Stuck scope: Tackling the adherent scope situation after hemostatic powder application: A case report and review of literature

Table 1 Published reports of endoscope entrapment or retention attributed to TC-325 (Hemospray) adhesion, distinguishing full case reports from conference abstracts

Ref.	Report type	Hemostatic agent	Indication/bleeding source	How the scope became stuck	How it was freed/managed	Complications/outcome
Smith et al[19] and Smith et al[20]	Conference abstract (SEAL prospective registry interim data, n = 82), with the same two events reported in the subsequent full registry publication (n = 63)	TC-325	Nonvariceal upper GI bleeding (UGIB), various lesions	Endoscope became adherent to esophageal mucosa after application in retroflexion (2 patients)	Not detailed	Not detailed; listed as technical complications
Yii et al[21]	Full case report	TC-325 (Hemospray)	Bleeding gastric cardia malignancy (lymphoma)	Powder adhesion after application; endoscope retained at the gastroesophageal junction	Endoscope left in situ under intensive care and withdrawn after approximately 48 hours once the powder had sloughed	Prolonged retention (approximately 48 hours); mechanical ventilation/critical care
Shaikh and Parikh[22]	Conference abstract	TC-325	Bleeding of gastric cardia and fundus	Adhesion after retroflexed application; endoscope retained approximately 6 hours	Traction after transfer to a tertiary center	Scope freed; further outcome not detailed
Crowley[23]	Full case report (anesthesia journal)	TC-325	Oozing esophageal mass (nonvariceal UGIB; hemoglobin 6.1 g/dL)	Gastroscope could be neither advanced nor withdrawn after application and was found adherent to the esophagus; position of the gastroscope during spraying (retroflexion) not stated	Sedation stopped to protect the airway; fiberoptic video bronchoscope passed orally alongside the gastroscope, secretions suctioned and the adhesive dislodged from the gastroscope with gentle back-and-forth movements; freed in under 15 minutes	No complication; procedure completed; report written from the anesthesia (airway-management) perspective
Syed et al[24]	Full case report	TC-325	Bleeding gastric GIST near the gastroesophageal junction (fundus in the abstract; lesser curve in the case description), treated in retroflexion	Powder coated the scope at the gastroesophageal junction and adhered to mucosa	Torque maneuvering plus withdrawal force (described as moderate in the abstract and as significant in the case description)	Scope freed; no recognized injury, although the authors could not exclude tissue trauma from the force applied; started on imatinib
Edwards et al[25]	Full case report (pediatric)	TC-325	Pediatric upper GI bleeding (22-month-old)	Transient adhesion of the distal endoscope to the esophagus after diffuse application in retroflexion	Constant traction for several seconds with gentle side-to-side rotation; a second endoscope was considered but not feasible because of patient size	No esophageal trauma on re-intubation and no immediate or long-term adverse effects; normal repeat endoscopy at 3 months
Guzik et al[26]	Conference abstract	TC-325	Retained endoscope, case series (upper GI bleeding); number of patients not stated in abstract	Powder adhesion	Not detailed (conference abstract)	Not detailed
Echeverria et al[27]	Full case report	TC-325 (with PuraStat gel)	Gastric cardia/fundus AVMs (arteriovenous malformations), upper GI bleeding, INR 7 (retroflexion)	Powder adhesion after retroflexed application	Aggressive water irrigation; scope removed after 90 minutes	Prolonged retention (90 minutes); no further GI bleeding documented; lost to outpatient follow-up
Present case	Full case report	TC-325	Bleeding gastric body ulcer (partial retroflexion)	Insertion tube coated with hydrated powder and bonded to cardia/gastroesophageal junction mucosa after application in partial retroflexion	Irrigation, viscous lidocaine, torque and forceps through the entrapped scope failed; second ultrathin (XP) gastroscope advanced alongside and forceps used to clear the adherent powder under direct vision	Scope freed after 30 minutes; no mucosal injury; no clinically evident rebleeding during admission; discharged to hospice

INR: International normalized ratio; GI: Gastrointestinal.