The process of using the hemostatic clip is mainly the process of hooking the "hooks" on both sides of the hemostatic clip to the "soft normal mucosa" and then clamping it. Therefore, the main point of the clamping process is to "hook" and "clamp" the "normal tissue".
Have you ever encountered the operation of clamping without hooking the normal tissue and having no choice but to clamp it down? If you often encounter this situation, it means that there is still room for improvement in the technique of hemostasis clipping.
For ESD or digestive tract perforation with large area, it may be difficult to use simple hemostasis clip closure. Under this circumstance, if you make hemostasis clip deliberately close, it may result in failure in closing or occuring hooking incomplete situation, which will results in closure failure. Thus, for ESD or digesticve tract peforation with large area, it is better to use titanium nylon rope to help the clip close.
When the clamped tissue is too tough, though the hemostasis clip can hook to normal tissue, it is difficult to achieve the ideal hemostasis clip closure process because the lesion cannot be "softened". We often encounter patients with esophageal union who have difficulty with hemostasis clip closure after POEM. The main reason for this problem is that the esophageal wall is scarred due to long-term inflammation.
When the clamped tissue is too brittle, such as when the cancerous tissue bleeds, the hemostasis effect of endoscopic hemostasis clips may be very poor or even unable to stop the bleeding because the clips cannot hook to the normal mucosa, resulting in the inability of the hemostasis clips to achieve the proper clamping effect.
The use of any titanium clip should take into account the impact of different positions on the hemostasis clip placement process. For example, the use of hemostasis clip in places like the upper gastrointestinal tract, the gastric fundus near the cardia, the lower less curved side of the gastric body near the posterior wall and the posterior wall of the duodenum is very difficult. Due to excessive angles or insufficient angles when inserting the release device, or the narrow ball space, difficult-to-be-exposed walls and many other factors, the foregoing places can make the release and clamping process of the hemostatic clip very difficult.