Reply to Curcio et al.

We appreciate the interest of Curcio et al. in our recent case series “Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring” [1]. Curcio et al. reported a case of refractory gastric ulcer bleeding treated with the endoloop/clips technique [2]. They applied clipping and detachable snaring (CDS) in a case of rebleeding that occurred 1 week after primary hemostasis with endoclip placement. The patient was pregnant and receiving extracorporeal membrane oxygenation treatment. Curcio et al. suggested that the endoscopic method with CDS would be helpful not only as the rescue bleeding control method but also as a useful first-line hemostatic method. We agree that the CDS method may be considered as first-line therapy when the endoscopist is limited in their use of standard hemostatic treatments and also in cases where there is a high probability of rebleeding. In our article, primary failure of endoscopic hemostasis was defined as uncontrolled bleeding despite attempts at control using all available endoscopic hemostatic methods except for the detachable snare. We performed successful CDS hemostatic treatment in three cases in which first-line hemostatic therapy had failed. Therefore, we consider that the CDS method would be feasible and useful as an endoscopic hemostatic method used as first-line therapy. In our study, rescue endoscopic hemostasis was defined as bleeding control treatment following failure of first-line therapy, and in cases of rebleeding second-line therapy was applied. Although our study was prospective in design, the CDS method is an unproven treatment modality that lacks scientific evidence, which is why we applied it only as the rescue therapy in the first instance. Large randomized controlled trials are required to determine the value of the CDS method.

As Curcio et al. commented, in cases of difficult-to-treat bleedings and especially in situations where few or no alternative endoscopic methods are available and the patient is in a poor condition, the CDS method would be an effective endoscopic treatment not only as rescue endoscopic control of nonvariceal upper gastrointestinal bleeding but also as first-line therapy.

• References

• 1 Lee JH, Kim BK, Seol DC et al. Rescue endoscopic bleeding control for nonvariceal upper gastrointestinal hemorrhage using clipping and detachable snaring: a case series. Endoscopy 2013; 45: 489-492
• 2 Curcio G, Traina M, Panarello G et al. Refractory gastric ulcer bleeding treated with new endoloop/clips technique. Dig Endosc 2011; 23: 203-204