Hirokatsu Matsui

Endoscopic bipolar electrocoagulation in upper gastrointestinal bleeding

A new endoscopically deliverable bipolar electrocoagulator has been developed, and employed clinically to treat upper gastrointestinal bleeding in 53 patients on 61 occasions. By direct application of the electrode to the bleeding vessels immediate hemostasis was achieved in 52 out of 53 bleeding vessels. Non-bleeding visible vessels were safely coagulated. Arrest of bleeding was permanent in 44 patients (83%), of whom 20 were candidates for emergency operation because of massive, continued or recurrent bleeding. Rebleeding after hemostasis by bipolar electrocoagulation was noted in 8 patients (15%); however, the majority of rebleeds were those with acute mucosal lesions who had serious underlying medical problems. Emergency operation was performed in 5 patients, and was averted in most patients after successful hemostasis by bipolar electrocoagulation. There were no complications related to the procedure. Bipolar electrocoagulation with our coagulator is a safe and easily applicable technique that is a promising addition to currently available endoscopic hemostatic methods.

Endoscopic bipolar electrocoagulation: development of a new bipolar coagulator for stopping gastrointestinal bleeding.

SummaryWe have developed an endoscopically deliverable bipolar coagulator with a pair of active bipolar electrodes and tested its efficacy and safety in canine gastric bleeding models. Hemostasis was achieved with a few applications in all “ulcer maker”, gastric serosal vessel, mesenteric vessel and endoscopic “hot biopsy” models. Histologically the mean muscular injury was 10.1% in ulcer maker models and 17.1% in hot biopsy models, significantly less than monopolar electrodes. No full thickness injury resulted. Initial clinical trials in 32 patients with upper gastrointestinal bleeding revealed 100% immediate hemostasis; it could stop spurting arterial bleeding. Our bipolar coagulator is a promising addition to the endoscopic hemostatic methods.

Contact Methods of Endoscopic Laser Treatment

Since the endoscopic Nd-YAG laser treatment was developed by Kiefhaber, et. al.(l), this method, has spread widely as an endoscopic treatment of gastrointestinal tumors as well as bleeding. Recently, we developed endoscopic contact irradiation with Nd-YAG laser, a more effective and safer therapy for gastrointestinal tumors and bleedings. For this method two kinds of probes made of new ceramics (Al2O3) were developed (2,3). One is a cylindrically shaped “microtip”, through which contact irradiation by Nd-YAG laser was carried out for the coagulation of tumors and bleeding vessels. After the efficacy and safety of this probe were confirmed in the basic experiments using bovine liver sections, mouse transplantable tumor (colon 38) and canine gastric mucosa (4,5), this probe has been used effectively in clinical cases.