Efficacy of Topical Metal Polyacrylates for the Prevention and Treatment of Bleeding After Retrograde Cholangiopancreatography

Abstract

Relevance In recent years, local hemostatic agents have become widespread, as their application at the incision area of the major duodenal papilla can stop or prevent bleeding. Aim of study To study the efficacy of topical application of incomplete silver salt of polyacrylic acid (PAAg) (Haemoblock) for the prevention and treatment of bleeding from the papillosphincterotomy area.Material and methods The prospective study included 211 patients who were hospitalized at the Regional Clinical Hospital in Ryazan from 2020 to 2023. In the main group of patients, for the purpose of hemostasis and prevention of bleeding, the area of the dissected major duodenal papilla was irrigated with 20 ml of an aqueous solution of PAAg. In the control group, irrigation was carried out with 20 ml of 0.9% sodium chloride. The main group included 111 patients (44 men, 67 women, mean age 55.09±20.97), the control group included 100 patients (43 men, 57 women, average age 53.85±20.34).Results In the main group of patients, bleeding from the MDP incision was observed in 83 cases after papillosphincterotomy, and in 82 cases in the control group. After irrigation with an aqueous solution of PAAg, bleeding from the MDP incision was arrested within 120 seconds in the main group in 70 patients, and in 51 patients in the control group, after irrigation with 0.9% sodium chloride solution. Within 300 seconds from the initiation of irrigation, hemostasis occurred in 12 of the 13 remaining patients in the main group with ongoing bleeding and in 27 of 31 patients in the control group. In two patients in the control group, bleeding was managed in 300 seconds without additional methods of endoscopic hemostasis. The use of additional methods of endoscopic hemostasis due to ongoing bleeding in the main group was required in one patient; the incision area was injected with an adrenaline solution. In the control group, additional endoscopic hemostasis was performed on two patients: in one case, injection with an adrenaline solution, in the other, diathermocoagulation of the incision area of MDP. In the early postoperative period, delayed bleeding was detected in 3 patients of the main group, which was significantly lower than the same indicator in the control group (7 observations).Conclusions Local application of PAAg for the treatment of early bleeding in papillosphicterotomy showed a significantly faster onset of hemostasis.

Keywords

• metal polyacrylates
• endoscopic papillosphincterotomy
• endoscopic retrograde cholecyostopancreatography
• bleeding
• endoscopic hemostasis