The use of hemostatic clips in interventional endoscopic procedures is a common practice
by endoscopists worldwide. We present here a case of clips at the cardioesophageal
junction being retained for more than 2 years (27 months).
A 37-year-old man presented in September 2011 with heartburn, nausea, and occasional
mild dysphagia to solid foods. He had undergone upper endoscopy in December 2009,
18 months earlier, when three metallic clips (Standard Clip 2951; Olympus Medical
Corp., Tokyo, Japan) had been applied upon diagnosis of a deep Mallory–Weiss tear.
His physical examination was unremarkable, and the results of routine blood tests
were within normal limits. Upper endoscopy in September 2011 revealed two clips near
the cardioesophageal junction ([Fig. 1]). In February 2012, upper endoscopy showed one clip; the second clip had detached
spontaneously ([Fig. 2] and [Fig. 3]).
Fig. 1 Retained hemostatic clips near the cardioesophageal junction, seen in upper endoscopy.
Fig. 2 The retained clip, at later upper endoscopy.
Fig. 3 Retained hemostatic clip (arrow) in plain abdominal radiograph.
Hemoclips are not magnetic resonance imaging (MRI)-safe, and are contraindications
to MRI [1]
[2]. The average time that clips remain in place was reported as 9.4 days in the Olympus
product insert and manual. It has been widely accepted that endoscopic clips detach
within a 2-week period [3]. Due to the short retention time of the clips, health personnel usually forget to
advise patients to abstain from diagnostic procedures that are contraindicated with
a stainless-steel hemoclip in place, such as MRI. However, a clip can still be retained
at 2 years, as reported in one case [3]. Our case showed that a clip can be retained even longer, for 2 years and 3 months.
We found only one study that specifically looked at the length of time for which clips
were retained and the prevalence of clip retention in humans [4]. In a retrospective study, 3 of 22 patients (13.6 %) had retained clips for a much
longer period than expected. In these 3 patients, clips were still attached 4 weeks,
8 weeks and 3 months after insertion.
The increased use of hemostatic clips raises a safety issue that should be addressed.
It may be appropriate that an abdominal radiograph should be done before an MRI scan
for all patients with a history of clip deployment, to detect retained clips. In a
case of clipping during endoscopy, the endoscopist should inform the patient about
the clip placement, and if an MRI scan is planned in a future hospital visit, the
patient should remind the health personnel to obtain a plain abdominal radiograph
before MRI.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH
