the operation with hemoclip. Clinically it is useful and effective to treat those cases supposed to be tackled toughly by hemoclip only.

 

To evaluate the clinical value of nylon ligation and metalic hemoclip on the treatment of pepric ulcer hemorrhage, the department of gastroenterology of the second people’s hospital of Yunan made a research in this regard. All patients with peptic ulcer hemorrhage who accepted endoscopic therapy with nylon ligation and metallic hemoclip in the hospital from January 2012 to June 2014 were retrospectively studied. The safety and efficacy were evaluated.

 

53 peptic ulcer hemorrhage patients were enrolled in this study. Successful treatments were achieved in all cases. Re-bleeding happened in 3 cases after endoscopic treatment which accepted a second endoscopic treatment. All the cases postoperative recovered well.

It is used for ulcer diameter smaller than 1cm and cicatrix around the ulcer. In these cases, using hemoclip merely could not stop bleeding effectively. If the bleeding is massive and affects the clear vision, inject 1:10000 methylepinephrine and see the bleeding point clearly. Follow the next steps to close up the clip. The end of hemorrhagic vascular is compressed and sealed.

It is used for ulcer diameter smaller than 1cm and cicatrix around the ulcer. In these cases, using hemoclip merely could not stop bleeding effectively. If the bleeding is massive and affects the clear vision, inject 1:10000 methylepinephrine and see the bleeding point clearly. Follow the next steps to close up the clip. The end of hemorrhagic vascular is compressed and sealed. 

 

 

Large area ulcer is hardly to be closed by using nylon ligation merely. We combine hemoclip and nylon ligator in the operation. Firstly, choose endoscope of double channel. Or make the endoscope frontier assisted by cap, and fix on the cap a transparent tube which is used as the second tunnel of device. Insert both nylon ligator and hemoclip and adjust the angle of both device. Anchor the hemoclip on the border of the ulcer. Make suction with cap and retract the ulcer, and close up ligator. Repeat these steps until the ulcer is completed closed. In this way , the ends of hemorrhagic vascular are sealed. 

After the operation, observe the patients closely and check if the patients have vomit with blood or black stool. Use PPI acid suppression treatments to protect the gastric mucosa. The patients diet should be taken care with sufficient nutrition. Inspect the ulcer and hemostasis status after one month. The operation successful rate is 100%. All the patients have ulcer sealed well in one month. The clips and ligators have falled off and discharged out of the body by defecate.

Tips of the operation:

.For cicatrix around ulcer and large area ulcer, hemoclips have difficulties in closing up the end of vascular and has high rate of rebleeding . While combined use of hemoclip and nylon ligator could have 100% successful rate and with rare rebleeding occurrence.

 

.The hemoclip should be vertical to the ulcer. Make propelling movement while closing the clip to make sure most of ulcer is closed.

.The position of the anchor should be around the ulcer and make sure the end of vessel is compressed and closed.

.Good skill of endoscope operation is required for the physician and the nurse. Make sure all the clips are closed by nylon ligator with proper strength.

.The second tunnel is the working tunnel of nylon ligator. If the second tunnel is attached outside the endoscope, the diameter of the device that enters oral cavity would be larger. Pay attention to check if the patients could bear the pain. Use it carefully for old patients or those with cardiopulmonary insufficiency.