Multicenter analysis of endoclot as hemostatic powder in different endoscopic settings of the upper gastrointestinal tract.

Gastrointestinal bleeding (GIB) still presents a demanding situation with high morbidity and mortality rates; thus hemostatic powders such as EndoClot (EC) have been developed to improve endoscopic armament. The aim of the present study was to determine which indications triggered the application of EC and to assess resulting hemostasis rates. Forty three patients undergoing endoscopical procedures in three hospitals; two tertiary care and one university hospital, were included. EC was applied in 48 endoscopies in 43 patients (27 male, age 65.5 years, range 28 - 92 years) following four different indications. EC was used in active GIB as rescue or first-line therapy giving a short-term and long-term hemostasis in 13/17 patients (76.5%). In the setting of non-active GIB, following conventionally achieved hemostasis or endoscopic interventions, EC was found to prevent bleeding in 19/21 patients (90.4%). EC induced hemostasis in 8/10 patients (80%) with impaired coagulation. EC failures resulted from tumor bleeding, Forrest I lesions or perforated duodenal ulcers. No major adverse events were recorded and one technical failure (2.1%) occurred. EC was applied as first line or salvage treatment in ongoing bleedings with promising results. Furthermore, EC was used after successful hemostasis or following endoscopic interventions to further reduce re-bleeding rates. We saw promising results in all indications, albeit lacking a control group.

Involvement of stretch-sensitive calcium flux in mechanical transduction in visceral afferents.

The spinal and vagal visceral innervation to the gastrointestinal tract contains mechanosensitive afferents that are activated by contraction, distension of smooth muscle or movement in the receptive field. The mechanism by which free nerve endings detect changes in smooth muscle tension is not clear. The present study investigated the effects of mechanical stimulation on dorsal root ganglion neurons in vitro. Neurons were cultured using standard techniques and used in experiments after 24-72 h. Intracellular calcium [Ca2+]i was visualized using a video microscopic technique (Attoflour) in Fura-2 loaded neurons. DRG neurons innervating the stomach or colon were identified by the presence of a retrograde tracer, dextran-conjugated Texas Red, injected into the visceral wall 14-28 days previously. Increases in [Ca2+]i were measured in response to transient (0.5 s) mechanical stimulation of the cell soma using a flame polished probe. Approximately 25% of the whole population of DRG neurons (n = 199) were mechanosensitive, showing a transient rise in [Ca2+]i. In labeled afferents (n = 12), approximately 40% of neurons were mechanosensitive. The increase in [Ca2+]i in response to mechanical stimulation was reduced (100 microM) or abolished (250 microM) by superfusion with gadolinium or by removal of extracellular calcium. Cell somata of visceral spinal afferents show a stretch-sensitive calcium flux that may be involved in sensory transduction of mechanical stimuli that lead to autonomic and sensory reflexes.