Elsevier

Gastrointestinal Endoscopy

Volume 78, Issue 5, November 2013, Pages 769-773
Gastrointestinal Endoscopy

New methods
Clinical endoscopy
Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study

https://doi.org/10.1016/j.gie.2013.07.037Get rights and content

Background

Current standard of care of acute variceal bleeding (AVB) combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. The latter may be challenging in an emergency setting with active bleeding that interferes with visualization.

Objective

To assess the effectiveness of a pre-established delivery protocol of a hemostatic powder to control AVB originating from the esophagus or the gastroesophageal junction.

Design

Prospective, 2-center study.

Setting

Two tertiary-care referral university hospitals.

Patients

Nine patients who received endoscopic hemostatic powder for actively bleeding varices.

Interventions

Endoscopic hemostasis.

Main Outcome Measurement

Primary hemostasis and rebleeding rates.

Results

Nine consecutive patients with confirmed AVB underwent treatment within 12 hours of hospital admission. Bleeding stopped during the endoscopy performed with application of 21 g of hemostatic powder from the cardia up to 15 cm above the gastroesophageal junction. No rebleeding was observed in any of the patients within 24 hours. No mortality was observed at 15-day follow-up.

Limitations

Small sample size.

Conclusion

Hemostatic powder has the potential to temporarily stop AVB. (Clinical trial registration number: NCT01783899.)

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)

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    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.

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    As reported in Table 1, most of the bleeding events were classified as oozing bleeding (Forrest Ib). Quality was deemed high in eight studies [12,14,18–20,25,27,34], and moderate or low in the other cases. Details on the methodological characteristics and quality of included articles are shown in Supplementary Table 1.

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    In severe peptic ulcer bleeding, it is often considered as a (temporary) salvage therapy.38 Hemospray was reported to be useful in emergency management of AVB as an added treatment modality to the medical management before definitive endotherapy, with no major adverse events or device-related mortalities.39 There is theoretical risk of gas embolization due to high-pressure gas delivery of the hemostatic agent to the bleeding site; however, the risk of embolization in this group of patients is most probably low because of the fact that the technique is a noncontact application with delivery pressure less than 15 mm Hg, that is, most often inferior to intravariceal pressure.40

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DISCLOSURE: The authors disclosed no financial relationships relevant to this publication.

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