The electrosurgical unit was investigated by the manufacturer and found to be normal. In our case, we assume that the explosion was due to the presence of combustible gases inside the stomach. Conclusion: This is the first report of an iatrogenic explosion during interventional endoscopy in the upper gastrointestinal tract

(UGI) using APC. To prevent this devastating complication, we propose learn more a stepwise process during upper endoscopy with APC to minimize the risk of a gastric explosion. This stepwise process can be easily remembered with the mnemonic ‘APC’: A – aspirate, P – preinsufflate, C – coagulate. Firstly, all stomach contents and potential combustible gases should be Aspirated to fully deflate the stomach before contemplating electrosurgical procedures. Secondly, only CO2 and not air should

be used during Preinsufflation. This should reduce the concentration of oxygen and other combustible gases to safer levels and thereby prevent explosions. Only following the completion of steps A and P, should screening assay the third step, Coagulation, be conducted with minimal risk. 1. Manner H, Plum N, Pech O, Ell C, Enderle M: Colon explosion during argon plasma coagulation. Gastrointestinal Endoscopy 2008; 67: 1123–1127. 2. Raillat A, de Saint-Julien J, Abgrall J: Colonic explosion during an endoscopic electrocoagulation after preparation with mannitol. Gastroenterol Clin Biol. 1982; 6: 301–302. D ASHE, S PONNUSWAMY, A VANDELEUR, ENDOSCOPY NURSES

COLLABORATIVE (ENC), A KENNY, T RAHMAN, R HODGSON Department of Gastroenterology & Hepatology, The Prince Charles Hospital, MCE公司 Rode Road, Chermside, Brisbane, Queensland 4032 Introduction: The ENDOCLOT Polysaccharide Hemostatic System is designed as an adjunct hemostasis tool for use in complex sustained gastrointestinal bleeding. Plant starch is modified using AMP® technology to create biocompatible, absorbable hemostatic polysaccharides. The interaction of AMP® particles with blood rapidly creates a gelled matrix that adheres to and seals the bleeding tissue. Particles are ‘water hungry’ leading to absorption of water from blood, resulting in high concentration of platelets, and coagulation proteins facilitating the physiologic clotting cascade. The manufacturers delivery system requires an air compressor, which forces particles through a catheter inserted via an endoscope to the site of bleeding. Early experiences of prolonged complex endoscopy led to significant issues with the air compressor. This was thus modified to improve functionality, improved endoscopic visualization and patient comfort. This study examined experiences with ENDOCLOT and the carbon dioxide delivery system at The Prince Charles Hospital in complex acute severe upper gastrointestinal haemorrhage. Methods: We prospectively collected the data of the patients who needed ENDOCLOT and the modified carbon dioxide delivery system usage in the last 10 months.