Clips and Loops



Clips and Loops


Hiroyuki Aihara, MD, PhD



The use of clip in endoscopy was first reported by Hayashi et al in 1975.1 Currently, clips are used for multiple indications including hemostasis for active bleeding, prophylactic mucosal defect closure after endoscopic mucosal resection (EMR), perforation closure, and preoperative marking.

The use of endoscopic loop was first reported by Hachisu et al2 in 1991 for the removal of large pedunculated polyps.




INDICATIONS


Endoclips (Fig. 37.1)



  • 1. Hemostasis for active bleeding (ulcers, diverticula, etc.)


  • 2. Prophylactic mucosal defect closure after polypectomy or EMR


  • 3. Closure of small gastrointestinal (GI) tract luminal perforations


  • 4. Endoscopic preoperative marking to assist surgical identification


Endoloops (Fig. 37.2)



  • 1. Prevention of post-polypectomy bleeding for pedunculated polyps (Paris Ip)


  • 2. Removal of subepithelial tumors (SETs) with or without retrieval of specimens3




CONTRAINDICATIONS


Endoclips

Any GI varices with or without bleeding.


Endoloops

Lesions without enough stalk length for polypectomy (Paris Isp, Is, IIa, IIc, or SETs showing extraluminal growth pattern).







FIG. 37.1 Endoclip. (Reprinted with permission from Olympus America, Inc.)

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May 29, 2020 | Posted by in GASTROENTEROLOGY | Comments Off on Clips and Loops

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