BLUTUNGEN Gastrointestinal bleeding. István Rácz, MD Petz Aladár County and Teaching Hospital Győr, Hungary - PDF

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BLUTUNGEN Gastrointestinal bleeding István Rácz, MD Petz Aladár County and Teaching Hospital Győr, Hungary Epidemiology Acute upper GI bleeding Ulcer bleeding: % / patients annually

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BLUTUNGEN Gastrointestinal bleeding István Rácz, MD Petz Aladár County and Teaching Hospital Győr, Hungary Epidemiology Acute upper GI bleeding Ulcer bleeding: % / patients annually Győr, Hungary UGIB pts. 148 in 2013 malignancy Malloryduodenitis unknown Weiss DU rare case oesophagitis erosive varices gastritis AGA data GU Endoscopic hemostasis indicated Ulcer bleeding Hemostatic methods Forrest Ia Forrest Ib Injection Forrest IIa Forrest IIb (?) Thermal Hemoclip Available endoscopic hemostatic methods (2013) Techniques ulcer tumor varix 1.) Injection (epinephrine-nacl) ) Thermo probe (HPU) ) Hemoclip ) Endo-loop ) Aethoxysclerol ) Band ligation ) Argon-plasma coag. (APC) ) Cyanoacrylate (Histoacryl) ) Fibrin glue (fibrinogen+thrombin) ) Oesophageal metal stent ) Over the scope clip (OVESCO) ) Hemospray + + - Available endoscopic hemostatic methods (2013) Techniques ulcer tumor varix 1.) Injection (epinephrine-nacl) ) Thermo probe (HPU) ) Hemoclip ) Endo-loop ) Aethoxysclerol ) Band ligation ) Argon-plasma coag. (APC) ) Cyanoacrylate (Histoacryl) ) Fibrin glue (fibrinogen+thrombin) ) Oesophageal metal stent ) Over the scope clip (OVESCO) ) Hemospray + + - rescue endoscopic therapy in 7 out of 100 pts (Forrest Ia,b or IIa) initial endo-rx (inj.+clipping or coag.) was failing multiple clips fixed by detechable snare sucess: all Gastric Varices Saurin SK et al. Hepatology 1992, 16, 1343 Gastro-oesophageal varices (GOV) GOV1 GOV2 IGV1 16% 8% 74% Isolated gastric varices (IGV) IGV2 2% N-butyl 2-cyanoacrylate (enbucrilate) (Histoacryl, add. Lipiodol, polymer. time 10 sec) bucrilate ocrilate, polymerisation time: sec gastric varices: well-established varix obliteration 70-90% rebleeding 30% secondary prophylaxis of bleeding primary prophylaxis for varices 10 mm EUS monitoring to find the main perforating feeding vein (Romero-Castro) Powder container CO 2 cartridge Single use - available with 7 or 10 Fr cathether What is Hemospray? Hemospray is a proprietary mineral blend powder developed specifically for endoscopic hemostasis. It contains no human or animal proteins or botanicals and has no known allergens. Hemospray is metabolically inert and deemed nontoxic, systemically or otherwise. How does Hemospray work? When Hemospray comes in contact with blood, the powder absorbs water, then acts both cohesively and adhesively, forming a mechanical barrier over the bleeding site. Studies & Publications Giday/Animal Study 2010 Sung/PU Study Acute Hemostasis: 19/20 patients No Recurrent Bleeding: 17/19 patients Procedural Adverse Events: None Device-related SAE: None Mortality/SAE at 30-day follow-up: None (20 patients) 2011 J. Clin. Gastroenterol 2013 Dec SEAL Product Evaluation Survey to Evaluate the Application of Hemospray in the Luminal Tract Objective: To gain clinical experience with Hemospray in Europe and Canada 97 patients Gastroduodenal ulceration 58% (n=41) Tumours 7% (n=5) Oesophageal ulceration 4% (n=3) Dieulafoy lesion 4% (n=3) Post EMR 3% (n=2) GAVE 3% (n=2) Other causes 21%(n=15). Hemospray indications (FDA) non-variceal acute upper GI bleeding lower GI bleeding (Canada) 12 tumor cases (1 pulsatile, 11 oozing bleeding) Hemospray application Immediate hemostasis in all 12 pts. after Hemospray (in 8 pts. first line treatment) Bleeding after esophageal EMR Bleeding after ampullary resection Endoscopic treatment of acute variceal hemorrhage using hemostatic powder TC-325: a prospective pilot study Ibrahim Mostafa et al. UEGW abstract 2013 Bi-centric prospective trial (Cairo-Brussels) Aim: to control acute oe. variceal bleeding Patients: 9 cirrhotic with variceal (oe/cardia) bleeding ITN narcosis Mean hemospray volume: 21 g/ pts. Results: Initial hemostasis: all No rebleeding, no mortality (15 days) 4 cases indications: - post-polypectomy bleeding - post-irradiation proctitis - anticoagulant, clopidogrel treatment successfull hemostasis in all cases CO 2 pressure 12 mmhg (1-2 cm) 55 mmhg! (in contact with the tissue) !!! Glasgow Cook policy: training programs Győr Győr Győr Own results: 75 year old female subcardial gastric cancer Endoscopic hemostatic therapy with hemospray Hemospray first conventional endoscopic hemostasis afterwords? Hemospray embolism? Hemospray in bleeding varices? Hemospray and surgery? Hemospray and endoscope damage? and?
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