Nabi Zaheer, Inavolu Pradev, Goud Rajesh, Darisetty Santhosh, Reddy D Nageshwar
Asian Institute of Gastroenterology, Hyderabad, India.
VideoGIE. 2025 Mar 14;10(7):380-385. doi: 10.1016/j.vgie.2025.03.002. eCollection 2025 Jul.
Intraprocedural bleeding is a significant concern during third-space endoscopy, particularly in procedures like peroral endoscopic myotomy and endoscopic submucosal dissection. Although coagulation forceps can be used to effectively manage large blood vessels, their use necessitates frequent instrument exchanges, disrupting procedural flow and increasing costs. This review describes several distinct coagulation techniques to achieve coagulation without the need for hemostatic forceps.
The following coagulation techniques were used: noncontact coagulation (SprayCoag E 5.5), saline immersion coagulation (SprayCoag E 5.5), contact coagulation with low-dose energy (PreciseSect E 0.9-1) or retracted tip of knife (SwiftCoag E 4), microwave coagulation using a bipolar device (10 W), and application of a novel self-assembling peptide (PuraStat).
All the techniques effectively coagulated the blood vessels, with a low incidence of breakthrough bleeding and need for adjunctive hemostatic techniques reported. The transition from air to saline lowers impedance, thereby reducing voltage, which in turn diminishes the dissection effect while enhancing coagulation efficiency. The dissection power of SprayCoag and other coagulation modes (SwiftCoag or PreciseSect) could be adjusted by increasing the target distance or reducing the energy dose, respectively. Use of a novel bipolar device enables coagulation using microwave energy and application of self-assembling peptide gel minimizes the need for an electrosurgical unit for coagulation.
Several coagulation techniques effectively seal large blood vessels during submucosal dissection procedures, reducing reliance on hemostatic forceps. Further studies comparing these methods with conventional approaches are warranted to confirm their broader clinical applicability.
术中出血是经自然腔道内镜手术中的一个重要问题，尤其是在经口内镜下肌切开术和内镜黏膜下剥离术等手术中。尽管凝血钳可有效处理较大血管，但使用时需要频繁更换器械，这会扰乱手术流程并增加成本。本综述介绍了几种无需使用止血钳即可实现凝血的不同凝血技术。
采用了以下凝血技术：非接触式凝血（SprayCoag E 5.5）、盐水浸没凝血（SprayCoag E 5.5）、低剂量能量接触式凝血（PreciseSect E 0.9 - 1）或刀头回缩式凝血（SwiftCoag E 4）、使用双极装置的微波凝血（10 W）以及应用新型自组装肽（PuraStat）。
所有技术均能有效凝血血管，报告的突破性出血发生率和辅助止血技术需求较低。从空气切换到盐水会降低阻抗，从而降低电压，这反过来会减弱剥离效果，同时提高凝血效率。SprayCoag的剥离功率和其他凝血模式（SwiftCoag或PreciseSect）可分别通过增加目标距离或降低能量剂量来调整。使用新型双极装置可利用微波能量进行凝血，应用自组装肽凝胶可减少对电外科设备进行凝血的需求。
几种凝血技术在黏膜下剥离手术中能有效封闭大血管，减少对止血钳的依赖。有必要进一步开展将这些方法与传统方法进行比较的研究，以确认其更广泛的临床适用性。
