Disposable Hemoclip

epinephrine underneath the clot in order to better remove it without risking immediate hemorrhage. In a second step, coagulation or mechanical hemostasis methods can be applied if necessary.

Injection of other agents. In addition to epinephrine, other agents, such as absolute alcohol, have also been used in injection therapy. The effect of these agents, however, is not superior to epinephrine and, moreover, they can cause mucosal ulcers and thus perforation. Sclerosing agents have been used for obliteration of angiodysplasias. Marwick and Kerlin (21) used 1.5% Sodium tetradecyl sulfate on angiodysplasias in the upper gastrointestinal tract. Bemvenuti and Julich reported on sclerotherapy of angiodysplasias with ethanolamine (2). Polido-canol (1 %) could also conceivably be used as a sclerosing agent. Injection therapy using sclerosing agents is less predictable than thermocoagulation making the latter preferable in our opinion.

Bleeding from rectal varices. Bleeding from rectal varices can often only be stopped by injection of a cyanoacrylate tissue glue (Histacryl, Glubran), similar to gastric fundus varices and esophageal varices (Fig. 20.21). Mucosal ulcers caused by ex-travascular injection can be problematic (Fig. 20.21 d) and can result in rebleeding and other problems. The equipment used is the same as for esophageal varices (Fig. 20.22). Only the use of Glubran is approved for this indication at least in Germany, though our own use of Histacryl for more than a decade mainly in the treatment of esophageal varices and gastric fundus var-

Acrylate Esophageal Varices

Fig. 20.22 Accessories for acrylic glue (Histacryl) therapy. Acrylic glue (Histacryl) vials, Lipiodol solution, an injection needle, and a disposable needle are required. It is important that all examiners and assistants wear protective glasses to prevent injury in case acrylic glue (Histacryl) accidentally spurts out of the injection needle. Lipiodol should be injected through the needle before and after the injection of acrylic glue (Histacryl).

Fig. 20.22 Accessories for acrylic glue (Histacryl) therapy. Acrylic glue (Histacryl) vials, Lipiodol solution, an injection needle, and a disposable needle are required. It is important that all examiners and assistants wear protective glasses to prevent injury in case acrylic glue (Histacryl) accidentally spurts out of the injection needle. Lipiodol should be injected through the needle before and after the injection of acrylic glue (Histacryl).

Olympus Hemoclip
Fig. 20.23 Hemoclip loaded on application device (Olympus) (image provided courtesy of Olympus).

Mechanical Methods

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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