Hemostasis Techniques Research Articles

МОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА РАНЫ ПЕЧЕНИ ПРИ ЕЕ РЕЗЕКЦИИ С ПРИМЕНЕНИЕМ НЕКОТОРЫХ МЕТОДОВ ЛОКАЛЬНОГО ГЕМОСТАЗА В ЭКСПЕРИМЕНТЕ

Background. Due to an increasing number of liver surgery, the problems of using secure hemostatic techniques during its resection are still relevant and require further study. Objective. To determine the optimal technique of local hemostasis during liver resection based on a comparative morphological assessment of the liver wound. Material and methods. The study was performed on 30 outbred white rats using local hemostatic techniques with further morphological examination of biological material on 7th and 21st days. Results. It has been established that cryohemostasis, electrocoagulation and local application methods of hemostasis are adequate ways to stop blood loss from a wound during liver resection. The analysis of the histological image of micro-preparations showed that the inflammatory response is present in all experiment series, regardless of hemostatic techniques. The disadvantage of using a TachoComb sponge is the need for its fixation to the wound surface, that of a collagen hemostatic sponge – a long period of its resorption, that of electrocoagulation – a damaging effect on liver tissue with marked inflammation. Conclusions. Local cryohemostasis appeared to be the most effective bleeding control technique. Its advantages are the following: it stops bleeding much faster than application techniques; it is characterized by minimal abdominal adhesions; it has a less pronounced damaging effect on liver parenchyma; it facilitates scar tissue formation and it is less likely to cause inflammatory changes in the resection zone.

Middle Hepatic Vein-Guided Cranial and Hilar Approach Using a Modified Two-Surgeon Technique in Laparoscopic Extended Left Medial Sectionectomy: A Technical Case Report With Videos.

Anatomical liver resection and liver resection close to major blood vessels are quite challenging and requirea high level of expertise.In addition, anatomical hepatectomy requires extensive knowledge of the positions of blood vessels and techniques for hemostasis because the resection surface is extensive and operations around blood vessels are required. A hepatic vein-guided cranial and hilar approach using a modified "two-surgeon technique" is effective in resolving these problems.Herein, we present a middle hepatic vein (MHV)-guided cranial and hilar approach using a modified two-surgeon technique in laparoscopic extended left medial sectionectomy to resolve these problems. This procedure is feasible and effective.

Successful direct clipping of the bleeding source of a colonic diverticular hemorrhage using the "long-hood gel-filling" method.

Although various endoscopic hemostasis techniques for colonic diverticular bleeding have recently been reported [1], identifying the bleeding diverticulum among other diverticula is difficult [2], and identifying the bleeding vessels within the diverticulum is even more difficult. The usefulness of a long hood (MAJ663; Olympus) [3] and endoscopic-viewing gel (VISCOCLEAR) [4] [5] when identifying the bleeding diverticulum has recently been reported. Here, we report successful direct clipping of the bleeding source for a colonic diverticular hemorrhage using a long hood and gel (the “long-hood gel-filling method”).

An innovated elastic compression hemostasis technique for extremity excision in patients with extensive burns: A prospective clinical randomized controlled trial

ObjectiveTo introduce an innovative elastic compression hemostasis technique for extremity excision in extensively burnt patients and investigate its effectiveness. MethodsTen patients were included and divided into 2 groups: the control group (4 patients, 12 extremities) receiving the conventional hemostasis technique and the experimental group (6 patients, 14 extremities) receiving the innovative technique. General data of the patients were collected, excision size measured, hemostasis time recorded, average blood loss per 1% total body surface area of the excised wound calculated, incidence of subcutaneous hematoma and take rate determined. ResultsThe 2 groups had no statistical difference in the baseline data. Average blood loss per 1% total body surface area of the excised wound in the upper and the lower extremities was (62.1 ± 11.5) mL and (35.6 ± 11.0) mL in the experimental group, significantly less than (94.3 ± 6.9) mL and (82.3 ± 6.2) mL in the control group; a reduction of 34.1% and 56.8% respectively. Hemostasis time in the upper and the lower extremities were (5.0 ± 0.7) min/1% total body surface area and (2.6 ± 0.3) min/1% total body surface area, respectively, in the experimental group, significantly less than (7.4 ± 0.6) min/1% total body surface area and (4.0 ± 0.9) min/1% total body surface area in the control group; a reduction of 31.8% and 34.9% respectively. The incidences of subcutaneous hematoma were 7.1% and 8.3%, and the take rate (85.9 ± 6.0)% and (86.5 ± 4.8)% in the experimental and the control group, respectively, with no statistically significant differences. ConclusionThe innovative elastic compression hemostasis technique is a reliable new method that significantly reduces blood loss during extremity excision in patients with extensive burns and is worth wider understanding and application.

Hemostatic Gauze Surgitamp and Granular Sorbent Molselect G-50 Application in the Treatment of Simulated Bleeding Liver Wounds

The aim of the study was to investigate the potential of Surgitamp hemostatic gauze and Molselect G-50 sorbent application in surgical hemostasis of simulated bleeding liver wounds in an in vivo experiment on laboratory animals. Materials and methods. The study included 30 laboratory animals: Chinchilla rabbits. Laboratory animals underwent median laparotomy under intravenous anesthesia (Zoletil 100 0.1 ml /kg, Xylavet 0.1 ml/kg), the right lobe of the liver was involved into the wound. At a 20 cm distance from the surface of the liver, a metal 92 g load in the form of a triangular prism was attached to the slider with the help of a thread. By operational readiness, the thread was burned, the prism fell vertically and hit the surface of the liver with a pointed end, this resulting in a simulated bleeding liver wound: a wound of the right lobe of the liver, linear in shape 3.0x0.7 cm, 0.6 cm deep, with uneven edges and active bleeding from the defect area. Hemostasis in the experimental group of animals (n=15) was carried out by covering the wound surface with a granular sorbent Molselect G-50, followed by tamponing the wound with a strip of hemostatic gauze Surgitamp. In the control group of animals (n=15) hemostasis was carried out by stitching a bleeding liver wound with a U-shaped suture with a PHA 3.0 thread until the edges of the wound converged. The effectiveness of hemostasis of the liver wounds was evaluated using the following parameters: the time of the final bleeding arrest, the volume of blood loss, the number of episodes of repeated bleeding. Results. Experimental studies have demonstrated that the surgical hemostasis technique with the hemostatic agent Surgitamp application combined with the granular sorbent Molselect G-50 allows for reliable hemostasis of simulated bleeding liver wounds, reducing the time of bleeding arrest from 461.0(420.0-501.0) sec to 280.0(264.0-308.0) sec (P=0.0001), simultaneously reducing the incidence of recurrent hemorrhages from 46.7% to 6.7% (P=0.035).

Feasibility and clinical benefits of the double-ProGlide technique for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants.

To access the efficacy and safety of the double-ProGlide technique for the femoral vein access-site closure in cryoballoon ablation with uninterrupted oral anticoagulants (OAC), and its impact on the electrophysiology laboratory time as well as hospital stay after the procedure in this observational study. Patients with atrial fibrillation undergoing cryoballoon ablation with uninterrupted OAC at Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China from May 2019 to May 2021 were enrolled in this study. From October 2020, double-ProGlide technique was consistently used for hemostasis (ProGlide group), and before that conventional manual compression was utilized (manual compression group). The occurrence of vascular and groin complications was accessed during the hospital stay and until the three-month follow-up. A total of 140 participants (69.30% of male, mean age: 59.21 ± 10.29 years) were evaluated, 70 participants being in each group. Immediate hemostasis was achieved in all the patients with ProGlide closure. No major vascular complications were found in the ProGlide group while two major vascular complications were occurred in the manual compression group. The incidence of any groin complication was obviously higher in subjects with manual compression than patients with ProGlide devices (15.71% vs. 2.86%, P = 0.009). In addition, compared with the manual compression group, the ProGlide group was associated with significantly shorter total time in the electrophysiology laboratory [112.0 (93.3-128.8) min vs. 123.5 (107.3-158.3) min, P = 0.006], time from sheath removal until venous site hemostasis [3.8 (3.4-4.2) min vs. 8.0 (7.6-8.5) min, P < 0.001], bed rest time [8.0 (7.6-8.0) h vs. 14.1 (12.0-17.6) h, P < 0.001] and hospital stay after the procedure [13.8 (12.5-17.8) h vs. 38.0 (21.5-41.0) h, P < 0.001]. Utilization of the double-ProGlide technique for hemostasis after cryoballoon ablation with uninterrupted OAC is feasible and safe, which has the clinical benefit in reducing the total electrophysiology laboratory time and the hospital stay length after the procedure.

MP51-02 AQUABLATION POSTOPERATIVE BLEEDING RISK REDUCTION

You have accessJournal of UrologyCME1 Apr 2023MP51-02 AQUABLATION POSTOPERATIVE BLEEDING RISK REDUCTION Dean Elterman, Steven A. Kaplan, Lori Lerner, Brian Helfand, Mihir Desai, Neil Barber, Rick Popert, Philip Charlesworth, and Thorsten Bach Dean EltermanDean Elterman More articles by this author , Steven A. KaplanSteven A. Kaplan More articles by this author , Lori LernerLori Lerner More articles by this author , Brian HelfandBrian Helfand More articles by this author , Mihir DesaiMihir Desai More articles by this author , Neil BarberNeil Barber More articles by this author , Rick PopertRick Popert More articles by this author , Philip CharlesworthPhilip Charlesworth More articles by this author , and Thorsten BachThorsten Bach More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Aquablation was originally studied in two FDA clinical trials spanning the years of 2015-2017 (WATER in prostates ≤80 mL, WATER II in prostates ≥80 mL). Aquablation was granted approval by FDA in December of 2017. Since then, commercial users have adopted a refined focal cautery approach for hemostasis. METHODS: Consecutive, commercial patients undergoing Aquablation from Asia, Europe, and North America were evaluated for bleeding risk of transfusion and takeback over the last 4 years. The source for the reported bleeding events was the FDA MAUDE database that requires manufactures to report global incidents. RESULTS: 13,447 Aquablation cases were performed with a mean prostate size of 90 mL (range 12 to 535 mL). Following the introduction of the focal bladder neck cautery protocol in January 2020, Figure 1 demonstrates a remarkable decline in bleeding risk requiring an intervention (either a transfusion, takeback for cautery, or takeback for clot evacuation). In 2021 and 2022, the risk of transfusion has reduced to 0.3% and 0.2%, respectively. CONCLUSIONS: Aquablation has leveraged imaging and robotics to allow surgeons to treat the a broad range of prostate sizes. However, early learnings in the development of the procedure, surgeons realized a standardized hemostasis technique was nececessry. Following the adoption of the standardized protocol, the bleeding risk has been reduced by 10-fold and allowing some surgeons the option of day-case Aquablation. Source of Funding: Not applicable © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dean Elterman More articles by this author Steven A. Kaplan More articles by this author Lori Lerner More articles by this author Brian Helfand More articles by this author Mihir Desai More articles by this author Neil Barber More articles by this author Rick Popert More articles by this author Philip Charlesworth More articles by this author Thorsten Bach More articles by this author Expand All Advertisement PDF downloadLoading ...

Bone wax technique for full-endoscopic lumbar laminotomy.

Hemostatic procedures in endoscopic spine surgery have not yet been established, especially in full-endoscopic spine surgery (FESS) performed under continuous irrigation, which has been a major concern for surgeons. Chu et al. had previously reported a technique to convey bone wax during full-endoscopic cervical spine surgery via intracorporeal route by using ball tip of the drill in 2018. However, to the best of our knowledge, there has been no report by surgeons to adopt bone wax as a hemostatic material in full-endoscopic lumbar surgery to date, probably because of difficulty in handling bone wax under continuous irrigation and through a narrow and long working channel in endoscope. We have renewed the bone wax technique (BWT) for hemostasis in FESS, improving its handling by introducing a nozzle applicator, without which the bone wax would stick to the working channel of the endoscope on the way to the bleeding target. This would result in significant loss of bone wax and repeated bone-wax contact would cause dirt build-up on the endoscope lens, which would then be pushed out from the wall of the working channel, thereby disturbing the laminectomy procedure and obfuscating the visual field. Technical details using nozzle-loaded bone wax have been demonstrated.

Comparison of three common tonsil surgery techniques: cold steel with hot hemostasis, monopolar and bipolar diathermy

PurposeTo analyze the risk of postoperative hemorrhage in tonsil surgery with different surgical methods, instruments, indications, and age groups. Monopolar diathermy compared to bipolar diathermy was of particular interest.MethodsThe data from tonsil surgery patients were retrospectively collected between 2012 and 2018 in the Hospital District of Southwest Finland. The surgical method, instruments, indication, sex and age and their association with a postoperative hemorrhage were analyzed.ResultsA total of 4434 patients were included. The postoperative hemorrhage rate for tonsillectomy was 6.3% and for tonsillotomy 2.2%. The most frequently used surgical instruments were monopolar diathermy (58.4%) cold steel with hot hemostasis (25.1%) and bipolar diathermy (6.4%) with the overall postoperative hemorrhage rates 6.1%, 5.9% and 8.1%, respectively. In tonsillectomy patients, the risk for a secondary hemorrhage was higher with bipolar diathermy compared to both monopolar diathermy (p = 0.039) and the cold steel with hot hemostasis technique (p = 0.029). However, between the monopolar and the cold steel with hot hemostasis groups, the difference was statistically non-significant (p = 0.646). Patients aged > 15 years had 2.6 times higher risk for postoperative hemorrhage. The risk of a secondary hemorrhage increased with tonsillitis as the indication, primary hemorrhage, tonsillectomy or tonsillotomy without adenoidectomy, and male sex in patients aged ≤ 15 years.ConclusionBipolar diathermy increased the risk for secondary bleedings compared to both monopolar diathermy and the cold steel with hot hemostasis technique in tonsillectomy patients. Monopolar diathermy did not significantly differ from the cold steel with hot hemostasis group regarding the bleeding rates.

Management of a Large Endometriotic Nodule of the Right Parametrium Involving the Sacral Roots, Vagina, Rectum, and Sigmoid Colon, with Intraoperative Bleeding

Deep endometriotic lesions may involve the deep parametrium which is highly vascular and includes numerous somatic and autonomous nerves (1,2). Surgeons who dissect in this area, must always be prepared to deal with major bleeding, and to master the different techniques of hemostasis. The goal of this video is to show the steps of laparoscopic excision of deep endometriotic lesion of the parametrium and the steps taken to control the bleeding encountered from one of the venous branches. Surgical educational video. Endometriosis referral center. Excision of the endometriotic parametrial nodule and the release of the sacral plexus, with excision of the vaginal involvement, rectal disc excision, and segmental resection of the sigmoid colon. The video shows the excision of a deep endometriosis involving the right parametrium, the mid rectum, the sigmoid colon, and the vagina. The excision of deep endometriosis of the parametrium followed the 10 steps previously described (1). During this procedure, careful dissection of arteries and veins branching from the internal iliac vessels is a crucial step. However, injury of one or more of the vessels can still occur. The movie presents the different techniques used to control the bleeding from a venous injury faced during the dissection around the nodule in the parametrium, including energy use, clips, hem-o-loks, and direct continuous pressure. Of note, hemostatic agents are available, however we have not yet successfully employed them in these circumstances in which large veins were injured. The ultimate solution in our case was the clamping of the injured vessels, allowing meticulous dissection and sectioning of all the feeding vessels, while taking care not to injure the sacral roots which were just beneath these veins. Total operative time was 4 hours. Surgery of deep endometriosis involving the sacral plexus may be successfully done laparoscopically. Thorough knowledge of the deep pelvis anatomy is mandatory, and the surgeon should master various techniques of hemostasis, particularly on deep veins.

New surgical technique for non-missile trauma hemostasis as a result of sewing needle.

Traumas are the most important cause of mortality in the pediatric population. Bleeding is an important complication, especially in traumatic brain injuries with coagulation problem addition. Low-velocity penetrating brain injuries may be caused by sewing needles, nails, and knives. There are few studies in the literature for this injury type. This study presented a surgical technique and treatment to increase hemostasis in a 2-year-old patient after a sewing needle injury.

Comparison of Endoscopic Hemostasis for Endoscopic Sphincterotomy Bleeding between a Novel Self-Assembling Peptide and Conventional Technique

Introduction: Recently, a novel self-assembling peptide hemostatic gel has become available in Japan. However, the safety and efficacy of this novel self-assembling peptide hemostatic gel remain unclear for bleeding after EST. The aim of this study was to evaluate the safety and efficacy of a novel self-assembling peptide hemostatic gel for bleeding after EST, and to perform a comparison to a conventional endoscopic hemostasis technique. Method: This retrospective study was carried out between January 2019 and October 2022. Patients who developed bleeding associated with EST were enrolled. The patients were divided into two groups based on the hemostasis technique used: a conventional hemostasis technique (Group A) or a novel self-assembling peptide hemostatic gel hemostasis technique (Group B). Result: A total of 62 patients (Group A, n = 36; Group B, n = 26) were included. Endoscopic hemostasis was initially obtained in 72.2% (26/32) of patients in Group A and in 88.4% (23/26) of patients in Group B, which was not significantly different (p = 0.1320). However, the procedure time was significantly shorter in Group B (mean, 9.38 min) compared with Group A (mean, 15.4 min) (p = 0.0103). There were no significant differences in the severity of bleeding between the two groups (p = 0.4530). Post-EST bleeding was observed in six patients (Group A, n = 4; Group B, n = 2). Adverse events were more frequently observed in Group A (n = 12) than in Group B (n = 1) (p = 0.0457). Conclusions: PuraStat application for EST bleeding might be safe and effective, and is comparable to the conventional endoscopic hemostasis technique, although further prospective randomized trials are needed.

Techniques of surgical hemostasis and sealing after laparoscopic partial nephrectomy

Background. The kidney cancer treatment remains cornerstone problem in our country for healthcare. Survival results of partial nephrectomy as a radical nephrectomy are similar in groups of patients with the same morphological features and was confirmed by previously results: “indications for nephron-sparing treatment of kidney cancer is determined with the degree of resectability, assessed subjectively by surgeon and his experience, ambitions and technical capabilities. It does not depend on oncological prognostic factors”. This thesis is actual due to oncological preoperative factors and limited only by tumor size. Therefore, development of technical capabilities, techniques and skills expand our capabilities in organ-preserving treatment.Aim. To evaluate the effectiveness and safety of bipolar coagulation with fibrin glue in comparison with the standard technique of surgical suture to the area of non-ischemic partial nephrectomy.Materials and methods. This is prospective trial which had included the results of treatment of 121 patients who received partial-nephrectomy for localized kidney cancer from 2015 to 2017 at the N.N. Petrov National Medical Research Center of Oncology. Two variants of hemostasis were used in the work: standard surgical (surgical suture) and electrohemostasis with an additional hemostatic component (fibrin glue). Among the selected patients, there were no patients with a single kidney and a pronounced violation of the excretory function of the organ.Results. The groups were comparable in terms of tumor size (р = 0.09), morphometric characteristics according to the R.E.N.A.L. scale (p = 0.07), no differences were found in clinical and morphological staging. The use of electrohemostasis with a hemostatic glue component did not significantly affect at the excretory function of the kidney, assessed on the 3rd and 10th days after laparoscopic non-ischemic resection, which indirectly confirms the functional safety of the tested technique (р &gt;0.05). The groups did not differ significantly in terms of the blood loss, hemotransfusions (р = 0.067), and none of delayed bleeding was found which indicates the reliability of electrohemostasis using an adhesive composition.Conclusion. We proposed a patent “Method of surgical hemostasis in laparoscopic partial nephrectomy” RU2654402C1 by combining bipolar coagulation in the 90 W-effect 7–8 mode and hemostatic fibrin glue (SURGIFLO, PERCLOT). Used adhesive compositions complement the achieved electrohemostasis, and also provide sealing of the area of the resected kidney tissue.

Shave biopsy technique and hemostasis pearl.

Nurse practitioners (NPs) are frequently called on to assess and diagnose patients presenting with suspicious or aggravated skin lesions. Performing shave biopsies and removing small neoplasms can be within the scope of a general NP. We offer a thorough review of shave biopsy methods, including required materials, photographic documentation, blade preparation and orientation, and hemostasis techniques. Diagnostic considerations when choosing a shave versus other biopsy techniques are reviewed as is the removal of lesions in cosmetically sensitive areas. Finally, a unique tip to diminish intraprocedure bleeding using aluminum chloride before procedure initiation is presented.

Results of therapeutic endoscopy in non-variceal upper gastrointestinal bleeding at Hue University of Medicine and Pharmacy Hospital

Background: Upper gastrointestinal bleeding is a frequent emergency in Viet Nam, most of them are non-variceal gastrointestinal bleeding. Despite of many improvements in diagnosis and management, the mortality rate of upper gastrointestinal bleeding is still significant high. In recent years, many endoscopic hemostasis techniques improved the prognosis of this emergency. This study was aimed at: 1. Describing characteristics and the endoscopic lesions in patients with non-variceal upper gastrointestinal bleeding. 2. Assessing efficacy of some endoscopic hemostasis techniques in non-variceal upper gastrointestinal bleeding. Subject and methods: Interventional study concludes 161 non-variceal upper gastrointestinal bleeding patients, 179 therapeutic upper endoscopy to get hemostasis in Gastroenterology - Endoscopy Center, Hue University of Medicine and Pharmacy Hospital from 11/2017 to 8/2020. Result: Mean age of the patients: 55.0 ± 17.3, minimum: 12, maximum: 94. Male/female ratio: 2.6. Positions of lesions: 10.6% in esophagus, 41.6% in stomach, 47.8% in duodenum. Causes of bleeding: peptic ulcer diseases (82.0%), esophago-gastric junction tear (9.9%), angiodysplasia (5.6%), and others (2.5%). Successful rate of initiating endoscopic hemostasis: 100%, permanent endoscopic hemostasis: 98.8%; recurrent bleeding rate: 4.3%, endoscopic hemostasis failure: 1.2%; operation rate: 1.2%. Conclusion: Endoscopic hemostasis techniques showed good safety and efficacy, failure and operation rate are very low. Key words: non-variceal upper gastrointestinal bleeding, endoscopic hemostasis

S2576 Application of Hemospray for Metastatic Bleeding Gastric Adenocarcinoma: A Case Report

Introduction: TC-325 hemostatic powder (Hemospray) is a mineral-based topical agent that acts as a mechanical barrier over a bleeding site. It is a non-invasive, safe, and effective modality in controlling active GI bleeding, with immediate response. Here, we present a case of bleeding metastatic gastric adenocarcinoma managed with Hemospray after the failure of standard endoscopic therapy. Case Description/Methods: A 64-year-old male presented to the emergency room (ER) for symptomatic anemia. His hemoglobin was 4.6 g/dL. CT imaging showed gastric cardia lesion with multiple hepatic metastases. After blood transfusion, EGD (Figure 1a) showed a cardia lesion with oozing blood from multiple sites. Endoscopic ultrasound with fine-needle aspiration, showing atypical cells. The patient continued to have melena requiring transfusions. CT angiogram was negative. Partial gastrectomy was not performed due to peritoneal carcinomatosis. Endoscopic hemostasis with epinephrine and clips failed (Figure 1b). Hemospray was deployed (Figure 1c) with an immediate response. Later patient underwent left gastric artery embolization (Figure 1d), liver biopsy and peritoneal node sampling that suggested metastatic adenocarcinoma with primary gastric malignancy. The patient and his family opted for palliative care and was discharged. Discussion: Gastric cancer accounts for 2-8% of overall UGIB and 58% bleeding risk compared to other GI malignancies. There are no specific guidelines and only limited evidence was available on managing malignancy-related UGIB. Nonresponsive, inoperable metastatic gastric cancer bleeding is challenging and extremely difficult to manage using conventional hemostasis techniques. Based on our case, we recommend utilizing Hemospray as a first-line, monotherapy or in combination to control bleeding until a definitive treatment, reducing morbidity and mortality.Figure 1.: (A) Submucosal gastric fundal mass distal to gastroesophageal junction with blood oozing from multiple sites (arrows), (B) Image showing endoscopic hemostatic clips placement (arrowheads), (C) Application of Hemospray over the Gastric Mass after unsuccessful attempts using standard-of-care hemostatic methods, (D) Showing embolization of the left gastroepiploic artery.

Effective application of self-assembling peptide matrix with the gel immersion technique and red dichromatic imaging for hemostasis of postendoscopic sphincterotomy bleeding.

Endoscopic sphincterotomy is an essential procedure during endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis or treatment of pancreaticobiliary disease; however, postendoscopic sphincterotomy bleeding occasionally occurs and is a potentially life-threatening adverse event [1]. Recently, a novel self-assembling peptide matrix (PuraStat; 3-D Matrix Europe SAS, France), which is approved for hemostasis in gastrointestinal endoscopic procedures, was launched [2]. Because of its characteristics, this product is not effective in achieving hemostasis of pooled blood, as the peptide matrix assembles when the solution comes into contact with body fluids. For effective hemostasis, the peptide matrix gel should be applied as close as possible to the bleeding point of the injured vessel wall. Herein, we report the effective application of PuraStat for hemostasis of postendoscopic sphincterotomy bleeding while securing an endoscopic field of view with the gel immersion technique [3] and red dichromatic imaging (RDI; Olympus, Japan) [4] [5] ([Video 1]).

2 bladder, or not 2 bladder? That is the question.

2 bladder, or not 2 bladder? That is the question.

Evaluation of the incidence of radial artery occlusion using different introducer sheaths and hemostasis techniques.

Radial artery occlusion (RAO) remains one of the most important complications of transradial access (TRA). Despite the identification of multiple predictors, the interaction between these predictors on the occurrence of RAO has not been evaluated. Consecutive patients undergoing TRA coronary angiography (CA) or percutaneous coronary intervention (PCI), were retrospectively analyzed to compare the effect of standard patent hemostasis using a one-bladder band versus two-bladder band with simultaneous ipsilateral ulnar artery compression and two introducer sizes on the primary endpoint of RAO. Access was obtained using 6-Frslender introducer sheath or 7-Frslender introducer sheath and hemostasis with either a one-bladder band or a two-bladder band. The radial artery was evaluated using ultrasound. Total of 2019patients undergoing CA or PCI were included in the analysis. In the one-bladder band group, the incidence of RAO with a 6-Frslender introducer sheath was 4.2%. In those receiving hemostasis with a two-bladder band, RAO occurred in 1% of patients receiving a 6-Frslender introducer sheath versus0.9% in those receiving a 7-Frslender introducer sheath (p = 0.68). Larger radial artery diameter, larger body weight, and a two-bladder hemostasis band with ipsilateral ulnar compression were independently associated with a lower incidence of RAO. A two-bladder band with simultaneous ipsilateral ulnar artery compression when used for radial artery hemostasis, is associated with a lower incidence of RAO, and can mitigate the penalty for a larger catheter with reassuring implications for use of a 7-Frcapable system for complex transradial PCI.

Implementation of new techniques in the management of upper gastrointestinal bleeding

Background: In recent years, many endoscopic hemostasis techniques helped to improve the prognosis of upper gastrointestinal bleeding. It includes: esophageal band ligation and Histoacryl injection in variceal upper GI bleeding; dilute adrenalin injection, hemoclipping, argon plasma coagulation and Hemospray in non-variceal upper GI bleeding. But domestic studies about these techniques’ efficacy are limited. Objectives: 1. To describe characteristics of patients and endoscopic lesions in upper GI bleeding. 2. To assess the efficacy of some endoscopic hemostasis techniques in upper GI bleeding. Subject and methods: Interventional study concluded 346 upper GI bleeding patients, 365 therapeutic upper endoscopy to get hemostasis in Gastroenterology - Endoscopy Center, Hue University of Medicine and Pharmacy Hospital from 11/2017 to 4/2022. Result: Mean age of patients is 55.6 ± 17.9, minimum is 9, maximum is 95. Male/female ratio is 2.5. The causes of bleeding: esophageal varices 35.5%, gastric varices 4.3%, peptic ulcer diseases 50.9%, esophago-gastric junction tear 5.5%, angiodysplasia 2.6%, and others 1.2%. Hemostatic techniques: esophageal band ligation 33.7%, Histoacryl injection 4.1%, hemoclipping 52.6%, dilute adrenalin injection 15.9%, APC 7.9%, Hemospray 0.8% and others 0.3%. Successful rate of initiating endoscopic hemostasis is high (100%), permanent hemostasis is high (99.1%); recurrent bleeding rate is low (2.3%), endoscopic hemostasis failure is low (0.9%); operation rate is low (0.9%). Conclusion: Endoscopic hemostasis techniques showed good safety and efficacy, failure and operation rate are very low. Using new techniques in case of failure of traditional techniques was beneficial and safe Key words: upper gastrointestinal bleeding, endoscopy