CLINICAL EVALUATION OF EMERGENCY ENDOSCOPIC HEMOSTASIS WITH BIPOLAR FORCEPS IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

Abstract Background A new hemostatic adhesive powder (UI-EWD) has been developed to reduce the high re-bleeding rates associated with the currently available hemostatic powders. The current study aimed to assess the efficacy of UI-EWD as a salvage therapy for the treatment of refractory upper gastrointestinal bleeding (UGIB). Methods A total of 17 consecutive patients who had failed to achieve hemostasis with conventional endoscopic procedures and had undergone treatment with UI-EWD for endoscopic hemostasis in refractory UGIB were prospectively enrolled in the study. We evaluated the success rate of initial hemostasis and rate of re-bleeding within 30 days. Results All patients underwent successful UI-EWD application at the bleeding site. Initial hemostasis occurred in 16/17 patients (94 %). Re-bleeding within 30 days occurred in 3/16 patients (19 %) who had achieved initial hemostasis. In the second-look endoscopy after 24 hours, hydrogel from UI-EWD was found attached at the bleeding site in 11/16 patients (69 %). Conclusion UI-EWD has a high success rate for initial hemostasis in refractory UGIB and shows promising results in the prevention of re-bleeding.

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Endoscopic Hemostasis of Upper Gastrointestinal Bleeding with Histoacryl: Last Resort Before Surgery

Endoscopy ◽

10.1055/s-2007-1005439 ◽

1996 ◽

Vol 28 (02) ◽

pp. 256-258 ◽

Cited By ~ 9

Author(s):

K. Y. Y. Kok ◽

C. K. Kum ◽

P. M. Y. Goh

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Upper Gastrointestinal

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Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

Endoscopy International Open ◽

10.1055/s-0043-118794 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1159-E1164 ◽

Cited By ~ 11

Author(s):

Oscar Cahyadi ◽

Markus Bauder ◽

Benjamin Meier ◽

Karel Caca ◽

Arthur Schmidt

Keyword(s):

Gastrointestinal Bleeding ◽

Salvage Therapy ◽

Upper Gastrointestinal Bleeding ◽

Clinical Success ◽

Treatment Algorithm ◽

Endoscopic Hemostasis ◽

Ulcer Bleeding ◽

Recurrent Bleeding ◽

Technical Success ◽

Upper Gastrointestinal

Abstract Background and study aims TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a treatment algorithm for TC-325 use.

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The Role of Hemostatic Powder in Endoscopic Hemostasis of Nonvariceal Upper Gastrointestinal Bleeding

Annals of Internal Medicine ◽

10.7326/m21-4267 ◽

2021 ◽

Author(s):

Alan N. Barkun ◽

Ali Alali

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Hemostatic Powder ◽

Upper Gastrointestinal

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The management of the patient with non-variceal upper gastrointestinal bleeding: from evidence to clinical practice

Italian Journal of Medicine ◽

10.4081/itjm.2016.713 ◽

2016 ◽

Vol 11 ◽

Author(s):

Maddalena Zippi ◽

Mariella Frualdo ◽

Luciano Mucci ◽

Marta Zanon ◽

Chiara Marzano ◽

...

Keyword(s):

High Risk ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

High Dose ◽

Cardiovascular Risks ◽

High Risk Patients ◽

Epinephrine Injection ◽

Risk Patients ◽

Upper Gastrointestinal

A multidisciplinary group of 7 experts developed this update and expansion of the recommendations on the management of acute non-variceal upper gastrointestinal bleeding (NVUGIH) from guidelines published from 2013. The Appraisal of Guidelines for Research and Evaluation (AGREE) process and independent ethics protocols were used. Sources of data included original and published systematic reviews. Recommendations emphasize early risk stratification, by using validated prognostic scales, and early endoscopy (within 24 hours). Endoscopic hemostasis remains indicated for high-risk lesions, whereas data support attempts to dislodge clots with hemostatic, pharmacologic, or combination treatment of the underlying stigmata. Clips or thermo-coagulation, alone or with epinephrine injection, are effective methods. Second-look endoscopy may be useful in selected high-risk patients, but is not routinely recommended. Intravenous high-dose PPI therapy after successful endoscopic hemostasis decreases both rebleeding and mortality in patients with high-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 72 hours after endoscopic hemostasis. For patients with UGIH who require a nonsteroidal anti-inflammatory drug, a PPI is preferred to reduce the rebleeding. Patients with NVUGIH needing secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) again as soon as cardiovascular risks outweigh gastrointestinal risks (usually within 7 days).

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