Plasma Coagulation Research Articles

COLD SNARE POLYPECTOMY: A SAFE PROCEDURE FOR REMOVING SMALL NON-PEDUNCULATED COLORECTAL LESIONS.

Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re-cognized as a risk factor for interval cancer. The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

Prospective Meta-analysis of Weight Loss Regained and Success Rate of Argon Plasma Coagulation to Suture and Surgery Procedures Post-bariatric Surgery: Status of the Art of Endoscopic Treatment.

This study performed a meta-analysis to compare the safety and efficacy of argon plasma coagulation (APC) concerning suture (SUT) and surgery (SUR). The One-Way tests were applied, with p <0.05 significant. The value of R2 was analyzed (heterogeneity), and the risk of bias of articles was evaluated. A total of 34 studies were found, eight about APC, twenty about SUT, and six about SUR. For the percentage of Weight Loss Regained (%WLR), the means for APC, SUT, and SUR were 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for success rate (%SR), the means were 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57, respectively with p >0.05, with R2 ≥ 50%. The APC proved to be efficient and safe like the other techniques.

Activation of intravascular blood coagulation in the early postoperative period in reconstructive abdominoplasty

Purpose of the study: to determine the activity of intravascular blood coagulation during the abdominoplasty and justify pharmacological thromboprophylaxis.Material and Methods. An open prospective study was conducted on a group of 100 patients undergoing abdominoplasty. The risk of venous thromboembolism (VTE) before the surgery was assessed using the Caprini risk assessment model in 2010. Prothrombin (PT) and fibrinogen (FG) levels, soluble fibrin-monomer complexes (SFMC), euglobulin clot lysis time (ECLT), antithrombin III (AT-III) level, and protein C (PC) level were determined before and after the surgery.Results. Using the Caprini risk assessment model, patients were categorized by VTE risk as follows: moderate risk – 64% and high risk – 36%. After the surgery, an increase in PT by 12.3% and 15.5% on days 3 and 5 was observed (p &lt; 0.01); an increase in FG by 0.49; 2.34 and 2.04 g/L on days 1, 3, and 5 was observed (p &lt; 0.01); an increase in SFMC at all postoperative stages by 4.7; 8.2; 10.8 and 10.0 times (p &lt; 0.01); an increase in ECLT by 2.8; 9.7, and 6.3 minutes on days 1, 3, and 5 (p &lt; 0.001); and a decrease in AT-III and PC levels immediately after the operation by 18.8% and 8.9%, on day 1 by 14.2% and 11.2%, and on day 3 by 8.8% and 6.3% (p &lt; 0.01).Conclusion. All patients undergoing abdominoplasty require pharmacological thromboprophylaxis due to moderate and high risk of venous thromboembolic complications. Abdominoplasty in the early postoperative period is accompanied by activation of plasma coagulation, inhibition of fibrinolytic system activity, and reduced activity of natural anticoagulants, which justifies the need for pharmacological thromboprophylaxis for at least 5 days.

Assessment of plasma hemostasis system in the early postoperative period in patients after abdominoplasty

Introduction Venous thromboembolic complications after abdominoplasty are associated with increased intraabdominal pressure and altered venous return without taking into account possible changes in the activity of the blood coagulation system.Purpose of work was to evaluate the state of the plasma hemostasis system in the early postoperative period in patients after abdominoplasty.Materials and methods The study included 100 patients who underwent aesthetic abdominoplasty. Prothrombin (PT), fibrinogen (FG), activated partial thromboplastin time (APTT), soluble fibrin-monomer complexes (SFMC), euglobulin clot lysis (ECL), antithrombin-III (AT-III), and protein C (PrC) levels were evaluated before surgery, immediately after surgery, on the first, third and fifth days after surgery. Statistical data analysis was performed using SPSS 16, Excel 2010 for Windows, using the Kruskal – Wallis criterion.Results Coagulation hemostasis was characterized by a decrease in PT immediately after the surgery and on the first day by 13.9 and 5.3, and an increase in PT on the third and fifth days by 12.3 and 15.5 (p &lt; 0.001), decrease in FG on the first, third and fifth days by 0.49 g/L, 2.34 g/L, and 2.04 g/L, respectively (p &lt; 0.001). SFMC increased at all postoperative stages by 4.7, 8.2, 10.8, and 10.0 times (p &lt; 0.001). Inhibition of XII-dependent fibrinolysis was characterized by an increase in ECL time on the first, third and fifth days by 2.8, 9.7, and 6.3 minutes, respectively (p &lt; 0.001). AT-III and PrC levels decreased immediately after the surgery by 18.8 and 8.9, on the first day by 14.2 and 11.2, and on the third day by 8.8 and 6.3 respectively (p &lt; 0.001).Discussion Activation of blood coagulation processes with imbalance of coagulation, anticoagulation, and fibrinolytic systems create conditions for venous thrombosis formation after abdominoplasty, which substantiates the necessity of VTE pharmacoloprophylaxis for at least five days.Conclusion In the early postoperative period abdominoplasty is accompanied by activation of plasma coagulation, inhibition of fibrinolytic system activity and reduction of natural anticoagulant activity.

The effect of argon plasma coagulation on surgical suture material

Introduction. In modern surgery, there are many types of different energy used to achieve hemostasis; one of them is the energy of argon plasma coagulation. However, the impact of energy affects not only the bleeding site; it also affects the stitches lying nearby the source of bleeding. The instructions for the use of a suture material or a coagulation tool do not describe the changes that may occur when they interact. A review of the literature found a small number of publications devoted to changes in the physical properties of suture material when exposed to it. This information is not sufficient to predict the effects of argon plasma coagulation energy on the suture material and, as a result, on wound healing or the quality of the postoperative scar.The objective was to determine changes in the biodestructive properties of synthetic absorbable suture materials with argon plasma coagulation in an in vivo experiment.Methods and materials. In the experimental study, the results of biodegradation of monofilament and polyfilament sutures after exposure to argon plasma coagulation energy were analyzed in comparison with control samples in the body of laboratory mice.Results. It can be unequivocally stated that the effect of argon plasma coagulation energy has an effect on the rate of biodegradation of both monofilament and polyfilament synthetic filaments implanted in muscle tissue.Conclusions. Suture material exposed to argon plasma coagulation may not meet the terms of partial or full biodegradation stated by the manufacturer, which may affect the quality of scar formation.

Snare Tip Soft Coagulation vs Argon Plasma Coagulation vs No Margin Treatment After Large Nonpedunculated Colorectal Polyp Resection: a Randomized Trial

Background and AimsThermal treatment of the defect margin after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal lesions reduces the recurrence rate. Both snare tip soft coagulation (STSC) and argon plasma coagulation (APC) have been used for thermal margin treatment, but there are few data directly comparing STSC to APC for this indication. MethodsWe performed a randomized 3 arm trial in 9 U.S. centers comparing STSC to APC to no margin treatment (control) of defects after EMR of colorectal non-pedunculated lesions ≥ 15 mm. The primary endpoint was the presence of residual lesion at first follow-up. ResultsThere were 384 patients and 414 lesions randomized, and 308 patients (80.2%) with 328 lesions completed ≥ 1 follow-up. The proportion of lesions with residual polyp at first follow-up was 4.6% with STSC, 9.3% with APC and 21.4% with controls (no margin treatment). The odds of residual polyp at first follow-up were lower for STSC and APC when compared to control, p=0.001 and p=0.01, respectively. The difference in odds was not significant between STSC and APC. STSC took less time to apply than APC (median 3.35 vs 4.08 minutes; p=0.019). Adverse event rates were low, with no difference between arms. ConclusionsIn a randomized trial STSC and APC were each superior to no thermal margin treatment after EMR. STSC was faster to apply than APC. Because STSC also results in lower cost and plastic waste than APC (APC requires an additional device ), our study supports STSC as the preferred thermal margin treatment after colorectal EMR. (Clinicaltrials.gov, Number NCT03654209)

Transoral outlet reduction: Outcomes of endoscopic Roux-en-Y gastric bypass revision in 284 patients at a community practice.

Transoral outlet reduction (TORe) is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass (RYGB) for weight recurrence; however, little has been published on its clinical implementation in the community setting. To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB. This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022. Patients were provided longitudinal nutritional support via virtual visits. The primary outcome was total body weight loss (TBWL) at twelve months from TORe. Secondary outcomes included TBWL at three months and six months; excess weight loss (EWL) at three, six, and twelve months; twelve-month TBWL by obesity class; predictors of twelve-month TBWL; rates of post-TORe stenosis; and serious adverse events (SAE). Outcomes were reported with descriptive statistics. Two hundred eighty-four adults (91.9% female, age 51.3 years, body mass index 39.3 kg/m2) underwent TORe an average of 13.3 years after RYGB. Median pre- and post-TORe outlet diameter was 35 mm and 8 mm, respectively. TBWL was 11.7% ± 4.6% at three months, 14.3% ± 6.3% at six months, and 17.3% ± 7.9% at twelve months. EWL was 38.4% ± 28.2% at three months, 46.5% ± 35.4% at six months, and 53.5% ± 39.2% at twelve months. The number of follow-up visits attended was the strongest predictor of TBWL at twelve months (R2 = 0.0139, P = 0.0005). Outlet stenosis occurred in 11 patients (3.9%) and was successfully managed with endoscopic dilation. There was one instance of post-procedural nausea requiring overnight observation (SAE rate 0.4%). When performed by an experienced endoscopist and combined with longitudinal nutritional support, purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.

SARS-CoV-2 infection of human lung epithelial cells induces TMPRSS-mediated acute fibrin deposition

Severe COVID-associated lung injury is a major confounding factor of hospitalizations and death with no effective treatments. Here, we describe a non-classical fibrin clotting mechanism mediated by SARS-CoV-2 infected primary lung but not other susceptible epithelial cells. This infection-induced fibrin formation is observed in all variants of SARS-CoV-2 infections, and requires thrombin but is independent of tissue factor and other classical plasma coagulation factors. While prothrombin and fibrinogen levels are elevated in acute COVID BALF samples, fibrin clotting occurs only with the presence of viral infected but not uninfected lung epithelial cells. We suggest a viral-induced coagulation mechanism, in which prothrombin is activated by infection-induced transmembrane serine proteases, such as ST14 and TMPRSS11D, on NHBE cells. Our finding reveals the inefficiency of current plasma targeted anticoagulation therapy and suggests the need to develop a viral-induced ARDS animal model for treating respiratory airways with thrombin inhibitors.

THE USE OF ARGON PLASMA COAGULATION IN ENDOSCOPY

Relevance: Argon plasma coagulation (APC) is a minimally invasive, non-contact electrosurgery method. This procedure is performed in the following conditions: bleeding in hollow organs, including ulceration after radiation therapy, Barrett’s esophagus, with the germination of a malignant tumor through a stent, benign neoplasms, precancerous conditions, some malignant tumors at the earliest stages. In this article, the authors present the first and successful experience of the use of APC in Kazakhstan during endoscopic interventions in patients with various pathologies.&#x0D; The aim of the study was to evaluate the effectiveness of the introduction of APC as an endoscopic treatment in patients with precancerous pathology and complications of surgical treatment in oncological patients.&#x0D; Methods: A retrospective analysis of the use and effectiveness of AIC was carried out in 15 patients with various pathologies who were on inpatient treatment at the National Research Oncology Center (NROC, Astana, Kazakhstan) during 2022.&#x0D; Results: Barrett’s esophageal APC was successfully performed in the NROC hospital in 6 patients, no signs of intestinal-type metaplasia of the esophageal epithelium were detected in the biopsy material. Two patients with post-radiation hemorrhagic proctitis underwent coagulation in Pulse 15Wt mode and argon flow of 0.4-1.0 L/min. A patient with the GAVE syndrome with hemorrhages underwent 2 sessions of APC in 35Wt mode with a gas flow of 0.8 L/min. In 3 patients with fistulas of the suture of the main bronchus, coagulation was performed after pulmonectomy and closure of the fistula was observed for 1 week. Two patients with esophagoenteroanastomosis failure underwent 2 sessions of APC using 40-watt argon with an interval of 5 days. After anterior rectal resection, the patient had a failure of anastomosis with a multi-chamber cavity and the presence of purulent contents. 4 courses of APC were conducted with an interval of 2 weeks, after the APC, the mouth of the main chamber narrowed, the discharge of pus stopped, as a result, there was a blind pocket up to 2.0 cm without additional chambers and signs of inflammation.&#x0D; Conclusion: The presented article describes the results of the introduction of APC as an endoscopic method of treating patients with various pathologies in an oncological clinic, and based on these results, APC can be recommended for widespread implementation throughout Kazakhstan.

Methods of endoscopic treatment of chronic radiation proctitis

Aim. To compare the clinical effectiveness of argon plasma coagulation (APC) and radiofrequency ablation (RFA) for the treatment of patients with chronic radiation proctitis (CRP) complicated by recurrent rectal bleeding.Methods. A prospective, randomized, single-center study conducted in the State Medical University of the Loginov Moscow State Medical Scientifi Centre. The study included 73 patients with 1—2 degrees of CLP on the RTOG/EORTC scale. The indication for endoscopic treatment was recurrent rectal bleeding. Endoscopic treatment was performed: APC (36 patients) and RF (37 patients), depending on randomization.Results. In 44 patients (60.2 %), of which 18 (50 %) patients in the APC group and 26 (70.2 %) patients in the RF group, a complete regression of the disease was revealed. Telangiectasia was detected in 18 patients (50 %) in the APC group and in 11 patients (29.7 %) in the RF group, which were a continuing source of bleeding. After regression of inflmmatory changes, the patients underwent the second stage of surgery corresponding to the randomization group. After the second stage of surgery in the APC group in 17 patients (94.4 %) and in the RF group in 11 patients (100 %), a complete regression of the disease was revealed. Postoperative pain syndrome occurs in two groups; however, the RF group experiences higher intensity and longer duration of pain.Conclusion: Radiofrequency ablation and argon plasma coagulation are effective and safe treatments for rectal bleeding in chronic radiation proctitis without erosive or ulcerative lesions.

Rescue band ligation for a symptomatic duodenal angioectasia at a challenging location involving ancillary lesion marking by argon plasma coagulation

Rescue band ligation for a symptomatic duodenal angioectasia at a challenging location involving ancillary lesion marking by argon plasma coagulation

Efficacy and Safety of Argon Plasma Coagulation for the Ablation of Barrett's Esophagus: A Systemic Review and Meta-Analysis.

Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett's esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE. A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics. A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC. High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.

Protein S antibody as an adjunct therapy for hemophilia B

AbstractHemophilia B (HB) is caused by an inherited deficiency of plasma coagulation factor IX (FIX). Approximately 60% of pediatric patients with HB possess a severe form of FIX deficiency (<1% FIX activity). Treatment typically requires replacement therapy through the administration of FIX. However, exogenous FIX has a limited functional half-life, and the natural anticoagulant protein S (PS) inhibits activated FIX (FIXa). PS ultimately limits thrombin formation, which limits plasma coagulation. This regulation of FIXa activity by PS led us to test whether inhibiting PS would extend the functional half-life of FIX and thereby prolong FIX-based HB therapy. We assayed clotting times and thrombin generation to measure the efficacy of a PS antibody for increasing FIX activity in commercially obtained plasma and plasma from pediatric patients with HB. We included 11 pediatric patients who lacked additional comorbidities and coagulopathies. In vivo, we assessed thrombus formation in HB mice in the presence of the FIXa ± PS antibody. We found an accelerated rate of clotting in the presence of PS antibody. Similarly, the peak thrombin formed was significantly greater in the presence of the PS antibody, even in plasma from patients with severe HB. Furthermore, HB mice injected with PS antibody and FIX had a 4.5-fold higher accumulation of fibrin at the thrombus induction site compared with mice injected with FIX alone. Our findings imply that a PS antibody would be a valuable adjunct to increase the effectiveness of FIX replacement therapy in pediatric patients who have mild, moderate, and severe HB.

Plasma heavy metals and coagulation levels of residents in E-waste recycling areas

Heavy metal exposure increased the risk of cardiovascular diseases (CVD). However, few studies investigated the effects of heavy metal exposure released by e-waste on coagulation, a risk factor for CVD. We conducted a cross-section study including residents living near and away from e-waste dismantling factories as exposed and reference groups for detecting plasma heavy metal concentrations, fibrinogen, activated coagulation factor X (FXa), and oxidative stress indicators of MDA and 8-isoprostane. We applied linear regression, ridge regression and Bayesian kernel machine regression (BKMR) models to estimate the associations between metal concentrations and coagulation. Furthermore, we explored the potential mediating role of oxidative stress. Our results showed that the concentrations of most heavy metals such as Cd, Co, Cr, Ni, Pb and fibrinogen in the exposed group were higher. Combined results of three statistical methods, we found Cd and Pb were associated with increased fibrinogen and FXa. In the linear regression, per one unit increase in log-transformed Cd and Pb was associated with 13.3 % and 15.4 % increase in fibrinogen, respectively. One unit increment in log-transformed Cd and Pb was associated with 14.2 % and 15.6 % higher FXa. The results of ridge regression were consistent with the basic linear regression. In the BKMR model, when all metals were at 60th or higher percentiles, the overall effect of the metal mixture was significantly associated with both fibrinogen and FXa compared to their 50th percentile. Increases in Cd and Pb were linked to higher oxidative stress, which potentially mediated the elevated coagulation levels. Our study suggests that exposure to heavy metals may increase coagulation levels and oxidative stress is a potential modulation pathway.

An expensive gastric piercing: an embedded lumen-apposing metal stent

Video 1Narration of case and demonstration of the endoscopic management of an embedded stent with stent-in-stent technique to induce pressure necrosis, followed by a combination of needle-knife electroincision, argon plasma coagulation, stent intubation and transection with the gastroscope shaft, and cold and hot snare resection.

PB1210 Incorporation of a2-Plasmin Inhibitor into Plasma Clots of Patients with Venous Thrombosis

PB1210 Incorporation of a2-Plasmin Inhibitor into Plasma Clots of Patients with Venous Thrombosis

PB1205 In Vitro Analysis of Plasma Clots with 0.7 to 10.4 g/L Fibrinogen Concentration by Turbidity, Permeation and Laser Scanning Electron Microscopy

PB1205 In Vitro Analysis of Plasma Clots with 0.7 to 10.4 g/L Fibrinogen Concentration by Turbidity, Permeation and Laser Scanning Electron Microscopy

PB1202 Fibrinogen Concentration and Plasma Clot Properties as Predictors of Cardiovascular Disease Mortality in Black South Africans

PB1202 Fibrinogen Concentration and Plasma Clot Properties as Predictors of Cardiovascular Disease Mortality in Black South Africans

PB1203 The Influence of Human Immunodeficiency Virus Infection and Antiretroviral Therapy on Plasma Clot Properties in a Group of Black South African Women

PB1203 The Influence of Human Immunodeficiency Virus Infection and Antiretroviral Therapy on Plasma Clot Properties in a Group of Black South African Women

Endoscopic Manifestations and Clinical Characteristics of Localized Gastric Light-Chain Amyloidosis.

To determine the endoscopic and clinical features of localized gastric amyloid light-chain (AL) amyloidosis, we retrospectively examined the characteristics of nine patients (eight men and one woman) encountered by the hospitals in our network. Lesions were predominantly flat and depressed with surface vascular dilatation (n=5); others were characterized by subepithelial lesions (n=2), mucosal color change (n=1), and a mass-like morphology with swollen mucosal folds (n=1). Colonoscopy (n=7), video capsule enteroscopy (n=2), serum (n=5) and urine immunoelectrophoresis (n=4), and bone marrow examination (n=3) were performed to exclude involvement of organs other than the stomach. As treatment for gastric lesions of AL amyloidosis, one patient each underwent endoscopic submucosal dissection (n=1) and argon plasma coagulation (n=1), while the remaining seven patients underwent no specific treatment. During a mean follow-up of 4.2 years, one patient died 3.2 years after diagnosis, but the cause of death, which occurred in another hospital, was unknown. The remaining eight patients were alive at the last visit. In conclusion, although localized gastric AL amyloidosis can show various macroscopic features on esophagogastroduodenoscopy, flat, depressed lesions with vascular dilatation on the surface are predominant.