With the continuous advancement of endoscopic minimally invasive technology, endoscopic frontier treatments such as ESD, POEM and STER have been rapidly developed and matured in a short period of time. Titanium clips play a very important role in these treatments, but they are almost all used in tissue closure and hemostasis, so clips are generally called hemostatic clips or titanium clips. The following is a brief list of the main application scopes of titanium clips and learn about them.
1. Polypectomy.
In polypectomy, it is mainly used on long pedicles (Ip, Isp types). It is mainly used to block the nutrient vessels that nourish the polyps after the titanium clips are clamped on the pedicles, which prevents the risk of bleeding after the removal of long pedicles or subpedicle polyps.
2. Closure of ESD wounds.
For larger ESD wounds, wound closure is generally not performed. For smaller ESD wounds with delayed risks, titanium clips need to be used to close the wounds. This is mainly to prevent complications of delayed bleeding and delayed perforation of ESD wounds. For ESD wounds that are too large and still need to be closed, it is necessary to choose to use the titanium clip nylon rope method to close them.
3. Ulcers with bleeding.
For ulcers with bleeding in upper gastrointestinal bleeding, such as ulcers in the gastric angle and gastric antrum, if the area is not large, the wound can be directly closed with titanium clips, while for ulcers with larger areas (exposed blood vessels), the two sides of the bleeding focus can be clamped to achieve the purpose of hemostasis.
4. Dieulafoy's bleeding.
Because the bleeding rate of Dieulafoy's disease is relatively fast but the lesions are relatively hidden or small, it is generally preferred to use titanium clips to clamp and stop bleeding directly, which is also a very effective way to treat Dieulafoy's disease. Unless endoscopic hemostasis fails and surgical treatment is required, most Duchenne diseases can still be successfully stopped under endoscopy.
5. POEM, STER, EFR and NOTES.
These technologies are the emerging popular cutting-edge endoscopic treatment technologies in recent years. Titanium clips are mainly used for wound closure for these operation techniques, while for POEM, STER and EFR, the closure process is simple clamping, and the clamping position is appropriate, powerful and of moderate density.
Most regular wounds can be closed with titanium clips to achieve the effect of simple interrupted sutures in surgery. NOTES is an active perforation, and its closure requires suturing both the mucosal layer and the muscular layer, so the suturing of NOTES is relatively more difficult. To achieve double-layer closure to form a "high and low staggered" titanium clip arrangement order, more care and patience are required. At present, this technology does not seem to have many large-scale reports.
6. Auxiliary positioning.
For smaller lesions such as small-scale advanced gastric cancer, when surgery cannot be accurately positioned, titanium clips can be used under direct endoscopy to mark the lesion with 1-2 titanium clips, so that surgeons can easily find the lesion during surgery, thereby successfully completing the surgery.
7. Titanium clip treatment of perforation.
For doctors and units with heavy workloads, digestive tract perforation is not rare anymore, and the treatment method is no longer the same as sending the patient to surgery. Endoscopic treatment mainly relies on simple closure with titanium clips. It can still achieve a relatively good closure effect. For wounds or perforations with larger areas, the titanium clip nylon rope method is required.
