Becker's ASC Review

20 EXECUTIVE BRIEFING 1 EXECUTIVE BRIEFING The volume and variety of procedures performed in ambulatory surgery centers (ASCs) is on the rise. Among Medicare-certified, single-specialty ASCs, endoscopy is the most common focus, and more than one-third (37%) 1 of certified multi-specialty ASCs have an endoscopy service line. Patient volumes for endoscopy are only expected to grow, especially since the U.S. Preventive Services Task Force now recommends adults begin colorectal cancer screening at age 45 2 . However, gastrointestinal bleeding is a serious challenge during endoscopic procedures, involving considerable mortality between 2% and 10% 3 , as well as high management costs. For ASC physicians who may experience a bleed during a colonoscopy or polypectomy, Olympus offers several solutions to help better manage patient outcomes, costs and efficiencies. To learn more about the risks and challenges associated with endoscopic procedures and the benefits that Olympus provides, Becker's Healthcare recently spoke with three experts: Robert Barrett, Senior Product Manager, Core GI Procedures, and Christian Stroupe, Marketing Director, Core GI Therapeutics, both from Olympus Corporation of the Americas; and Ahmed Saeed, MD, Gastroenterologist, HCA Midwest Health in Kansas City, Mo. Hemostasis during endoscopic procedures is now fast and easy with tech Olympus has developed an innovative, two-step solution that may enable physicians to quickly identify and control gastrointestinal bleeding. The Olympus EVIS X1 TM endoscopy system includes an imaging mode called Red Dichromatic Imaging (RDI TM ) technology, which improves the visibility of bleeding points within the mucosa and enhances the visibility of deep blood vessels compared to white light 4 . Once a bleeding point has been identified, physicians can then use Olympus' EndoClot® Polysaccharide Hemostatic System (PHS) — an advanced powder hemostatic agent — to control it. Typically, physicians use white light for inspection during endoscopic procedures. The Olympus CV-1500 video system center has five LEDs — violet, blue, green, amber and red — which together create white light. For RDI technology, the red, green and amber LEDs are turned on in continuous sequence. Red and amber light penetrate deeply into human mucosal tissue, compared to the shorter wavelength of blue light," Mr. Barrett said. "This allows physicians to see underlying, deep blood vessels more clearly. Amber light is also highly absorbed by hemoglobin, so RDI technology provides increased contrast between blood, which contains hemoglobin, and the surrounding mucosa, which doesn't." If an active bleed occurs during an endoscopic procedure, there's a high concentration of blood and hemoglobin compared to the surrounding areas. With RDI™ technology, the bleeding point appears darker to the clinician. RDI technology can also be used proactively during endoscopic procedures to minimize large bleeds. With RDI technology, physicians can assess the area around lesions in the colon before making incisions, resections or snaring to confirm there are no underlying blood vessels that could introduce significant bleeding. According to Dr. Saeed, RDI technology can be utilized to identify exposed blood vessels at the base of a resection site. "It's quick and effective in pinpointing blood vessels that need to be pre-treated with coagulation, whether closure is planned or not. It also can efficiently localize actively bleeding vessels in a resection site to treat with coagulation," Dr. Saeed said. Once a bleed is detected using RDI technology, EndoClot® PHS can be applied to control gastrointestinal bleeding in the lumen. According to Mr. Stroupe, EndoClot PHS is a powder-based hemostatic agent that is applied endoscopically through a catheter. Once the powder comes in contact with the blood, it absorbs the water from the bleeding site and accelerates the clotting cascade with red blood cells and platelets. "Many physicians use EndoClot PHS for post-polypectomy bleeds, peptic ulcer bleeds and even malignant tumor bleeds," Mr. Stroupe said. "It allows them to intervene quickly and efficiently and may reduce the need for mechanical interventions like clips as well." This gives physicians greater flexibility with the application of hemostasis interventions. Although the ASC setting is typically used for less complex procedures like screening and surveillance colonoscopy, Dr. Saeed mentions that he still does find large polypectomies and endoscopic mucosal resections. "EndoClot PHS can be used on its own or as an adjunct technique for hemostasis and applied to control bleeding after a large polypectomy or endoscopic mucosal resection when conventional techniques like clips fail or are difficult to apply," Dr. Saeed said. "It's safe to apply and can add efficiency when conventional hemostasis techniques fail." Managing GI bleeding in the ASC: How tech is driving efficiency + safety for endoscopy

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