Aims and Methods Introduction Conclusions Results ...

Early Clinical Experience of Endoclot™ in the Treatment of Acute Gastro-Intestinal Bleeding

West Hertfordshire Hospitals NHS Trust

K. Halkerston , J. Evans , D. Ismail , S. Catnach, R. Chaudhary, M. Fullard , A. King, A. Leahy Watford General Hospital, West Hertfordshire Hospitals NHS Trust, United Kingdom

Results

Introduction EndoClot™ is a new novel haemostatic powder for the treatment of gastrointestinal bleeding. The Endoclot™ Polysaccharide Hemostatic System (PHS) is designed to be used as an adjunct haemostasis tool for the control of

Use in Endoscopy

EndoClot™ was used in a total of 6 patients, (5 men, 1 woman; aged between

A

B

C

D

49 and 83 years, mean age 68 years). In 2 patients, EndoClot™ was applied following endoscopic mucosal resection of a rectal polyp after bleeding was not

bleeding during emergency endoscopic interventions and procedures that

resolved with cautery. In a further 2 patients, EndoClot™ was applied over a

induce bleeding including: endoscopic mucosal resection (EMR), polypectomy

duodenal ulcer with endoscopic stigmata of recent haemorrhage when there

and biopsy. We report our initial experiences of EndoClot™ as an adjunct

was residual bleeding despite adrenaline injection and gold probe cautery.

haemostatic therapy for cases of gastrointestinal bleeding. This is the first UK In another patient, EndoClot™ was applied following clipping of a spurting

report of its endoscopic use.

vessel at the gastro-oesophageal junction (likely Mallory-Weiss tear). In these 5 patients, application of EndoClot™ resolved any continued bleeding. There was also no rebleeding within 14 days of the procedure, no mortality or major

Aims and Methods EndoClot™ was used as an adjunct therapy in the treatment of acute upper

adverse events.

gastrointstinal bleeding where a dual therapy (adrenaline injection, electrocautery or clip placement) had not controlled bleeding following a diagnostic or

A sixth patient had EndoClot™ applied to what was first thought to be a

therapeutic intervention.

duodenal ulcer with a probable vessel, when there was residual bleeding despite adrenaline injection and clip application (see photos). This patient was re-scoped

Up to 1g of AMP® (absorbable modified polymers) was applied in each patient

the following day after further bleeding and subsequent investigations

using the EndoClot™ air compressor and applicator (Figure 1).

confirmed a carcinoma of the pancreatic head with duodenal infiltration.

Sequential application of Endoclot TM. A and B) Duodenal ulcer with bleeding despite adrenaline injection and 2 x clip application. C) during Endoclot application. D) post application haemostasis.

Conclusions

Figure 1

EndoClot™ appears to be a safe and effective adjunct to existing therapies in the treatment of gastrointestinal bleeding. It may be particularly useful in case where EMR has caused more diffuse mucosal bleeding. Larger prospective studies are required to establish its exact role alongside established methods of haemostasis. References

AMP® 1,2,or 3g canisters

Air compressor

Delivery system

Applicator

1. Hemostatic system EndoClot PHS - http://www.youtube.com/watch?v=365IzL2YoF4. {Accessed 02.05.2013} 2. EndoClot ™ http://www.vitramed.com/EndoClot.aspx. {Accessed 02.05.2013} 56285_©Poster Design by Medical Illustration WHHT. 6/13