In the latest episode of the Gastroenterology & Endoscopy Podcast we explore the innovative realm of Hemoclips, or Through-The-Scope-Clips, and their pivotal role in enhancing endoscopic procedures. Initially designed for hemostasis, these multifaceted tools have now widened their scope, proving to be indispensable in a variety of clinical scenarios.

Hemoclips
Hemoclips, now often referred to as "clips", have seen their application extend beyond their original purpose of hemostasis. They are now employed for a range of uses including closing perforations, post-resection defects, marking, and attaching devices like stents and feeding tubes. For instance, during procedures involving gastric, esophageal, or colon perforation, clips can effectively seal the defect, averting further complications. This adaptation of clips over time truly signifies a leap in medical innovation.

Understanding the Anatomy and Deployment of Clips:
Grasping the anatomy and the mechanisms governing the deployment of clips is essential for their effective utilization. A typical clip comprises a stem with two arms with distal teeth. The design might vary; for instance, the arms' shape and number could differ, and so can the length of the stem. This length variation affects their use in narrow areas like small bowel strictures or esophageal stenosis. For example, a longer stem in a small bowel stricture could exacerbate the condition by rubbing against the mucosa on the opposite side. It’s imperative that we understand the anatomy to ensure the appropriate selection and use of these clips.

Advancing and Applying Clips with Precision:
The advancement and application of these Through-The-Scope clips demand precision and care. When initially advancing the clip into the working channel of the scope, it's crucial to hold close to the tip to prevent bending the arm. Once the clip has navigated through the working channel and reaches the tip of the scope, it should be gently pushed out, opened, and pulled back towards the scope. For example, when addressing a bleeding lesion, the clip should be open and advanced towards the lesion by moving the endoscope. And at that pivotal moment, when the clip is near the target vessel or defect to be closed, it should be pushed out with the hand, then closed and released by the assistant. This meticulous handling and application of clips can significantly bolster patient outcomes.

Mastering the Use of Clips:
The art of mastering the use of clips lies in a thorough understanding of their anatomy, their mechanics, and the knack of deploying them accurately, and applying them with precision. It's a journey of practice and learning that unveils the full potential of these versatile tools, thereby elevating patient care to new heights.

Links / References:

• EndoCollab.com: A Visual Guide to Hemoclips Applications

Conclusion:
The Gastroenterology & Endoscopy field continually evolves with advancements like  Hemoclips, pushing the boundaries and offering new horizons for better patient care. Mastering the use of these clips is not just about enhancing procedural efficiency but also about ensuring safer and improved patient outcomes.

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