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1.
Gastrointest Endosc Clin N Am ; 30(1): 1-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739956

RESUMO

The over-the-scope clip is a novel endoscopic tool developed for tissue compression in the gastrointestinal tract. It has already revolutionized the management of acute perforations and leaks. In the past decade, it has also increasingly been used for treatment of severe and/or refractory gastrointestinal hemorrhage. Available studies report high rates of primary hemostasis and rebleeding. This article provides an overview on available literature, potential indications, and technical aspects of hemostasis with over-the-scope clip.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Instrumentos Cirúrgicos , Endoscopia Gastrointestinal/métodos , Desenho de Equipamento , Hemostase Endoscópica/métodos , Humanos
2.
Gastrointest Endosc Clin N Am ; 30(1): 13-23, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739960

RESUMO

Endoscopic treatment of lower gastrointestinal bleeding can be challenging. This article reports on the use of the endoscopic clipping over the scope technique to treat acute severe lower gastrointestinal bleeding. In particular, it describes the approaches and outcomes of using the technique for acute severe bleeding in the colon and the anal transition zone. The following synopsis is the one that you supplied, but lightly copyedited. Please confirm OK. Please note that the synopsis will appear in PubMed: Endoscopic treatment of lower gastrointestinal bleeding can be challenging. This article reports on the use of the endoscopic clipping over the scope technique to treat acute severe lower gastrointestinal bleeding. In particular, it describes the approaches and outcomes of using the technique for acute severe bleeding in the colon and the anal transition zone.


Assuntos
Doenças do Ânus/cirurgia , Doenças do Colo/cirurgia , Endoscopia Gastrointestinal/instrumentação , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Instrumentos Cirúrgicos , Doença Aguda , Canal Anal/cirurgia , Colo/cirurgia , Endoscopia Gastrointestinal/métodos , Desenho de Equipamento , Hemostase Endoscópica/métodos , Humanos , Ligadura/instrumentação , Ligadura/métodos , Resultado do Tratamento
3.
Gastrointest Endosc Clin N Am ; 30(1): 91-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739969

RESUMO

Clipping over the scope (C-OTS) is a novel closure technique used for the treatment of nonvariceal gastrointestinal bleeding, especially for high-risk lesions. C-OTS devices cost more than clipping through the scope and thermal devices. The high upfront cost of C-OTS may pose a barrier to its use and the cost-effectiveness of C-OTS for peptic ulcer disease bleeding is unknown. Cost-effectiveness studies of C-OTS for peptic ulcer bleeding as both first-line and second-line therapy can provide the current estimate of the conditions in which the use of C-OTS is cost-effective and give insights of the determinants to the cost-effectiveness of C-OTS.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Hemostase Endoscópica/instrumentação , Úlcera Péptica Hemorrágica/cirurgia , Padrão de Cuidado/economia , Instrumentos Cirúrgicos/economia , Análise Custo-Benefício , Endoscopia Gastrointestinal/economia , Endoscopia Gastrointestinal/métodos , Desenho de Equipamento , Hemostase Endoscópica/economia , Hemostase Endoscópica/métodos , Humanos , Úlcera Péptica/economia , Úlcera Péptica/cirurgia , Úlcera Péptica Hemorrágica/economia , Recidiva
4.
BMC Gastroenterol ; 19(1): 225, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31870315

RESUMO

BACKGROUND: Conventional endoscopic treatments can't control bleeding in as many as 20% of patients with non-variceal gastrointestinal (GI) bleeding. Recent studies have shown that over-the-scope-clip (OTSC) system allowed for effective hemostasis for refractory GI bleeding lesions. So we aimed to conduct a systematic review to evaluate the effectiveness and safety of the OTSC system for management of acute non-variceal upper GI bleeding. METHOD: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 2007 to May 2019. The literature was selected independently by two reviewers according to the inclusion and exclusion criteria. The statistical analysis was carried out using Comprehensive Meta-Analysis software version 3.0. RESULTS: A total of 16 studies including 769 patients with 778 GI bleeding lesions were identified. Pooled technical success was achieved in 761 lesions [95.7%; 95% confidence interval (CI), 93.5-97.2%], and the pooled clinical success was achieved in 666 lesions (84.2, 95% CI, 77.4-89.2%). The incidence of re-bleeding was reported in 81 patients and the post-procedure mortality was 10.9% (n = 84). Only 2 (0.3%) patients occurred complications after OTSC system procedure. CONCLUSIONS: Our study demonstrated that the OTSC system was a technically feasible modality and highly efficacious in achieving hemostasis in acute non-variceal upper gastrointestinal bleeding.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Doença Aguda , Estudos de Viabilidade , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/efeitos adversos , Hemostase Endoscópica/instrumentação , Humanos , Viés de Publicação , Recidiva , Resultado do Tratamento
6.
Minerva Gastroenterol Dietol ; 65(1): 70-76, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30417630

RESUMO

INTRODUCTION: Endoscopic hemostasis in patients with non-variceal bleeding (NVGIB) with standard therapy has improved outcomes. However, persistent bleeding and re-bleeding continues to drive morbidity and mortality. Use of over-the-scope clips (OTSC) is an emerging treatment modality for managing gastrointestinal (GI) bleeding. We performed a systematic review and meta-analysis to evaluate the ability of OTSC to achieve primary hemostasis and re-bleeding rates as primary therapy and rescue endoscopic interventions in patients with NVGIB. EVIDENCE ACQUISITION: We searched articles in PubMed, Ovid Medline In- Process & Other Non-Indexed Citations, Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus from inception to July 2017 using keywords such as "OTSC" and "NVGIB." EVIDENCE SYNTHESIS: A total of 16 studies which involved 475 patients met the inclusion criteria. 288 patients were treated with OTSC as primary therapy while 187 patients were treated with OTSC as rescue therapy. Primary hemostasis rate achieved with primary endoscopic therapy with OTSC was 0.93 (95% CI: 0.89-0.96). Similarly, primary hemostasis rate achieved with rescue endoscopic therapy with OTSC was 0.91 (95% CI: 0.84-0.95). Re-bleeding rates after primary endoscopic therapy with OTSC was 0.21 (95% CI:0.08-0.43) and 0.25 (95% CI:0.17-0.34) with rescue therapy. There was a decreased risk of re-bleeding in patients treated with OTSC as primary therapy versus rescue therapy. RR=0.52 (95% CI: 0.31-0.89). CONCLUSIONS: This meta-analysis demonstrates success on the use of OTSC as primary and rescue therapy in the management of NVGIB. Further trials should clarify the ideal setting for the use of OTSC and assess the cost of these devices as compared to standard therapy.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/instrumentação , Humanos
7.
J Surg Res ; 234: 334-342, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30527494

RESUMO

BACKGROUND: Recently, atmospheric low-temperature plasma (LTP) has attracted attention as a novel medical tool that might be useful for achieving hemostasis. However, conventional plasma sources are too big for use with endoscopes, and the efficacy of LTP for achieving hemostasis in cases of gastrointestinal bleeding is difficult to investigate. In this study, to solve the problem, we developed a 3D-printed LTP jet that has a diameter of 2.8 mm and metal body for endoscopic use. The characteristics, hemostasis efficacy, and safety were investigated. MATERIALS AND METHODS: On investigating the basic characteristics of the developed plasma jet, the electron densities, gas temperatures, and reactive species were measured by emission spectroscopy and thermocouple. To evaluate the efficacy of such hemostatic treatment, porcine gastrointestinal bleeding was treated with the device. In addition, to investigate the safety of such treatment, the CO2 LTP-treated tissue was compared with tissue that was treated with clipping-based or argon plasma coagulation-based hemostasis for 5 d, and hematoxylin and eosin staining was used to evaluate tissue damage in the treated regions. RESULTS: The measurement of emission spectroscopy, power, and electron density of various gas plasmas suggested that a high-density (1014 cm-3) LTP of CO2 was generated by the LTP jet, and the gas temperature was 41.5°C at 3 mm from the outlet of the LTP jet. The CO2 LTP achieved hemostasis of oozing blood by 70 ± 20 s. In addition, the CO2 LTP resulted in earlier recovery than clipping-based or argon plasma coagulation-based hemostases, and the treated regions had no damage by the CO2 LTP treatment. CONCLUSIONS: These results indicated that the developed LTP plasma jet has the potential to be used for endoscopic hemostasis.


Assuntos
Dióxido de Carbono/uso terapêutico , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Hemostáticos/uso terapêutico , Gases em Plasma/uso terapêutico , Animais , Coagulação com Plasma de Argônio , Hemostase Endoscópica/instrumentação , Impressão Tridimensional , Suínos , Resultado do Tratamento
9.
Fed Regist ; 83(203): 52970-72, 2018 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-30358955

RESUMO

The Food and Drug Administration (FDA or we) is classifying the hemostatic device for intraluminal gastrointestinal use into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the hemostatic device for intraluminal gastrointestinal use's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.


Assuntos
Hemostase Endoscópica/classificação , Endoscopia Gastrointestinal/classificação , Endoscopia Gastrointestinal/instrumentação , Segurança de Equipamentos , Hemostase Endoscópica/instrumentação , Humanos
11.
Eur J Gastroenterol Hepatol ; 30(9): 995-996, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30048368

RESUMO

Dieulafoy lesions (DL) are abnormally large arterial lesions that fail to decrease in size as they emerge from the submucosa to the mucosal surface. Endoscopic treatment has become the mainstay of therapy for actively bleeding DL lesions. In this meta-analysis, we aim to assess the efficacy of both techniques in achieving primary hemostasis of actively bleeding DL lesions and their rates of rebleeding. Our search included the Pubmed, Scopus and CINAHL electronic databases. The initial search yielded 440 articles and after appropriate review by 2 individual reviewers, 5 studies met inclusion criteria. Review manager version 5.3 was used for statistical analysis. There were 75 patients treated with EBL and 87 patients treated with EHC. The success rate of primary hemostasis of EBL for bleeding DL lesions was 0.96 [95% confidence interval (CI): 0.88-0.99]. The success rate of primary hemostasis of EHC for bleeding DL lesions was 0.91 (95% CI: 0.83-0.96). The recurrence of bleeding for patients treated with EBL was 0.06 (95% CI: 0.02-0.15). The recurrence of bleeding for patients treated with EHC was 0.17 (95% CI: 0.10-0.28). There was no statistical significance in primary hemostasis or rebleeding in patients treated with EBL or EHC. There was no significant heterogeneity between studies included in the analysis. Endoscopic band ligation and endoscopic hemoclip placement are efficacious procedures for the treatment of NVUGIB secondary to DL with similar rates of primary hemostasis and rebleeding.


Assuntos
Malformações Arteriovenosas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Trato Gastrointestinal/irrigação sanguínea , Hemostase Endoscópica/instrumentação , Instrumentos Cirúrgicos , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico , Distribuição de Qui-Quadrado , Desenho de Equipamento , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/efeitos adversos , Humanos , Ligadura , Razão de Chances , Recidiva , Fatores de Risco , Resultado do Tratamento
12.
J Pediatr Gastroenterol Nutr ; 67(4): 458-463, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29927862

RESUMO

OBJECTIVE: There is little published experience with the use of over-the-scope clips (OTSCs) in pediatric patients. The aim of this study is to present our single-center experience utilizing OTSCs for nonvariceal gastrointestinal (GI) bleeding. METHODS: This is a retrospective case series of pediatric patients who underwent endoscopic management of GI bleeding during which OTSCs were used. RESULTS: Eleven cases of OTSC utilization for hemostasis were identified in 10 unique patients between November 2014 and May 2016. The median age at intervention was 14.7 years (range 3.9-16.8 years) and median weight was 39 kg (range 17.4-85.8 kg). Technical success and hemostasis were achieved in all cases and there were no complications. Median follow-up was 32.9 months (range 21.2-39.4 months). All nonanastomotic ulcers (4), polypectomy bleeding (2), and sphincterotomy bleeding (1) had no evidence of recurrent GI bleeding at last follow-up. Two patients with anastomotic ulcerations required additional medical interventions. CONCLUSIONS: Our series demonstrates the safety and effectiveness of the OTSCs in the pediatric population for acute GI bleeding throughout the GI tract. In our experience, it is effective for nonanastomotic ulcers, postpolypectomy bleeding, and postsphincterotomy bleeding even when other hemostatic techniques have failed. OTSCs may be less effective in the setting of anastomotic ulcerations, reaffirming the refractory nature of these lesions.


Assuntos
Endoscopia Gastrointestinal/instrumentação , Gastroenteropatias/complicações , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Instrumentos Cirúrgicos , Adolescente , Criança , Pré-Escolar , Endoscopia Gastrointestinal/métodos , Feminino , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/métodos , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
Gastrointest Endosc Clin N Am ; 28(3): 307-320, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29933777

RESUMO

Despite major improvements in endoscopic devices and therapeutic endoscopy, rebleeding rates and mortality have remained the same for several decades. Therefore, much interest has been paid to emerging therapeutic devices, such as the over-the-scope clip and hemostatic sprays. Other emerging technologies, such as radiofrequency ablation, endoscopic suturing devices, and ultrasound-guided angiotherapy, are also being investigated to improve therapeutic outcomes in specific situations. This narrative review details the technical aspects, clinical applications, outcomes, and potential limitations of these devices in the context of nonvariceal upper gastrointestinal hemorrhage.


Assuntos
Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Hemostáticos/uso terapêutico , Instrumentos Cirúrgicos , Ablação por Cateter/métodos , Hemostase Endoscópica/métodos , Hemostase Endoscópica/tendências , Humanos , Recidiva
14.
Gastrointest Endosc Clin N Am ; 28(3): 321-330, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29933778

RESUMO

This article examines use of the Doppler endoscopic probe (DEP) for risk stratification and as a guide to definitive hemostasis of nonvariceal upper gastrointestinal (NVUGI) bleeding and colonic diverticular hemorrhage. Studies report that lesions with high-risk stigmata of recent hemorrhage (SRH) have a higher rate of a positive DEP signal compared with those without such SRH. Lesions with a persistently positive DEP signal after endoscopic hemostasis have a higher 30-day rebleeding rate. Studies document arterial blood flow underneath stigmata of recent hemorrhage as a risk factor for rebleeding of focal nonvariceal gastrointestinal lesions. With DEP probe as a guide, rates of definitive endoscopic hemostasis and clinical outcomes are improved compared with standard visually guided treatment.


Assuntos
Endossonografia/métodos , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Ultrassonografia Doppler/métodos , Endossonografia/instrumentação , Trato Gastrointestinal/diagnóstico por imagem , Hemostase Endoscópica/instrumentação , Humanos , Ultrassonografia Doppler/instrumentação
15.
Gastroenterology ; 155(3): 674-686.e6, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29803838

RESUMO

BACKGROUND & AIMS: Endoscopic hemostasis is effective in treatment of bleeding peptic ulcers. However, rebleeding is difficult to treat and associated with substantial morbidity and mortality. We performed a prospective randomized trial to determine whether over-the-scope clips (OTSCs) are more effective than standard treatment of severe recurrent upper gastrointestinal bleeding. METHODS: We performed our study at 9 academic referral centers (in Germany, Switzerland, and Hong Kong) from March 2013 through September 2016. Adult patients with recurrent peptic ulcer bleeding following initially successful hemostasis (66 patients in the intent-to-treat analysis) were randomly assigned to groups (1:1) that underwent hemostasis with either OTSC or standard therapy. Standard therapy was defined as hemostasis with through-the-scope clips (TTSC, n = 31) or thermal therapy plus injection with diluted adrenaline (n = 2). The primary endpoint was further bleeding (a composite endpoint of a persistent bleeding despite endoscopic therapy according to the protocol or recurrent bleeding within 7 days after successful hemostasis). Patients with further bleeding were allowed to cross over to OTSC therapy. Main secondary endpoints were mortality, necessity of surgical or angiographic salvage therapy, duration of stay in the hospital or intensive care, number of blood units transfused, and complications associated with endoscopic therapy. RESULTS: Persistent bleeding after per-protocol hemostasis was observed in 14 patients (42.4%) in the standard therapy group and 2 patients (6.0%) in the OTSC group (P = .001). Recurrent bleeding within 7 days occurred in 5 patients (16.1%) in the standard therapy group vs 3 patients (9.1%) in the OTSC group (P = .468). Further bleeding occurred in 19 patients (57.6%) in the standard therapy group and in 5 patients (15.2%) in the OTSC group (absolute difference 42.4%; 95% confidence interval 21.6-63.2; P = .001) Within 30 days of follow-up, 1 patient in the standard therapy group (3.0%) and 1 patient in the OTSC group (3.0%) required surgical therapy (P = .999). Within 30 days of the procedure, 2 patients died in the standard therapy group (6.3%) and 4 patients died in the OTSC group (12.1%) (P = .672). There were no significant differences in the other secondary endpoints. CONCLUSIONS: In prospective randomized trial, we found endoscopic treatment with OTSCs to be superior to standard therapy with TTSCs for patients with recurrent peptic ulcer bleeding. STING Study, Clinicaltrials.gov no: NCT1836900.


Assuntos
Hemostase Endoscópica/instrumentação , Úlcera Péptica Hemorrágica/terapia , Instrumentos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemostase Endoscópica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Resultado do Tratamento
16.
Eur J Gastroenterol Hepatol ; 30(6): 626-630, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29505477

RESUMO

BACKGROUND AND AIM: Endoscopic treatment is widely accepted as the first-line therapy selection for esophageal variceal bleeding. Nevertheless, endoscopic injection sclerotherapy requires experienced endoscopists and is associated with a high risk of bleeding. Our study evaluates the feasibility and efficacy of transparent cap-assisted endoscopic sclerotherapy in the management of esophageal varices. PATIENTS AND METHODS: A randomized-controlled trial was conducted in a tertiary referral center from April 2015 to May 2016. Patients who received endoscopic sclerotherapy were randomized in a blinded manner into two groups: the transparent cap-assisted group (n=59) and the control group (n=61). RESULTS: The average injection sites were reduced in the transparent cap-assisted group compared with the control group (1.2±0.4 vs. 1.4±0.05, P=0.000), whereas no difference was observed in the dosage of lauromacrogol (16.97±4.91 vs. 16.85±4.57, P=0.662) and the hemorrhage that occurred during injection made no difference (50.8 vs. 61.0%, P=0.276); yet, salvage hemostasis methods were used in only nine patients in the transparent cap-assisted group compared with 17 patients in the control group (25.0 vs. 38.7%, P=0.0936). The cost of each procedure in the cap-assisted group was ¥2578 (1878-4202), whereas it was ¥3691 for the control group (2506-5791) (P=0.023). Moreover, in both groups, no esophageal constriction was observed during the 6-month follow-up period, whereas the rebleeding rate between two groups showed no statistical significance in 6 months (89.8 vs. 93.4%, P=0.563). CONCLUSION: Transparent cap-assisted sclerotherapy provided a clear field of vision and helped to fix the targeted veins, thus significantly reducing the use of the salvage hemostasis method during sclerotherapy injection hemorrhage. It is also associated with reduced injection sites and endoscopic therapy cost.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Esofagoscópios , Esofagoscopia/instrumentação , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/instrumentação , Polietilenoglicóis/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/instrumentação , China , Análise Custo-Benefício , Desenho de Equipamento , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/economia , Esofagoscópios/economia , Esofagoscopia/efeitos adversos , Esofagoscopia/economia , Estudos de Viabilidade , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/economia , Custos de Cuidados de Saúde , Hemostase Endoscópica/efeitos adversos , Hemostase Endoscópica/economia , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol , Polietilenoglicóis/efeitos adversos , Polietilenoglicóis/economia , Estudos Prospectivos , Recidiva , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/economia , Escleroterapia/efeitos adversos , Escleroterapia/economia , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
17.
J Clin Gastroenterol ; 52(4): 307-312, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29517984

RESUMO

BACKGROUND: To assess the safety and efficacy of the Instinct clip in the acute endoscopic treatment of upper gastrointestinal bleeding (UGIB). MATERIALS AND METHODS: This is the first large series reporting this clip in achieving hemostasis. A retrospective descriptive chart review was performed on patients presenting with recent overt GI bleeding treated with endoclip therapy at Mount Sinai Beth Israel Medical Center between May 2013 and January 2016. Results are expressed in absolute numbers, percentages, and trends. RESULTS: In total, 178 consecutive patients with UGIB were included. Source of bleeding was identified as duodenal ulcer (29.2%), gastric ulcer (22.5%), gastro-esophageal junction tear (8.4%), anastomosis (5.6%), erosive gastropathy (5.6%), Dieulafoy (5.1%), gastric polyp (4.5%), postendoscopic procedure (3.9%), angioectasia (3.4%), esophageal ulcer (2.8%), benign duodenal mass (2.8%), peg tube site (2.3%), gastric neoplasm (1.7%), esophagitis (1.1%), and small bowel ulcer (1.1%). Lesions demonstrated active bleeding in 47.5% (11.3% spurting and 36.2% oozing) and nonbleeding lesions in 52.5% (25.0% visible vessel, 11.9% hematin in ulcer base, 10.0% adherent clot, 5.6% flat spot). Initial hemostasis was achieved in 96.6%. Additional methods were used in 24.1% (argon plasma coagulation and epinephrine injection in 21.3%, surgery in 0.6%, and interventional radiology in 2.2%). There were no adverse events. In-hospital rebleeding was 7.3% and 3.9% presented with rebleeding within 30 days. Average procedure duration was 22.9 minutes and average length of hospital stay was 11.3 days. CONCLUSIONS: The Instinct clip, when used for UGIB, seems to be safe and effective with similar rebleeding rates compared with other modalities.


Assuntos
Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Úlcera Duodenal/cirurgia , Desenho de Equipamento , Feminino , Hospitais Universitários , Humanos , Masculino , Cidade de Nova Iorque , Segurança do Paciente , Úlcera Péptica Hemorrágica/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Úlcera Gástrica/cirurgia
18.
Surg Today ; 48(6): 649-655, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29453623

RESUMO

PURPOSES: Modern electrosurgical tools have a specific coagulation mode called "soft coagulation". However, soft coagulation has not been widely accepted for surgical operations. To optimize the soft coagulation environment, we developed a novel suction device integrated with an electrosurgical probe, called the "Suction ball coagulator" (SBC). In this study, we aimed to optimize the SBC design with a prototyping process involving a bench test and preclinical study; then, we aimed to demonstrate the feasibility, safety, and potential effectiveness of the SBC for laparoscopic surgery in clinical settings. METHODS: SBC prototyping was performed with a bench test. Device optimization was performed in a preclinical study with a domestic swine bleeding model. Then, SBC was tested in a clinical setting during 17 clinical laparoscopic colorectal surgeries. RESULTS: In the bench tests, two tip hole sizes and patterns showed a good suction capacity. The preclinical study indicated the best tip shape for accuracy. In clinical use, no device-related adverse event was observed. Moreover, the SBC was feasible for prompt hemostasis and blunt dissections. In addition, SBC could evacuate vapors generated by tissue ablation using electroprobe during laparoscopic surgery. CONCLUSIONS: We successfully developed a novel, integrated suction/coagulation probe for hemostasis and commercialized it.


Assuntos
Eletrocoagulação/instrumentação , Desenho de Equipamento , Hemostase Endoscópica/instrumentação , Animais , Cirurgia Colorretal/instrumentação , Modelos Animais de Doenças , Estudos de Viabilidade , Feminino , Hemorragia/cirurgia , Humanos , Laparoscopia , Suínos
19.
Dig Liver Dis ; 50(4): 360-365, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29398415

RESUMO

BACKGROUND: Subepithelial tumors (SETs) originating from the muscularis propria layer are unlikely to be resected completely and safely. We developed the Forcep Strip Method (FSM) for the resection of SETs in the stomach. AIMS: This study aimed to evaluate the feasibility and safety of the FSM. METHODS: Endoscopic SET resection using electrical forceps was performed in 11 consecutive patients with clinical indications for lesion removal. Following injection around the tumor, the adjacent mucosa or submucosa was grasped with the hot forceps and pulled away to form a "tent". The tumor was dissected from the muscularis propria layer and carefully removed using coagulating forceps. RESULTS: The FSM was successful in 10 of the 11 patients in the series; one patient required surgery due to respiratory depression during the procedure. The complete resection rate was 100% and no major complications including bleeding and perforation occurred. Mean procedure time was 39.3 ±â€¯14.7 min, mean hospitalization time was 5.0 ±â€¯1.2 days, and mean tumor size was 17.1 ±â€¯4.7 mm. CONCLUSION: FSM was found to be an easy, safe, and effective procedure for the treatment of gastric SETs originating from the muscularis propria layer.


Assuntos
Ressecção Endoscópica de Mucosa/instrumentação , Mucosa Gástrica/cirurgia , Neoplasias Gástricas/cirurgia , Idoso , Eletrocirurgia/métodos , Ressecção Endoscópica de Mucosa/métodos , Estudos de Viabilidade , Feminino , Mucosa Gástrica/patologia , Hemostase Endoscópica/instrumentação , Hemostase Endoscópica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Neoplasias Gástricas/patologia
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