A new endoscopic spraying technique has been developed to control hemorrhage from the upper gastrointestinal tract by evaluating the efficacy of various blood clotting factors and by improving the spraying device. The results are follows:
1) Aprotinin, a proteolytic enzyme, inhibited fibrinolytic action of fresh gastric juice on fibrin clot in vitro. In a dog model of acute gastric bleeding, a significant reduction in bleeding time was accomplished by spraying thrombin together with fibrinogen or cryoprecipitate as compared to thrombin alone.
2) Fibrinogen dissolved in saline and thrombin dissolved in saline containing Aprotinin solution, were simultaneously sprayed under direct vision through the lumens of the 4-lumen tube placed in the biopsy channel of a fiberoptic endoscope. Hemostasis was successful in 38 of 43 patients, or 88%, showing upper gastrointestinal bleeding. The spraying technique following local injection of ethanol resulted in hemostasis in all or 8 patients with severe arterial bleeding from gastric ulcer.