A novel clinical application for endoscopic mucosal clipping

Background: Endoscopic hemoclipping has been shown to be effective in the treatment of gastrointestinal bleeding. Here we describe a novel clinical application for endoscopic application of metal clips. Methods: A middle- aged man with inoperable squamous cell cancer of the esophagus underwent per protocol a barium esophagogram to document tumor margins prior to radiation therapy. This study failed to localize the full extent of the tumor. At endoscopy, the tumor margins were clearly visible. To delineate the proximal and distal margins, detachable metallic clips were passed through the accessory channel of a standard endoscope and using a clip fixing device the clips were placed at each level. Subsequently, a chest x-ray was obtained. Results: Placement of mucosal clips facilitated radiotherapy. Conclusions: Endoscopic mucosal clipping may serve as a useful technique for localizing or marking gastrointestinal lesions, especially for demarcating a precise radiation field when conventional techniques fail.