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Эндоскопия/Колопроктология
Methodical Approaches to Hemostasis with 1% Water Solution of Polyacrylic Acid Partial Silver Salt with Silver Nanoparticles in Bleedings after Endoscopic Polypectomy /Biopsy of Mucous Membrane and Polyps in Large Intestines
V.V. Veselov,
O.S. Ozerova,
S.N. Skridlevsky
Relevance

Different drug and mechanical endoscopic hemostasis techniques and their combinations intended to improve hemostasis reliability, reduce the bleeding relapse rate and the need for emergency surgeries are used now. The advanced developments, including the simplest treatment method of the bleeding regions, irrigation with hemostatic drugs, are relevant methods intended to improve the endoscopic hemostasis outcome
Materials and methods

The study included 22 bleeding instances, of which 9 occurred after biopsy of mucous membrane and polyps of large intestines (Group 1) and 13, after polypectomy (Group 2). For hemostasis, the bleeding wound was irrigated with 1% water solution of polyacrylic acid partial silver salt with silver nanoparticles. The hemostatis effect is achieved by creating a polyacrylic matrix structure containing albumin molecules, forming of a harm polymethacrylate film comprising several micro-layers, and its subsequent substitution with fibrin. The bleeding region was irrigated with the drug via a spray catheter inserted into the endoscope's forceps aperture. The need for additional endoscopic hemostasis methods to stop acute bleeding when administering 10 ml to 30 ml of the drug with 1 min to 2 min exposure was assessed. The comparative analysis of the drug efficiency in Group 1 and 2 of patients was conducted. The polypectomy method was taken into account in Group 2. The precise Fisher's variance ratio (bilateral) was used in statistical analysis.
Results

No allergic reactions were observed in either case. In Group 1, no additional endoscopic hemostasis methods were necessary to stop bleeding, the technique efficiency was 100%. In Group 2, additional hemostasis methods were used in 8 (61.53%) cases: clipping in 5 (38.46%) cases, clipping with coagulation with clip forceps, in 1 (7.69%) case, spark ball hemostasis, in 1 (7.69%) case and loop coagulation of the bleeding vessel, in 1 (7.69%) case. The comparative analysis suggested that additional endoscopic hemostatic methods (F=0.00552, p<0.05) were statistically more frequently administered in Group 2. The need for additional hemostasis did not depend on the polypectomy method: cold excision method (F=0.59207, p>0.05), one-stage electroexcision (F=0.55944, p>0.05) or fragment-by-fragment mucosectomy (F=0.19231, p>0.05). The visualization of the bleeding source and the wound defect boundaries was not affected in 8 (61.53%) cases (Group 2) that required additional hemostasis after initial drug irrigation, which enabled to administer additional hemostatic methods efficiently in 100% cases.
Conclusions

1 The technique of irrigating the wound with 10 ml to 30 ml of 1% water solution of polyacrylic acid partial silver salt with silver nanoparticles is a 100% efficient hemostasis method in biopsies of mucous membrane and polyps of large intestines.
2. The need for additional, endoscopic, hemostasis after the initial irrigation of the wound with 10 ml to 30 ml of 1% water solution of polyacrylic acid partial silver salt with silver nanoparticles for post-polypectomy hemostasis does not depend on the initial type of endoscopic intervention.
3. The initial wound irrigation with 10 ml to 30 ml of 1% water solution of polyacrylic acid partial silver salt with silver nanoparticles after polypectomy allows for clear visualization of the wound boundaries, the bleeding source and to perform additional hemostasis efficiently.