New methodsClinical endoscopyEndoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study
Section snippets
Patients
Fourteen consecutive patients with known liver cirrhosis and suspected acute variceal bleeding originating from the esophagus up to the gastroesophageal (GE) junction consented to be included in the study. The ethics committees of Erasme University Hospital (B406201214760) and Theodor Bilharz Research Institute (TBRI-IRB01/13) approved the protocol, and the study was registered in clinicaltrials.gov under the number NCT01783899.
Hemostatic powder
TC-325 is a granular, mineral, nonabsorbable powder used for the
Results
Between January 2013 and March 2013, 14 patients with cirrhosis (13 patients after hepatitis C and 1 alcoholic patient) and a suspected first episode of AVB provided consent. Five were excluded (3 patients without acute bleeding and 2 patients with bleeding originating from duodenal varices) and 9 had confirmed AVB originating from the esophagus or the GE junction. Patient characteristics are summarized in Table 1. Endoscopy was performed with patients under sedation without endotracheal
Discussion
The current series shows that in cases of acute esophageal variceal bleeding, the endoscopic application of a hemostatic powder after a protocol requiring minimal expertise allows the bleeding to stop, the patient to stabilize, and additional therapy to be performed, if needed, under optimal conditions within the next 24 hours. Early management of AVB with hemostatic powder might therefore avoid failures or delay of acute hemostasis related to technical failures or to the lack of expert
References (9)
- et al.
Refractory acute variceal bleeding: what to do next?
Clin Liver Dis
(2010) - et al.
Use of the endoscopically applied hemostatic powder TC-325 in cancer-related upper GI hemorrhage: preliminary experience (with video)
Gastrointest Endosc
(2012) - et al.
In vitro examination of the effects of the hemostatic powder (Hemospray™) on coagulation and thrombus formation in humans [abstract]
Gastrointest Endosc
(2012) - et al.
Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis
Hepatology
(2007)
Cited by (49)
Experience with the use of a hemostatic powder in 152 patients undergoing urgent endoscopy for gastrointestinal bleeding
2021, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :The application was challenging in five cases (3.3%), due to difficult anatomy, scope position and/or obstruction of the catheter. Second, previous studies have reported on the efficacy of Hemospray® application in acute GIB [17–21]. The largest study to this day, published in 2019 by Alzoubaidi et al., included 314 patients.
High rate of re-bleeding after application of Hemospray for upper and lower gastrointestinal bleeds
2020, Digestive and Liver DiseaseEfficacy of hemostatic powders in upper gastrointestinal bleeding: A systematic review and meta-analysis
2019, Digestive and Liver DiseaseCitation Excerpt :The odds ratio for immediate hemostasis was 0.84 (0.06–11.47; p = 0.9), thus showing no difference between the two treatment regimens. The seven-day rebleeding rate was reported in 12 studies [13,15,16,18–20,24–29], (534 patients) as depicted in Fig. 3A. Rate of bleeding recurrence within seven days from the index procedure was 17.9% (10.3%–25.5%). The high heterogeneity observed (I2 = 83.4%) prevents to draw conclusions about this outcome.
Portal Hypertensive Bleeding
2019, Clinical Gastrointestinal EndoscopyNew Developments in Managing Variceal Bleeding
2018, GastroenterologyHemostatic powder for acute upper gastrointestinal bleeding: Recent research advances
2023, World Chinese Journal of Digestology
DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.
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