We are excited to bring you a brand new video on “Tips for Placement of Clips for Hemostasis”. In this lecture, we will delve into the important topic of clip placement for achieving hemostasis during medical procedures.
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Our expert speaker will be discussing the various through the scope clips that are available, emphasizing their different arm lengths and opening widths. Additionally, he will highlight the unique characteristics of each clip, including their ability to be rotated within the endoscope’s channel.
During the lecture, a real case study will be presented. The speaker will focus on a challenging situation involving an ulcer located between the bulk and second duodenum. To address this specific case, a special scope is required, with its working channel positioned on the left. The speaker will demonstrate the precise technique of placing a clip on the ulcer, ensuring that it comes out from the left side.
Throughout the episode, our expert will stress the importance of certain techniques for successful clip placement. These techniques include pushing the clip out, pulling it back, targeting the desired area for deletion, and advancing the scope with the open clip. He will also highlight the need for a slight turn of the endoscope at the moment of releasing the clip.
To avoid pushing the clip too deeply into the lesion, the speaker will advise angling the clip rather than deploying it in a straight direction. For an ulcer, he recommends using the wheel of the endoscope to create a slight angle during deployment.
When dealing with a lesion that is further away, the clip should be opened away from the lesion, and one of the arms of the clip can be used to hook onto the mucosa. To deploy the clip in this situation, the scope should be twisted to the right, the clip advanced out, closed, and then deployed.
For clips placed outside the endoscope, they should be pulled back close to the endoscope before targeting the lesion, with the scope being moved to target the lesion, not just the clip. The clip should be exposed and then pulled back slightly into the channel. The scope is advanced towards the lesion to ensure accurate targeting, while exposing the least amount of clip possible during placement.
During the episode, our expert will also demonstrate a valuable trick for dealing with ulcers during endoscopy. If the scope is twisted, it may prove challenging to advance the clip. In such cases, the technique involves pulling back the scope into the stomach in a neutral position. The clip is then pulled into the working channel, advanced towards the lesion, pushed out into the lumen (away from the lesion), and finally opened and closed before being released.
The importance of maintaining a neutral position, opening the clip away from the lesion, and aiming at the vessel and lesion will be emphasized consistently throughout the episode.
To provide visual guidance, the episode will feature a video showcasing the correct placement of clips during medical procedures. This video is an essential resource for understanding the proper technique and ensuring successful outcomes.
Furthermore, the features of clips with larger working channels will be explored, including their ability to be rotated using the handle outside. It will be crucial to instruct an assistant on the desired angle of the clip (horizontal or vertical) based on the specific location of the lesion.
Lastly, our expert will address the challenges encountered when placing clips near awkwardly positioned lesions, such as those located between the first and second duodenum or around the cardia. Additionally, he will provide tips for dealing with scopes that may be twisted or in a long position, as well as lumen filled with liquids. Ensuring the clip remains close to the working channel to prevent twisting or breakage will also be highlighted.
We are thrilled to present this video course packed with valuable tips and insights on clip placement for hemostasis procedures. Watch in the EndoCollab community now. Join Here
Outline
– Introduction to the topic: Placement of clips for hemostasis
– Overview of the large variety of through the scope clips used
– Focus on the different arm lengths and opening widths of the clips
– Discussion on the ability of some clips to be rotated in the endoscope’s channel, and special tricks to rotate them
– Real case example of an ulcer located between the bulk and second duodenum
– Importance of using a special scope for proper removal of the ulcer
– Demonstration of how to place a clip on the ulcer, with the clip coming out from the left
– Emphasis on pushing the clip out, pulling it back, targeting deletion, and advancing the scope with the open clip
– Technique for angling the clip during deployment to avoid pushing it too much into the lesion
– Recommendations for placing clips for lesions further away, including hooking onto the mucosa and twisting the scope to the right
– Technique for placing a clip outside, pulling it back close to the endoscope before targeting the lesion
– Importance of moving the scope, not just the clip, to target the lesion
– Proper exposure of the clip during placement
– Demonstration of a trick for dealing with ulcers during endoscopy
– Technique for advancing the clip in a neutral position to avoid difficulty in advancement
– Emphasis on maintaining a neutral position, opening the clip away from the lesion, and aiming at the vessel and lesion
– Importance of video for proper placement of the clip during a medical procedure
– Discussion on the ability to rotate clips using large working channels
– Instruction of the desired angle of the clip to the assistant (horizontal or vertical)
– Adjusting the clip to the specific location of the lesion before advancing
– Proper technique for pushing out, opening, closing, and releasing the clip on target
– Caution on clips opening further once posed, to avoid touching the bleeding vessel or lesion
– Challenges of placing clips in awkward positions and with a twisted or long scope
– Considerations for advancing the clip close to the working channel to prevent twisting or breaking off
– Recommended neutral or straight position of the scope when advancing the clip
