A major problem in the endoscopic management of acute gastrointestinal bleeding (GIB) is the difficulty in identifying the bleeding source which may be obscured by overlying blood and clots. Traditionally, efforts at overcoming this problem have been aimed at techniques to remove blood either by lavage using large bore gastric tubes or by suction using large channel therapeutic endoscopes. A novel but simple option is to alter the characteristics of blood so that visibility is improved and clot dissolution facilitated. Hydrogen peroxide 3% (H2O2) is a safe oxidizing agent which causes oxidation of hemoglobin resulting in "loss of red" color leaving a relatively clear solution. Following in-vitro studies, we evaluated the safety and efficacy of H2O2 in a bleeding canine model. Methods: Male dogs (weight 25-30Kg) were anticoagulated with Heparin 10,000 units, and multiple biopsies taken at the body of the stomach to induce bleeding lesions. Blood was allowed to accumulate, H2O2 was then flushed through a 5Fr catheter and the blood immediately became translucent. The previously biopsied sites (source of bleeding) were then clearly visualized. Any resulting effervescence was disperse by simethicone. There was no mucosal damage observed endoscopically immediately and 24 hours later. Biopsies taken one hour later showed mild superficial gastritis. This pilot study demonstrates that H2O2 is safe to the gastric mucosa in dogs. H2O3 may have potential applications in the endoscopic management of GIB by improving visualization and clot dissolution. Studies are presently ongoing to evaluate the efficacies of H2O2 in the endoscopic approach to GIB.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging