Effective Control Of Bleeding Research Articles

External Soft-Tissue Hemostatic Clamp Compared to a Compression Tourniquet as Primary Hemorrhage Control Device in Pilot Flow Model Study.

Acute blood loss represents a leading cause of death in both civilian and battlefield trauma, despite the prioritization of massive hemorrhage control by well-adopted trauma guidelines. Current Tactical Combat Casualty Care (TCCC) and Tactical Emergency Casualty Care (TECC) guidelines recommend the application of a tourniquet to treat life-threatening extremity hemorrhages. While extremely effective at controlling blood loss, the proper application of a tourniquet is associated with severe pain and could lead to transient loss of limb function impeding the ability to self-extricate or effectively employ weapons systems. As a potential alternative, Innovative Trauma Care (San Antonio, Texas USA) has developed an external soft-tissue hemostatic clamp that could potentially provide effective hemorrhage control without the aforementioned complications and loss of limb function. Thus, this study sought to investigate the effectiveness of blood loss control by an external soft-tissue hemostatic clamp versus a compression tourniquet. The external soft-tissue hemostatic clamp would be non-inferior at controlling intravascular fluid loss after damage to the femoral and popliteal arteries in a normotensive, coagulopathic, cadaveric lower-extremity flow model using an inert blood analogue, as compared to a compression tourniquet. Using a fresh cadaveric model with simulated vascular flow, this study sought to compare the effectiveness of the external soft-tissue hemostatic clamp versus the compression tourniquet to control fluid loss in simulated trauma resulting in femoral and posterior tibial artery lacerations using a coagulopathic, normotensive, cadaveric-extremity flow model. A sample of 16 fresh, un-embalmed, human cadaver lower extremities was used in this randomized, balanced two-treatment, two-period, two-sequence, crossover design. Statistical significance of the treatment comparisons was assessed with paired t-tests. Results were expressed as the mean and standard deviation (SD). Mean intravascular fluid loss was increased from simulated arterial wounds with the external soft-tissue hemostatic clamp as compared to the compression tourniquet at the lower leg (119.8mL versus 15.9mL; P <.001) and in the thigh (103.1mL versus 5.2mL; P <.001). In this hemorrhagic, coagulopathic, cadaveric-extremity experimental flow model, the use of the external soft-tissue hemostatic clamp as a hasty hemostatic adjunct was associated with statistically significant greater fluid loss than with the use of the compression tourniquet.Paquette R, Bierle R, Wampler D, Allen P, Cooley C, Ramos R, Michalek J, Gerhardt RT. External soft-tissue hemostatic clamp compared to a compression tourniquet as primary hemorrhage control device in pilot flow model study. Prehosp Disaster Med. 2019;34(2):175-181.

Layered nanofiber sponge with an improved capacity for promoting blood coagulation and wound healing

Effective bleeding control and wound healing are very important and can be life saving. However, traditional wound dressings with structural deficiencies are not effective in controlling bleeding and promoting the regeneration of functional tissues. In this study, a three-dimensional (3D) layered nanofiber sponge was obtained by expanding two-dimensional (2D) nanofiber membranes into the third dimension. This sponge has a layered nanofiber structure, which increases the interfacial interaction between the sponge and blood cells to accelerate hemostasis. Through fine-tuning of structure, the 3D nanofiber sponge acquires properties beneficial to wound healing such as good elasticity and high permeability and fluid absorption ratio. The 3D nanofiber sponges are both highly compressible and resilient, providing tamponade for deep wounds and creating a good 3D dynamic microenvironment to regulate cellular behavior. Further research has demonstrated that the layered nanofiber structure could promote the regeneration of functional dermis and the restoration of differentiated adipocytes during the early repair phase. Experiments using model mice with full-thickness skin defects have shown that the layered nanofiber structure could effectively accelerate wound healing and reduce scar formation. This layered 3D nanofiber sponge design is easy to produce. Due to its excellent wound healing property, this porous nanofiber sponge has great potential for future clinical application as wound dressings.

Uniportal thoracoscopic left upper lobectomy with suture repair of pulmonary artery injury following effective bleeding control and vascular defect exposure

Uniportal thoracoscopic left upper lobectomy with suture repair of pulmonary artery injury following effective bleeding control and vascular defect exposure

Injectable chitosan-nano bioglass composite hemostatic hydrogel for effective bleeding control

Effective bleeding control is a major concern in trauma and major surgeries. Chitosan (Ch) as hemostatic agent has been widely used and when applied at the site of injury it acts by aggregating blood cells and forming a plug. Our prime interest is to improve the blood clotting property of Ch hydrogel. Incorporation of nanobioglass (nBG) with silica (activate coagulation factor XII), calcium (activate intrinsic pathway) and phosphate (initiates extrinsic pathway) ions into Ch hydrogel (protonated NH2 group) would act at the same time and bring about rapid blood clot formation. Sol-gel method was followed to synthesize nBG particles and its particle size was found to be 14 ± 3 nm. 2%Ch-5%nBG hydrogel was then prepared and studied using SEM and FTIR. The prepared hydrogel was injecable and was also cytocompatible with HUVEC. In in vitro blood clotting study and in vivo major organ injury model, 2%Ch-5%nBG hydrogel formed rapid blood clot than 2%Ch hydrogel. Hence, 2%Ch-5%nBG hydrogel might have great potential to achieve effective bleeding control during critical situations.

Emerging chitin nanogels/rectorite nanocomposites for safe and effective hemorrhage control.

Excessive bleeding due to trauma, surgery and diseases may cause severe mortalities. Here, an emerging chitin nanogel/rectorite nanocomposite is developed for effective hemorrhage control. Chitin chains are intercalated into rectorite and subsequent mechanical high speed stirring generates chitin nanogels, which assemble on the surface of the rectorite nanoplates through electrostatic interactions to form a sandwich structure. The in vitro experiments reveal that the nanocomposite exhibits favorable biocompatibility and negligible hemolysis (<3.5%) as compared to rectorite (40%). The nanocomposite stops bleeding in 121 s in rat tail incision and exhibits higher hemostatic activity in the rabbit artery injury model as compared to a commercialized chitosan hemostat, Celox. The efficient blood clotting activity is attributed to the induction of a coagulation cascade by rectorite and the quick adsorption and aggregation of platelets and red blood cells by chitin. The enhanced biocompatibility and hemostatic activity of the chitin/rectorite nanocomposite make it a safe and cost effective hemostat to control bleeding.

The development and prospect of the treatment for bone and soft tissue tumor in China

With the rapid development of modern medicine, significant stride has been achieved in the field of bone and soft tissue tumor in China.The early efforts in the treatment of bone tumor led to the foundation of Bone Tumor Group of Chinese Medical Association in 1985, which marked the initial formation of standardized diagnosis and treatment of bone tumor.Since then, the guidelines of diagnosis and treatment of bone tumor were widely spread and obeyed. The gradually evolution of limb-salvage technique, the improved en-bloc resection procedure in spine and pelvis tumor,the effective bleeding control measure have made concrete basis for higher survival rate, better functional status and life quality for patients than before. With new breakthroughs in the field of molecular biology and immunology, the development in stereotactic radiation and combination of new material and mega-data with medicine, the treatment of bone tumor is entering a new era of precision and personalized medicine.

Two cases of debulking surgery for lower limb diffuse plexiform neurofibroma with transcatheter arterial embolisation

IntroductionDiffuse plexiform neurofibroma (DPN) in patients with neurofibromatosis type 1 (NF1) causes motility dysfunction in severe cases. Transcatheter arterial embolisation (TAE) is an effective haemorrhage control method in vascular tumour surgery. Presentation of caseWe performed debulking surgery for DPN in the buttock and posterior thigh of two NF1 patients. Preoperative TAE with gelatine particles to tumour feeder vessels was conducted in both cases. Operative bleeding volumes were 500 and 4970 mL, respectively. In the latter case, the resection area extended to the upper poles of the buttocks, and the tumour invaded deeply into the surrounding tissues. Massive haemorrhage occurred, and internal iliac arterial balloon was inflated temporarily to further suppress the bleeding. Delayed wound healing due to TAE occurred; debridement and wound closure were required. Motor function improvement was confirmed in both patients. DiscussionBleeding volumes varied because of highly developed collateral pathways and tumour invasiveness. As the upper pole of the buttock was perfused by the superior gluteal artery and its numerous collateral vessels, complete haemostasis was difficult despite adequate TAE. Because delineating the tumour border from the normal tissue was impossible due to the high tumour invasiveness, cutting into the hypervascular tumour was inevitable. As gelatine particles were absorbed but remained within the vessels, prolonged wound ischaemia and delayed healing occurred. ConclusionAlthough TAE with gelatine particles and balloon occlusion were reliable haemorrhage control methods in debulking surgery for lower limb DPN, optimal haemorrhage control technique, compatible with haemostasis and wound healing, was desired.

Fabrication of porous starch microspheres by electrostatic spray and supercritical CO2 and its hemostatic performance

Effective control of bleeding is critical to saving lives whether on the battle field or in civilian life. Microporous starch (MS) is a promising hemostat for its extensive sources, huge surface area and good biocompatibility. However, the hemostatic performance of MS is limited because of its complex preparation process and lack of effective component to activate coagulation factors. Herein, porous starch microspheres modified by calcium (Ca-PSM) with dense shell and honeycomb micro-porous core were prepared by electrostatic spray and supercritical CO2 for the first time. The topological morphology of Ca-PSM changed with the increase of Tween-80 content within 0.5%. Ca-PSM possessed excellent water absorbability due to high specific surface area, and what's more, it showed good hemostatic performance because of the synergistic effects of physical adsorption and chemical activation mechanisms. The results of thrombelastograph (TEG) showed that the initial clotting time (R) and coagulation time (R + K) of Ca-PSM-1 were shortened by 47.1%, 53.3% than that of control group. The maximum blood clot strength (MA) of Ca-PSM-1 was also significantly raised. Furthermore, it was noteworthy that Ca-PSM could activate clotting cascade and induce erythrocyte adsorption. In summary, Ca-PSM as a hemostat will be a promising and alternative candidate for clinical application.

Shape-adaptive composite foams with high expansion and absorption used for massive hemorrhage control and irregular wound treatment

Effective bleeding control is becoming more and more important in the military field and civilian trauma arena. However, traditional hemostats present limitations, they have been proven to be less useful for irregular, deep or penetrating wounds with uncontrollable hemorrhage caused by minor-caliber weapons, shrapnel or explosive devices. Here, a series of porous polyvinyl alcohol (PVA)/alginate composite foams (PACFs) were prepared through crosslinking reaction and lyophilization process. The effect of different content of alginate on the physicochemical properties and hemostatic function of the PACF were evaluated. The results demonstrated that PACF could not only rapidly absorb plasma, but also stimulate blood cells, thus further promoting blood coagulation. In addition, the PACF with higher alginate content showed increased capability to enhance thrombus generation, blood clotting, and blood cells adhesion and aggregation. More importantly, the PACF exhibited over 2000% volume expansion, high flexibility and shape-adaptive ability, and could therefore expand to entirely fill and conform to the shape of wound cavity. The in vivo hemostatic tests further demonstrate the high hemostatic efficiency of PACF. These results suggest that PACF has strong potential as a hemostatic material to be applied for massive hemorrhage control and deep/irregular wounds treatment.

Preliminary results: use of multi-hole injection nails for intramedullary nailing with simultaneous bone cement injection in long-bone metastasis.

For symptomatic metastasis of the long bones, intramedullary nailing has been the most accepted fixation method. Intramedullary nailing has effective control of pain, perioperative bleeding, and local tumor progression by augmentation with bone cement around the nail. Here, we report the preliminary results of a new surgical implant that allows for simultaneous injection of bone cement while inserting a percutaneous, flexible intramedullary nail. We performed palliative surgeries for long-bone metastasis using a multi-hole injection nail (MIN) with multiple side holes in the distal one third. When the nail tip entered the metastatic cancer lesion, the bone cement injection was started, and continued until the nail was completely seated. Ten patients with advanced cancer underwent palliative surgery using the new implant with simultaneous bone cement injection for humeral (n = 4), femoral (n = 4), and tibial (n = 2) metastases. The mean operative time was 42min (range, 36-52min). The mean length of the injection nail was 23.0cm (range, 18.0-33.0cm), and the mean volume of cement was 28.0ml (range, 14.0-40.0ml). Marked pain palliation (p < 0.001) and functional recovery (p = 0.01) were verified. The mean Musculoskeletal Tumor Society (MSTS) functional score improved significantly from 12.5 at 6weeks preoperatively, to 24.9 postoperatively. No acute postoperative complications, including cement embolism, occurred. This minimally invasive surgical method with MIN could be useful for stabilization of long-bone metastases in patients with advanced cancer.

Topical tranexamic acid for the treatment of acute epistaxis in the emergency department

ObjectiveTo evaluate the effectiveness and potential benefits of topical tranexamic acid (TXA) in the management of acute epistaxis. MethodsRetrospective review was performed among all patients presenting to the institution's emergency department (ED) with epistaxis between September 2014 and August 2016. Patients achieving hemostasis with standard of care agents, such as oxymetazoline, lidocaine, or epinephrine were excluded. The primary outcome was the ED length of stay (LOS). Secondary outcomes included the incidence of hospital admission, otolaryngologist consultation, nasal packing, prophylactic antibiotic use, and ED visit for rebleeding within seven days of treatment. ResultsAmong 122 patients, 30 received topical TXA (500mg injectable solution soaked onto packing material and applied to the affected nostril) and 92 were managed with standard care. Nearly half (46.7%) of TXA-treated subjects received TXA either alone or in combination with standard of care agents as their initial treatment strategy. No significant difference was observed in the ED LOS (272 vs 232min in TXA and standard care arms, respectively, p=0.26). However, TXA was associated with a significant reduction in otolaryngologist consults (30.0% vs 65.2%, p=0.002) and nasal packing (16.7% vs 23.9%, p=0.003). ConclusionsThis investigation did not demonstrate a significant difference in ED LOS among patients with acute epistaxis treated with topical TXA or standard care. However, this data does add to existing evidence that TXA may be associated with a reduction in resource utilization, suggesting it may provide more effective bleeding control. Overall, more data is needed to confirm the potential benefits of this practice.

Predictive factor for volume reduction of uterine fibroids after short-term use of ulipristal acetate

ObjectivesUlipristal acetate (UPA) is a selective progesterone receptor modulator, which has been used to treat uterine fibroids. Many published reports about the outcomes indicate effective control of bleeding and reduction in the fibroid volume following both short- and long-term therapy. However, the reported volume reduction varies across different reports. Therefore, the purpose of this study was to investigate the factors that can affect the volume reduction of uterine fibroids, after short-term UPA therapy in patients with symptomatic uterine fibroids. Study designWomen treated with UPA for 3 months, between November 2013 and February 2017, for symptomatic uterine fibroids were evaluated retrospectively. The fibroid volume was measured using ultrasonography or magnetic resonance imaging. Response was defined as any reduction in volume after treatment and non-response was defined as no change or increase in volume. ResultsTotally, 152 women were treated with UPA and the median volume reduction was 13.1% (interquartile range [IQR] −16.8 to 36.7). Response to treatment was seen in 92 of 152 (60.5%) patients, while 60 women (39.5%) showed no response. Median number of fibroids in the response group was less than that in the non-response group (P = 0.030; median 2, IQR 1–4 vs. median 4, IQR 1–6). On multivariate regression analysis, fewer number of uterine fibroids was an independent factor for predicting a good response to UPA (odds ratio 0.830, CI: 0.710–0.969, P = 0.019). ConclusionAn independent factor that can affect the volume reduction after a 3-month UPA therapy in women with uterine fibroids was the number of fibroids. This indicates that UPA might be ineffective for volume reduction in cases with multiple leiomyomas. However, future prospective studies comparing solitary and multiple leiomyomas for response to UPA are necessary.

Superhydrophobic/Superhydrophilic Janus Fabrics Reducing Blood Loss.

Hemostatic fabrics are most commonly used in baseline emergency treatment; however, the unnecessary blood loss due to the excessive blood absorption by traditional superhydrophilic fabrics is overlooked. Herein, for the first time, superhydrophobic/superhydrophilic Janus fabrics (superhydrophobic on one side and superhydrophilic on the other) are proposed: the superhydrophilic part absorbs water in the blood to expedite the clotting while the superhydrophobic part prevents blood from further permeating. Compared with the common counterparts, effective bleeding control with reducing blood loss more than 50% can be achieved while the breathability largely remain by using Janus fabrics. The proposed prototypes can even prolong the survival time in the rat model with serious bleeding. This strategy for reducing blood loss via simply tuning wettability is promising for the practical applications.

Clinical Update: Concepts of Prehospital Traumatic Hemorrhage Control in the Operational K9.

Major trauma often involves varying degrees of hemorrhage. Left unattended, any amount of trauma-induced hemorrhage may rapidly become life threatening. Similar to humans, Operational canines (OpK9s) can suffer penetrating trauma and blunt trauma that lead to compressible and noncompressible hemorrhage. Preserving organ function and saving the life of a massively bleeding OpK9 require the implementation of immediate and effective hemostatic measures. Effective hemorrhage control interventions for the exsanguinating OpK9 are similar to those for humans: direct pressure, wound packing, hemostatic agents and devices, pressure bandage, and, possibly, tourniquet application. Although tourniquet application is a life-saving intervention in humans experiencing extremity hemorrhage, it is not considered a necessary, immediate-action life-saving intervention for canines with extremity injuries. This article provides a brief description of the basic methods for identifying life-threatening hemorrhage and achieving immediate hemostasis in the bleeding OpK9 during the prehospital period.

Novel hemorrhage control technologies and their potential applicability in trauma medicine

Mortality due to hemorrhage is potentially preventable but remains a prevalent problem in trauma care. Despite advances in prehospital hemorrhage control, exsanguination remains the leading and second-leading cause of mortality in military and civilian trauma, respectively. Novel hemorrhage control technologies for military and civilian prehospital use include the iTClamp (iTraumaCare, Edmonton, Canada), a mechanical clamp used to close wounds; XStat (RevMedx, Wilsonville, OR), a syringe applicator that injects expandable cellulose sponges into a wound for internal compression and clotting acceleration; ResQFoam (Arsenal Medical, Watertown, MA), liquids injected into the abdominal cavity that mix and transform into an expandable solid to compress internal organ wounds; and TraumaGel (Cresilon, Brooklyn, NY), a biocompatible gel that promotes clotting and polymerizes to form a mesh to seal the wound. These 4 technologies all show promise in effective hemorrhage control, and have been designed for quick and easy use in the setting of prehospital trauma care. However, these products are still in the early stages of development with limited research data for human use. Therefore, efficiency of use, effectiveness in hemostasis, and safety should be examined for each technology to determine whether any of them warrant widespread adoption for hemorrhage control.

Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation.

Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.

Long-term efficacy and safety of prophylaxis with recombinant factor VIII in Chinese pediatric patients with hemophilia A: a multi-center, retrospective, non-interventional, phase IV (ReCARE) study

Background: The first recombinant factor VIII (rFVIII) product was launched in China in 2007. However, until now, no study has been conducted to describe the efficacy and safety of prophylaxis with rFVIII in Chinese pediatric patients with hemophilia A (HA).Objective: To summarize the efficacy and safety data on prophylaxis with rFVIII in Chinese pediatric patients with HA.Methods: ReCARE (Retrospective study in Chinese pediatric hemophilia A patients with rFVIII contained regular prophylaxis) was a retrospective study conducted in 12 hemophilia treatment centers (HTCs) across China. The primary endpoints included reduction in annualized bleeding rate (ABR); the secondary endpoints included evaluation of joint function (number and sites of target joints) using Gilbert score and Hemophilia Joint Health Score (HJHS), quality of life (QoL) and factors affecting treatment choices. Safety assessment of rFVIII was also conducted.Results: We analyzed a total of 183 male pediatric patients (mean age, 7.1 ± 4.23 years) who received prophylaxis between 1 November 2007 and 31 May 2013. Compared with baseline, prophylaxis with rFVIII significantly reduced overall annualized joint bleed rate (AJBR) (p < .001) and ABR (p < .001). Inhibitor formation was reported in 5 (2.7%) patients and hemarthrosis was reported in 1 patient. The mean number of target joints was positively related to age (p < .001) and weight (p = .003) at baseline. Responses from survey questionnaires reported that effective bleeding control, joint protection, improvement in quality of life, favorable medical insurance policies, and economic capability were reasons for choosing prophylaxis.Conclusion: Prophylaxis with rFVIII reduced bleeding and number of target joints, even with a low-dose regimen, in Chinese pediatric patients with HA. Other than the efficacy and safety, factors such as poor disease control, improved economic stability and stable financial support made prophylaxis as an attractive treatment option.ClinicalTrials.gov ID: NCT02263066.

Enzymatic Hydrolysis of Silk Fibroin Peptide for Hemorrhage Control

Effective hemorrhage control becomes increasingly significant in today’s military and civilian trauma, while the topical hemostats currently available in market still have various disadvantages. In this study, the silk fibroin peptide (SFP) was prepared through alcalase hydrolysis of silk fibroin. The result of thromboelastographic (TEG) method showed that the SFP can significantly strengthen the coagulation in blood. The results of APTT measurements reflected the acceleration of activation of intrinsic pathway. In the murine hepatic injury model, the blood loss and the bleeding time significantly reduced with the use of SFP as compared with the equal masses of gauze. Based on these results, it can be suggested that the developed SFP has the excellent hemostatic effect, caused no observable tissue damage at the site of application and would be a promising material in clinical hemostatic application.

Preparation and Characterization of 2,2,6,6-Tetramethylpiperidine-1-oxyl (TEMPO)-Oxidized Cellulose Nanocrystal/Alginate Biodegradable Composite Dressing for Hemostasis Applications

Hemorrhage is common in surgery, and excessive bleeding is the main reason for trauma death. Effective control of bleeding is becoming more and more important in military and civilian trauma. In this work, oxidized cellulose nanocrystal/alginate composite films and sponges were successfully prepared and their usages as the hemostatic materials were investigated. Carboxyl functionalization on the cellulose nanocrystal surface not only played a fundamental role in the structural of composites, but also contributed to absorb plasma and stimulate erythrocytes and platelets. Fourier transform infrared (FTIR) and X-ray photoelectron spectroscopy (XPS) spectra showed that the carboxyl groups were successfully introduced on the cellulose nanocrystal surface by TEMPO-mediated oxidization. The oxidized cellulose nanocrystals (TOCN)/alginate (SA) composites were in the presence of Ca2+ solution cross-linking. Physical properties tests results indicated that the ultrahigh porosity (sponge), surface homogeneity (film)...

Super-Selective Mesenteric Embolization Provides Effective Control of Lower GI Bleeding.

Introduction. We aimed to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolization (SMAE) in managing lower GI bleeding (LGIB). Method. A retrospective case series of patients with LGIB treated with SMAE in our health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multidetector CT angiography (CE-MDCT), were referred for DSA +/− SMAE. Data collected included patient characteristics, screening modality, bleeding territory, embolization technique, technical and clinical success, short-term to medium-term complications, 30-day mortality, and progression to surgery related to procedural failure or complications. Results. There were fifty-five hospital admissions with acute unstable lower gastrointestinal bleeding which were demonstrable on CE-MDCT or RS over a 31-month period. Eighteen patients proceed to embolization, with immediate success in all. Eight patients (44%) had clinical rebleeding after intervention, warranting repeated imaging. Only one case (5.6%) demonstrated radiological rebleeding and was reembolized. Complication rate was excellent: no bowel ischaemia, ischaemic stricture, progression to surgery, or 30-day mortality. Conclusion. SMAE is a viable, safe, and effective first-line management for localised LGIB. Our results overall compare favourably with the published experiences of other institutions. It is now accepted practice at our institution to manage localised LGIB with embolization.