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
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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 :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.
Portal Hypertensive Bleeding
2019, Clinical Gastrointestinal EndoscopyNew Developments in Managing Variceal Bleeding
2018, GastroenterologyCitation Excerpt :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
Hemostatic 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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