Hemoclips & Hemostasis

Mechanical and thermal hemostasis devices form the core of endoscopic bleeding control. Modern operators choose among several modalities based on lesion type, vessel size, location, and access angle — combination therapy (mechanical or thermal plus dilute epinephrine injection) is more effective than single-modality treatment for high-risk peptic ulcer bleeding.

Through-the-scope (TTS) clips apply rotation, opening, and closure under endoscopic control. They are first-line for visible vessels in non-fibrotic ulcers, post-polypectomy bleeding, Mallory-Weiss tears, and small Dieulafoy lesions. Multi-clip closure of mucosal defects after EMR or perforation is also a routine application. Over-the-scope clips (OTSC) apply far stronger compressive force than TTS clips and capture deeper tissue; they are used for refractory bleeding in fibrotic ulcers, large Dieulafoy lesions, anastomotic dehiscence, and acute perforations. Once an OTSC is placed, the field is altered — TTS clips can be added but the OTSC itself is not easily revisable.

Thermal modalities — bipolar (gold probe) and monopolar coagulation, argon plasma coagulation, and contact heater probes — coagulate vessels by heat-induced protein coagulation. They are particularly suited to angiodysplasias and oozing capillary-bed bleeding. Thermal therapy in the right colon and at thin-walled lesions requires cautious settings because of perforation risk.