The experience of minimally invasive – endoscopic methods used to stop bleeding in upper sections of the digestive system

Abstract

Introduction. Over the past decade, the number of minimally invasive surgical interventions both in the scheduled and urgent endoscopic surgery has increased significantly. With the development of modern video endoscopic systems, endoscopic surgical tools and accessories have been actively developing. A modern development is Hemosprey from Cook, which is certified and has been widely used in the countries of the European Union, Canada, and the USA since 2011. It is provided in the form of dry hemostatic glue of inorganic origin, which is endoscopically delivered with the help of aerosol. When the powder contacts with blood, it absorbs water and creates a gel that acts as a cohesive and adhesive by creating a stable mechanical barrier around the bleeding site. This methodology is not common in Ukraine, therefore we have made an attempt to study the efficiency of this drug in the regional hospital setting. The relevance of this issue is highlighted by the high morbidity among the population – an average number of people hospitalized with bleeding constitutes 1 per 1000 people. Depending on the etiological factor, the mortality rate is 3-50%. The general mortality rate in case of gastrointestinal bleeding constitutes 3.1% in Kyiv and 8.5% - generally in Ukraine. Among patients, the working-age population prevails. The aim. To study the efficiency of the method used to stop bleeding using Hemospray in the settings of endoscopic intervention. To research the efficiency of using hemostatic glue both as a mono-method and in combination with other endoscopic methods for endo-hemostasis of gastrointestinal bleeding. Materials and methods. The observed cohort included 7 patients (5 men, 2 women) aged 28-79 (average age - 52±7.1), who during the first stage received treatment at Lviv Regional clinical hospital, surgery department No. 3, surgery department No. 2, and during the second stage in 2018-2019 – at the gastroenterological department of Lviv Regional Clinical Hospital. Video endoscope Fujinone-250, clipping devices Hemoclips from Olympus, Hemosprey preparation for hemostasis, manufacturer – Cook. When the bleeding stopped, powder hemostasis was combined with clipping of the bleeding source upon the surgeon-endoscopist’s decision. Results. This endoscopic hemostasis using Hemospray resulted in the avoidance of urgent surgery and saved the lives of 7 patients both when used as a mono-method and when combined with endoscopic clipping with subsequent conservative therapy. None of the patients had recurrent bleeding. Patients had various etiology and causes of gastrointestinal bleeding. 100% of patients that were treated with the endoscopic hemostasis using Hemospray had a positive effect. Conclusions. Hemospray shows a high efficiency when it comes to stopping urgent bleeding from upper sections of the digestive system with the help of Hemospray both as a mono-method or in combination with other endoscopic methods. [ 1, 10]. Hemospray has the following key benefits over other endoscopic methods: non-thermal – there is no thermal contact with tissues, which makes it impossible for the high risk of complications to appear; non-traumatic – since no pressure is exerted to stop bleeding, the risk of tissue injury is reduced to zero; Contactless – aerosol delivery system presupposes the need for direct mechanical and contact force; safe – disposable cannulas that come as part of the kit – minimize the risk of infectious disease transmission when contacted with blood; Convenience and ease of use – the powder is used on the source of bleeding, therefore it does not require the in face approach and accurate targeting, which is especially important when working in hard-to-reach places [ 2, 4, 6].

Keywords

• video gastroscopy, gastrointestinal bleeding, endoscopic hemostasis, endoscopic methods used to stop bleeding, forrest qualification of bleeding, hemospray