Intro to Hemostasis
The most common cause of hospitalization due to GI disease
Bleeding
What is tamponade?
Applying to direct pressure
What is angiogenesis?
Formation new blood vessels/cells
Layers of tissue in the Colon
Mucosa, Submucosa, Muscularis, Serosa
"Hemostasis" means...
The process that stops bleeding
5 ways to stop a bleed
1. Mechanical
2. Thermal
3. Pharmacological
4. Topical treatment
5. Combination therapy
What part of the colon is most prone to delayed bleeds?
Right, ascending colon
What is closure?
- Unclear depth (risk of perf)
- Partial/full thickness defect
- Perforation or transmural resection
What percent of bleeds happen in the upper GI tract?
70-80%
How to deploy Boston Scientific clips
Snap, crackle, pop!
How long does angiogenesis take to occur?
~21 days
What feature of Mantis makes is helpful for closure?
Anchor prongs to grasp tissue
The 3 steps of hemostasis are...
Vasoconstriction, platelet aggregation, clot formation
Post polypectomy bleeds can occur ____ days after index procedure
~29 days
(Jensen, et al.)
Factors for delayed bleeds in the Colon
Increased polyp size, location, use of anticoagulants, NSAIDs
What is a full thickness defect?
A lesion that has migrated into the Muscularis
(Sydney Classification type III)
Most common cause of lower GI bleeds
Diverticular disease
How long do Resolution 360/Ultra/Mantis clips stay on?
~6-8 weeks
Avg cost of a delayed bleed from colonoscopy
$13k
Polypectomy v EMR v ESD
Polypectomy:
- Only on mucosal layer
- For lesions <20 mm
- Methods: Biopsy Forceps, Hot/Cold Snares
EMR:
- En bloc or piecemeal
- For large lesions confined to mucosa and submucosa
- No perceived risk of malignancy
- Methods: Lift and snare (lower GI), ligate (upper GI)
ESD:
- En bloc
- For large flat lesions >20mm confined to mucosa and submucosa
- Methods: Submucosal lift & dissection