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ASGE Postgraduate Course at ACG 2022: Expanding th ...
Q & A
Q & A
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Video Transcription
So, we have a few questions for our speakers. Perfect. We have a couple of questions for Dr. Barkun. One is, what do you recommend to do for clearance if erythromycin isn't available in your center? And the second one is, what do you do if you have a rebleed on someone who has a number of standard clips in place, in terms of Ovesco or what to do next? Okay. I'm not sure I heard the full second one. I'll start with the first one. So, the data on metoclopramide is not very good. There are two abstracts out there and a couple of other studies have been done. The best data is on erythro. You can try metoclopramide if you want to as well. Other than that, you just, you know, you have to deal with it more than that. I don't have any magic solution, I don't think, for you at this point in time. As such, you may have to take the patient back a second time after and do a second look again. Not a classic second look, but another look to see what the source of bleeding is. So, use your common sense, I think, as such. And in rare cases, you can consider doing NG tube. But the NG tube is so uncomfortable, increases the risk of aspiration and doesn't do much when you have a lot of clots, which is what we're talking about here. The second one was, I apologize, I didn't hear it properly. Oh, hemoclips in place. Okay. So, first of all, my rule of thumb is more than three hemoclips, you're in trouble. If by three hemoclips you haven't managed to treat the lesion, then the clip grabs another clip and it becomes a very quick siphon of annihilation as such. So, I usually try never to put more than three clips and try and use other things. If you have multiple clips in place, you're in trouble to a certain extent. I think you have to use your judgment. You don't have to worry about using a thermal because the clip, you're not going to burn, and the clip is there and you're going to burn at a distance because it does not conduct like that. So, that's not an issue. I think you have to use your judgment as such. And that may be a place where you may want to use an over-the-scope clip or just grab the whole thing and ball game over. But I do want to caution the end over-the-scope clip. This would be re-bleeding, so it would make sense. But many people don't know how to use the over-the-scope clip well. If you're in a duodenum, it can get very tricky and very busy and so on. And the data are not clear for primary closure. So, again, that's an important message because we all like shiny new objects and start using them right away. And it's not clear right now that it would be the role to play. But that's not directly related to that question. Thank you very much to the speakers and excellent audience questions. We are going to end this morning's session.
Video Summary
In this video, Dr. Barkun addresses questions related to clearance options when erythromycin is unavailable and managing rebleeding in patients with standard clips. He suggests that metoclopramide can be tried as an alternative to erythromycin, but the data is limited. If rebleeding occurs, a second look procedure may be necessary to identify the source of bleeding. The use of an NG tube is not recommended in cases with significant clotting. Multiple hemoclips can pose challenges, and Dr. Barkun advises against using more than three clips and suggests considering alternative approaches like thermal methods or over-the-scope clips. However, caution should be exercised with over-the-scope clips as their efficacy and use can be complicated. The video concludes by acknowledging valuable audience questions.
Keywords
erythromycin
metoclopramide
rebleeding
hemoclips
over-the-scope clips
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