Endoclip

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Image:Resolution clip.jpg
A single-use rotatable endoclip in packaging

An endoclip is a metallic mechanical device used in endoscopy in order to close two mucosal surfaces without the need for surgery and suturing. Its function is similar to a suture in gross surgical applications, as it is used to join together two disjointed surfaces, but, can be applied through an endoscopic camera. Endoclips have found use in treating gastrointestinal bleeding (both in the upper and lower GI tract), in preventing bleeding after therapeutic procedures such as polypectomy, and in closing perforations of the gastrointestinal tract. Many forms of endoclips exist of different shapes and sizes, including two and three prong devices, which can be administered using single use and reloadable systems, and may or may not open and close to facilitate placement.

Contents

Structure and function

Image:GU with clip.jpg
Successful closure of the gastric ulcer with an endoclip

The endoclip was first described by Hayashi and Kudoh in 1975,[1] and was termed the "staunch clip". Initial attempts to incorporate the clip into applications in endoscopy (such as clipping bleeding blood vessels) were limited by the applicator system of the clip.[1] However, by 1988, an easy to use applicator delivery system was developed, and a functional reloadable endoclip system was described.[2] This consisted of a stainless steel clip (of size approximately 6 mm long and 1.2 mm wide at the prongs) with a metal deployment device (that could be used to insert the clip into the endoscopic camera, and deployed outside the camera) enclosed in a plastic sheath.[1] These clips were initially reloadable.

Endoclips in use today have a variety of additional sizes, shapes and sizes. Clips with two and three prongs (TriClip®, Cook Medical[3]) have been described and used for various applications.[4] Rotatable clips have been devised to improve localization of deployment.[5] Also, clips that open and close (as opposed to single-deployment) have also been developed (Resolution® Clip, Boston Scientific[6]), and also facilitate the appropriate location of deployment.[7]

When a treatable lesion is identified on endoscopy (such as a bleeding vessel), an endoclip can be inserted through the channel of the endoscope until the sheathed clip is visible on the endoscopic image, and the handle for deployment handed to the nurse assistant. The clip is unsheathed by retraction at the handle, positioned, and "fired" by the assistant to treat the lesion.

Applications of endoclips

Gastrointestinal bleeding

Endoclips have found a primary application in hemostasis (or the stopping of bleeding) during endoscopy of the upper (through gastroscopy) or lower (through colonoscopy) gastrointestinal tract.[1] Many bleeding lesions have been successfully clipped, including bleeding peptic ulcers,[4] Mallory-Weiss tears of the esophagus,[8] Dieulafoy's lesions,[9] stomach tumours,[10] and bleeding after removal of polyps.[11] Bleeding peptic ulcers require endoscopic treatment if they show evidence of high risk stigmata of re-bleeding, such as evidence of active bleeding or oozing on endoscopy or the presence of a visible blood vessel around the ulcer.[12][13] The alternatives to endoscopic clipping of peptic ulcers are thermal therapy (such as electrocautery to burn the vessel causing the bleeding), or injection of epinephrine to constrict the blood vessel. Comparative studies between endoclips and thermal therapy make the point that endoclips cause less trauma to the mucosa around the ulcer than electrocautery,[14] but no definitive advantage to either approach has reached consensus by gastroenterologists.[15][16]

Other applications

Image:Postpolypectomy ulcer.jpg
An ulcer seen after polypectomy (left) with a visible vessel suggesting recent bleeding is successfully closed with two endoclips (right)

Endoclips have also found an application in preventing bleeding when performing complicated endoscopic procedures. For example, prophylactic clipping of the base of a polyp has been found to be useful in preventing post-polypectomy bleeding, especially in high-risk patients or patients on anticoagulant medications.[17] In addition, clips can be used to close perforations of the gastrointestinal tract, that may have been caused by complicated therapeutic endoscopy procedures, such as polypectomy, or by the endoscopic procedure itself.[18] Clips have also been used to secure the placement of endoscopic feeding tubes,[19] and to orient the bile duct to assist with endoscopic retrograde cholangiopancreatography, a procedure used to image to bile duct.[20]

Safety

Endoclips have been seen to dislodge between 1 and 3 weeks from deployment,[21] although lengthy clip retention intervals of as high as 26 months have been reported.[1][9] Endoclips are believed to be safe and no major complications (such as perforation or impaction) have been reported with them, although concern has been raised about blocking the outflow of the bile duct if clips are deployed in the duodenum.[1]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 {{#if:Devereaux CE, Binmoeller KF
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  2. {{#if:Binmoeller KF, Thonke F, Soehendra N |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Binmoeller KF, Thonke F, Soehendra N }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Binmoeller KF, Thonke F, Soehendra N }} }} }}{{#if:Binmoeller KF, Thonke F, Soehendra N |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1993 |{{#if: | ({{{month}}} 1993) | (1993) }} }} }}{{#if:Binmoeller KF, Thonke F, Soehendra N | . }}{{#if:Binmoeller KF, Thonke F, Soehendra N1993 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic hemoclip treatment for gastrointestinal bleeding] |Endoscopic hemoclip treatment for gastrointestinal bleeding }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Endoscopy |. Endoscopy }}{{#if:25 | 25 }}{{#if:2 | (2) }}{{#if:167-70 |: 167-70 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[1] }}{{#if: |. ISSN {{{issn}}} }}{{#if:8491134 |. PMID 8491134 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
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  4. 4.0 4.1 {{#if:Lin HJ, Lo WC, Cheng YC, Perng CL |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lin HJ, Lo WC, Cheng YC, Perng CL }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lin HJ, Lo WC, Cheng YC, Perng CL }} }} }}{{#if:Lin HJ, Lo WC, Cheng YC, Perng CL |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Lin HJ, Lo WC, Cheng YC, Perng CL | . }}{{#if:Lin HJ, Lo WC, Cheng YC, Perng CL2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic hemoclip versus triclip placement in patients with high-risk peptic ulcer bleeding] |Endoscopic hemoclip versus triclip placement in patients with high-risk peptic ulcer bleeding }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Am. J. Gastroenterol. |. Am. J. Gastroenterol. }}{{#if:102 | 102 }}{{#if:3 | (3) }}{{#if:539-43 |: 539-43 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1111/j.1572-0241.2006.00962.x |. doi:10.1111/j.1572-0241.2006.00962.x }}{{#if: |. ISSN {{{issn}}} }}{{#if:17100962 |. PMID 17100962 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  5. {{#if:Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H }} }} }}{{#if:Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2000 |{{#if: | ({{{month}}} 2000) | (2000) }} }} }}{{#if:Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H | . }}{{#if:Yoshikane H, Hidano H, Sakakibara A, Niwa Y, Goto H2000 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Feasibility study on endoscopic suture with the combination of a distal attachment and a rotatable clip for complications of endoscopic resection in the large intestine] |Feasibility study on endoscopic suture with the combination of a distal attachment and a rotatable clip for complications of endoscopic resection in the large intestine }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Endoscopy |. Endoscopy }}{{#if:32 | 32 }}{{#if:6 | (6) }}{{#if:477-80 |: 477-80 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[2] }}{{#if: |. ISSN {{{issn}}} }}{{#if:10863916 |. PMID 10863916 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  6. {{
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  7. {{#if:Jensen DM, Machicado GA, Hirabayashi K |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Jensen DM, Machicado GA, Hirabayashi K }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Jensen DM, Machicado GA, Hirabayashi K }} }} }}{{#if:Jensen DM, Machicado GA, Hirabayashi K |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Jensen DM, Machicado GA, Hirabayashi K | . }}{{#if:Jensen DM, Machicado GA, Hirabayashi K2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers] |Randomized controlled study of 3 different types of hemoclips for hemostasis of bleeding canine acute gastric ulcers }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:64 | 64 }}{{#if:5 | (5) }}{{#if:768-73 |: 768-73 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1016/j.gie.2006.06.031 |. doi:10.1016/j.gie.2006.06.031 }}{{#if: |. ISSN {{{issn}}} }}{{#if:17055872 |. PMID 17055872 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  8. {{#if:Yamaguchi Y, Yamato T, Katsumi N, Morozumi K, Abe T, Ishida H, Takahashi S |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Yamaguchi Y, Yamato T, Katsumi N, Morozumi K, Abe T, Ishida H, Takahashi S }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Yamaguchi Y, Yamato T, Katsumi N, Morozumi K, Abe T, Ishida H, Takahashi S }} }} }}{{#if:Yamaguchi Y, Yamato T, Katsumi N, Morozumi K, Abe T, Ishida H, Takahashi S |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2001 |{{#if: | ({{{month}}} 2001) | (2001) }} }} }}{{#if:Yamaguchi Y, Yamato T, Katsumi N, Morozumi K, Abe T, Ishida H, Takahashi S | . }}{{#if:Yamaguchi Y, Yamato T, Katsumi N, Morozumi K, Abe T, Ishida H, Takahashi S2001 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome] |Endoscopic hemoclipping for upper GI bleeding due to Mallory-Weiss syndrome }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:53 | 53 }}{{#if:4 | (4) }}{{#if:427-30 |: 427-30 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1067/mge.2001.111774 |. doi:10.1067/mge.2001.111774 }}{{#if: |. ISSN {{{issn}}} }}{{#if:11275881 |. PMID 11275881 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  9. 9.0 9.1 {{#if:Teo EK, Fock KM |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Teo EK, Fock KM }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Teo EK, Fock KM }} }} }}{{#if:Teo EK, Fock KM |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1998 |{{#if: | ({{{month}}} 1998) | (1998) }} }} }}{{#if:Teo EK, Fock KM | . }}{{#if:Teo EK, Fock KM1998 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Dieulafoy's disease treated by endoscopic haemostatic clipping] |Dieulafoy's disease treated by endoscopic haemostatic clipping }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:J. Gastroenterol. Hepatol. |. J. Gastroenterol. Hepatol. }}{{#if:13 | 13 }}{{#if:3 | (3) }}{{#if:320-1 |: 320-1 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[3] }}{{#if: |. ISSN {{{issn}}} }}{{#if:9570248 |. PMID 9570248 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  10. {{#if:Cheng AW, Chiu PW, Chan PC, Lam SH |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Cheng AW, Chiu PW, Chan PC, Lam SH }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Cheng AW, Chiu PW, Chan PC, Lam SH }} }} }}{{#if:Cheng AW, Chiu PW, Chan PC, Lam SH |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2004 |{{#if: | ({{{month}}} 2004) | (2004) }} }} }}{{#if:Cheng AW, Chiu PW, Chan PC, Lam SH | . }}{{#if:Cheng AW, Chiu PW, Chan PC, Lam SH2004 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic hemostasis for bleeding gastric stromal tumors by application of hemoclip] |Endoscopic hemostasis for bleeding gastric stromal tumors by application of hemoclip }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Journal of laparoendoscopic & advanced surgical techniques. Part A |. Journal of laparoendoscopic & advanced surgical techniques. Part A }}{{#if:14 | 14 }}{{#if:3 | (3) }}{{#if:169-71 |: 169-71 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1089/1092642041255522 |. doi:10.1089/1092642041255522 }}{{#if: |. ISSN {{{issn}}} }}{{#if:15245670 |. PMID 15245670 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  11. {{#if:Letard JC, Kaffy F, Rousseau D, Nivet JM |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Letard JC, Kaffy F, Rousseau D, Nivet JM }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Letard JC, Kaffy F, Rousseau D, Nivet JM }} }} }}{{#if:Letard JC, Kaffy F, Rousseau D, Nivet JM |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2001 |{{#if: | ({{{month}}} 2001) | (2001) }} }} }}{{#if:Letard JC, Kaffy F, Rousseau D, Nivet JM | . }}{{#if:Letard JC, Kaffy F, Rousseau D, Nivet JM2001 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} [Post-polypectomy colonic arterial hemorrhage can be treated by hemoclipping]] |[Post-polypectomy colonic arterial hemorrhage can be treated by hemoclipping] }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if:French | (in French) }}{{#if: | ({{{format}}}) }}{{#if:Gastroenterol. Clin. Biol. |. Gastroenterol. Clin. Biol. }}{{#if:25 | 25 }}{{#if:3 | (3) }}{{#if:323-4 |: 323-4 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[4] }}{{#if: |. ISSN {{{issn}}} }}{{#if:11395682 |. PMID 11395682 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  12. {{#if:Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC }} }} }}{{#if:Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2003 |{{#if: | ({{{month}}} 2003) | (2003) }} }} }}{{#if:Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC | . }}{{#if:Sung JJ, Chan FK, Lau JY, Yung MY, Leung WK, Wu JC, Ng EK, Chung SC2003 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison] |The effect of endoscopic therapy in patients receiving omeprazole for bleeding ulcers with nonbleeding visible vessels or adherent clots: a randomized comparison }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Ann. Intern. Med. |. Ann. Intern. Med. }}{{#if:139 | 139 }}{{#if:4 | (4) }}{{#if:237-43 |: 237-43 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[5] }}{{#if: |. ISSN {{{issn}}} }}{{#if:12965978 |. PMID 12965978 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  13. {{#if:Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC }} }} }}{{#if:Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2000 |{{#if: | ({{{month}}} 2000) | (2000) }} }} }}{{#if:Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC | . }}{{#if:Lau JY, Sung JJ, Lee KK, Yung MY, Wong SK, Wu JC, Chan FK, Ng EK, You JH, Lee CW, Chan AC, Chung SC2000 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers] |Effect of intravenous omeprazole on recurrent bleeding after endoscopic treatment of bleeding peptic ulcers }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:N. Engl. J. Med. |. N. Engl. J. Med. }}{{#if:343 | 343 }}{{#if:5 | (5) }}{{#if:310-6 |: 310-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[6] }}{{#if: |. ISSN {{{issn}}} }}{{#if:10922420 |. PMID 10922420 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  14. {{#if:Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C }} }} }}{{#if:Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2001 |{{#if: | ({{{month}}} 2001) | (2001) }} }} }}{{#if:Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C | . }}{{#if:Cipolletta L, Bianco MA, Marmo R, Rotondano G, Piscopo R, Vingiani AM, Meucci C2001 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial] |Endoclips versus heater probe in preventing early recurrent bleeding from peptic ulcer: a prospective and randomized trial }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:53 | 53 }}{{#if:2 | (2) }}{{#if:147-51 |: 147-51 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[7] }}{{#if: |. ISSN {{{issn}}} }}{{#if:11174282 |. PMID 11174282 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  15. {{#if:Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD }} }} }}{{#if:Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2002 |{{#if: | ({{{month}}} 2002) | (2002) }} }} }}{{#if:Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD | . }}{{#if:Lin HJ, Hsieh YH, Tseng GY, Perng CL, Chang FY, Lee SD2002 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding] |A prospective, randomized trial of endoscopic hemoclip versus heater probe thermocoagulation for peptic ulcer bleeding }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Am. J. Gastroenterol. |. Am. J. Gastroenterol. }}{{#if:97 | 97 }}{{#if:9 | (9) }}{{#if:2250-4 |: 2250-4 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[8] }}{{#if: |. ISSN {{{issn}}} }}{{#if:12358241 |. PMID 12358241 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  16. {{#if:Kovacs TO, Jensen DM |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Kovacs TO, Jensen DM }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Kovacs TO, Jensen DM }} }} }}{{#if:Kovacs TO, Jensen DM |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2007 |{{#if: | ({{{month}}} 2007) | (2007) }} }} }}{{#if:Kovacs TO, Jensen DM | . }}{{#if:Kovacs TO, Jensen DM2007 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic treatment of ulcer bleeding] |Endoscopic treatment of ulcer bleeding }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Current treatment options in gastroenterology |. Current treatment options in gastroenterology }}{{#if:10 | 10 }}{{#if:2 | (2) }}{{#if:143-8 |: 143-8 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[9] }}{{#if: |. ISSN {{{issn}}} }}{{#if:17391629 |. PMID 17391629 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  17. {{#if:Friedland S, Soetikno R |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Friedland S, Soetikno R }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Friedland S, Soetikno R }} }} }}{{#if:Friedland S, Soetikno R |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Friedland S, Soetikno R | . }}{{#if:Friedland S, Soetikno R2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Colonoscopy with polypectomy in anticoagulated patients] |Colonoscopy with polypectomy in anticoagulated patients }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:64 | 64 }}{{#if:1 | (1) }}{{#if:98-100 |: 98-100 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[10] }}{{#if: |. ISSN {{{issn}}} }}{{#if:16813811 |. PMID 16813811 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  18. {{#if:Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M }} }} }}{{#if:Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2004 |{{#if: | ({{{month}}} 2004) | (2004) }} }} }}{{#if:Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M | . }}{{#if:Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M2004 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic clip application for closure of esophageal perforations caused by EMR] |Endoscopic clip application for closure of esophageal perforations caused by EMR }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:60 | 60 }}{{#if:4 | (4) }}{{#if:636-9 |: 636-9 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[11] }}{{#if: |. ISSN {{{issn}}} }}{{#if:15472698 |. PMID 15472698 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  19. {{#if:Frizzell E, Darwin P |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Frizzell E, Darwin P }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Frizzell E, Darwin P }} }} }}{{#if:Frizzell E, Darwin P |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:2006 |{{#if: | ({{{month}}} 2006) | (2006) }} }} }}{{#if:Frizzell E, Darwin P | . }}{{#if:Frizzell E, Darwin P2006 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic placement of jejunal feeding tubes by using the Resolution clip: report of 2 cases] |Endoscopic placement of jejunal feeding tubes by using the Resolution clip: report of 2 cases }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:64 | 64 }}{{#if:3 | (3) }}{{#if:454-6 |: 454-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1016/j.gie.2006.02.051 |. doi:10.1016/j.gie.2006.02.051 }}{{#if: |. ISSN {{{issn}}} }}{{#if:16923504 |. PMID 16923504 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  20. {{#if:Scotiniotis I, Ginsberg GG |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Scotiniotis I, Ginsberg GG }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Scotiniotis I, Ginsberg GG }} }} }}{{#if:Scotiniotis I, Ginsberg GG |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1999 |{{#if: | ({{{month}}} 1999) | (1999) }} }} }}{{#if:Scotiniotis I, Ginsberg GG | . }}{{#if:Scotiniotis I, Ginsberg GG1999 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic clip-assisted biliary cannulation: externalization and fixation of the major papilla from within a duodenal diverticulum using the endoscopic clip fixing device] |Endoscopic clip-assisted biliary cannulation: externalization and fixation of the major papilla from within a duodenal diverticulum using the endoscopic clip fixing device }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:50 | 50 }}{{#if:3 | (3) }}{{#if:431-6 |: 431-6 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if:10.1053/ge.1999.v50.97369 |. doi:10.1053/ge.1999.v50.97369 }}{{#if: |. ISSN {{{issn}}} }}{{#if:10462673 |. PMID 10462673 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
  21. {{#if:Binmoeller KF, Grimm H, Soehendra N |{{#if: |[[{{{authorlink}}}|{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Binmoeller KF, Grimm H, Soehendra N }}]] |{{#if: |{{{last}}}{{#if: |, {{{first}}} }} |Binmoeller KF, Grimm H, Soehendra N }} }} }}{{#if:Binmoeller KF, Grimm H, Soehendra N |{{#if: | ; {{{coauthors}}} }} }}{{#if: | ({{{date}}}) |{{#if:1993 |{{#if: | ({{{month}}} 1993) | (1993) }} }} }}{{#if:Binmoeller KF, Grimm H, Soehendra N | . }}{{#if:Binmoeller KF, Grimm H, Soehendra N1993 | }}{{#ifeq: | no | | {{#if: |“|"}} }}{{#if: |[{{{url}}} Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma] |Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma }}{{#ifeq: | no | | {{#if:|”|"}} }}{{#if: | (in {{{language}}}) }}{{#if: | ({{{format}}}) }}{{#if:Gastrointest. Endosc. |. Gastrointest. Endosc. }}{{#if:39 | 39 }}{{#if:2 | (2) }}{{#if:172-4 |: 172-4 }}{{#if: |. {{#if: |{{{location}}}: }}{{{publisher}}} }}{{#if: |. doi:[12] }}{{#if: |. ISSN {{{issn}}} }}{{#if:8495838 |. PMID 8495838 }}{{#if: |. Bibcode: {{{bibcode}}} }}{{#if: |. OCLC {{{oclc}}} }}{{#if: |. {{{id}}} }}{{#if: |. Retrieved on [[{{{accessdate}}}]]{{#if: | , [[{{{accessyear}}}]] }} }}{{#if: | Retrieved on {{{accessmonthday}}}, {{{accessyear}}} }}{{#if: | Retrieved on {{{accessdaymonth}}} {{{accessyear}}} }}{{#if: |. [{{{laysummary}}} Lay summary]{{#if: | – {{{laysource}}}}} }}{{#if: | ([[{{{laydate}}}]]) }}.{{#if: | “{{{quote}}}” }}
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