PTU-029 The Use Of Endoclot™ Therapy In The Endoscopic Management Of Gastrointestinal Bleeding

Abstract

had better mean comfort score (0.4 vs 2.0, p < 0.001) even with intravenous sedation during gastroscopy in 17 (55%) patients. Conclusion Real-time viewing of oesophageal capsule potentially offers a less invasive means of variceal screening/surveillance with better patient comfort. Introduction Attempts in employing a simple technique of capsule endoscopy for visualisation of the upper GI tract has, thus far, been experimental, cumbersome and potentially expensive. We describe the first human series for comprehensive visualisation of the upper GI tract using the simple Intromedic MiroCam-Navi system. Our aim was to demonstrate the manoeuvrability of this magnetic capsule and evaluate its ability to completely visualise and maintain views in the upper GI tract. Methods 26 volunteers observed a 12 hr overnight fast. 30 mins before the examination volunteers drank a preparation mixture of 20 mg of maxalon syrup with simethicone and pronase. After capsule ingestion, volunteers were allowed sips of water during the procedure. The MiroCam-Navi magnet was placed at strategic points on the body surface and rotated to hold and manoeuvre the capsule. Control was assessed by moving and holding the capsule for 1 min to visualise each of the following stations: lower oesophagus, cardia, fundus, body, incisura, antrum and pylorus and also by traversing across the stomach and through the pylorus. Total procedure time was taken from the moment of ingestion of the capsule to either reaching the duodenum, or after attempting a maximum of 10mins to traverse the pylorus. All volunteers subsequently underwent a standard upper GI endoscopy within 3 days. Results Volunteers' median age was 38 yrs (range 26-45), median BMI 24.1 (range 19.4-38.2), median volume of water consumed 800 mls (range 200 mls-1500 mls) and median procedure time 24 min (range 12-39 min). Table 1 shows the success of clear visualisation of landmarks REFERENCEThe capsule could be held in the lower oesophagus, cardia, fundus, body and antrum in 92%, 88%, 92%, 88% and 81% occasions respectively. The capsule could be moved from the fundus to the antrum in all cases and traverse the pylorus in 50% (n = 13). Age ≥40 was associated with successful pyloric traversing (p = 0.04).There was positive concordance for 8 out of 9 minor pathological findings with standard upper GI endoscopy. A small 4 mm submucosal lesion was missed by capsule endoscopy in the cardia of one volunteer where views were obscured. Conclusion This is the first convincing demonstration of the potential value of MACE in the upper GI tract. There is a high degree of visualisation and control, with some improvement required for optimising fundal views and traversing the pylorus.

Novel use of Absorbable Modified Polymer (AMP®); EndoClot™ as an adjunct in the management of bleeding from the liver bed during laparoscopic cholecystectomy

“…Halkerston et al ( 2013 ) reported in a short case series of six patients treated with AMP as an adjunct in the management of upper gastrointestinal bleeding and colonic bleeding following endoscopic mucosal resection (EMR). Patel et al 2014 recently reported the safety and efficacy of AMP in 18 patients with a 89% (n = 16) success in achieving hemostasis. In their case series the upper intestinal bleeds (n = 16) were initially managed with adrenaline injections, clipping and diathermy whereas for the lower intestinal bleeds (n = 3), all following EMR, argon plasma coagulation was also utilized.…”

“…As bleeding occurred from the surface of the liver application of clips was not technically possible. Although AMP Endoclot™ has not been previously used at an intra-peritoneal site, there is evidence for safety of its use on raw surfaces as reported in EMR of colonic polyps (Halkerston et al 2013 ; Patel et al 2014 ). None of the case series in the literature has reported side effects with AMP usage.…”

“…Absorbable Modified Polymer (AMP®) is a polysaccharide which is sprayed on to a bleeding surface and acts by absorbing fluid and increasing the concentration of platelets, red blood cells and clotting factors at the site. Although short case series of using AMP in gastrointestinal bleeding are available (Halkerston et al 2013 ; Patel et al 2014 ) this is the first report of its intra-peritoneal use.…”