- Case study
- Open Access
Novel use of Absorbable Modified Polymer (AMP®); EndoClot™ as an adjunct in the management of bleeding from the liver bed during laparoscopic cholecystectomy
© Chandrasinghe et al. 2015
- Received: 15 February 2015
- Accepted: 12 May 2015
- Published: 11 June 2015
Absorbable modified polymer (AMP) is a novel local haemostatic agent derived from a natural polysaccharide. Its safety and efficacy has been evaluated in upper and lower gastrointestinal bleeding without reported side effects. We report the safe use of AMP as an adjunct in the management of serious bleeding during laparoscopic cholecystectomy.
- Absorbable modified polymer
Serious intra-operative bleeding during laparoscopic cholecystectomy is rare with an incidence of less than 2% (Tuveri and Tuveri 2007; Marakis et al. 2007; Vagenas et al. 2006). The incidence is high in patients with liver disease, specifically, in cirrhosis with portal hypertension (Kaushik 2010). Absorbable Modified Polymer (AMP®) is a polysaccharide which is sprayed on to a bleeding surface and acts by absorbing fluid and increasing the concentration of platelets, red blood cells and clotting factors at the site. Although short case series of using AMP in gastrointestinal bleeding are available (Halkerston et al. 2013; Patel et al. 2014) this is the first report of its intra-peritoneal use.
AMP is a polysaccharide derived from natural sources (Endoclotplus 2014). The substance has no reaction with components of human blood but promotes clotting through a dehydrating mechanism increasing the concentration of clotting factors and cells at the site. The residual particles are lysed by amylase and glucoamylase and is completely cleared from the site within few hours to days (Endoclotplus 2014). Halkerston et al. (2013) reported in a short case series of six patients treated with AMP as an adjunct in the management of upper gastrointestinal bleeding and colonic bleeding following endoscopic mucosal resection (EMR). Patel et al. 2014 recently reported the safety and efficacy of AMP in 18 patients with a 89% (n = 16) success in achieving hemostasis. In their case series the upper intestinal bleeds (n = 16) were initially managed with adrenaline injections, clipping and diathermy whereas for the lower intestinal bleeds (n = 3), all following EMR, argon plasma coagulation was also utilized. In two patients who developed delayed hemorrhage, despite initial response to AMP, the authors found a gastro intestinal stromal tumour (1) and a Dieulafoy lesion (2), suggesting that use of Endoclot™ must be restricted to a facilitatory role and should not replace conventional attempts to achieve hemostasis. Our patient was a high-risk candidate for intraoperative bleeding due to existing liver failure. As bleeding occurred from the surface of the liver application of clips was not technically possible. Although AMP Endoclot™ has not been previously used at an intra-peritoneal site, there is evidence for safety of its use on raw surfaces as reported in EMR of colonic polyps (Halkerston et al. 2013; Patel et al. 2014). None of the case series in the literature has reported side effects with AMP usage.
PCC, KID and AD were actively involved in patient management, manuscript preparation and critical appraisal of the same. All authors read and approved the final manuscript.
We wish to thank the patient for consenting for the publication.
Compliance with ethical guidelines
Competing interests The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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