Endoscopic hemostatic powder spray: Current evidence and clinical applications

Table 1 Characteristics of commercially available and investigational hemostatic powders

	Composition	Mechanism of action	Delivery system	Biodegradability and clearance	Advantages	Limitations
TC-325 (Hemospray®)	Inert mineral powder	Absorbs liquid, concentrates clotting factors, and forms a mechanical barrier	High-pressure CO2 cartridge	Non-absorbable and excreted	Broad coverage; effective for diffuse bleeding	Perforation risk with high CO2 pressure; catheter clogging
EndoClot®	Absorbable modified polymer	Absorbs liquid and accelerates the physiological coagulation cascade	Air compressor	Absorbable and degrades within 3 days	Low delivery pressure	Slow spraying; catheter clogging
Ankaferd Blood Stopper®	Standardized plant extracts	RBC aggregation, largely independent of classic coagulation	Syringe via catheter	Absorbable and excreted	Plant-derived; animal data suggest anti-infective, wound-healing-promoting, and antitumor activity	Limited clinical evidence
UI-EWD (NexPowder™)	Oxidized dextran and amino acid derivative	Forms highly adhesive hydrogel upon hydration	Integrated low-pressure air pump	Non-absorbable; excreted in about 66 hours	Employing liquid coating technology via a fluidized bed granulator; strong adhesion and good durability	Evidence primarily from Korean cohorts
CEGP-003 (CG-Bio)	Absorbable macromolecule with EGF	Forms gel and releases EGF	Alto-shooter gun system	Absorbable	Combined hemostatic and wound-healing functions	Limited clinical evidence
Self-Propelling Thrombin Powder	CaCO3, thrombin, tranexamic acid	CO2-bubble propelled; activates coagulation	CO2 pump	Absorbable	Self-propelled; against blood flow; suitable for pulsatile bleeding	Just preclinical and early-stage research
Polysaccharide Hemostatic Powder	Plant starch and carboxymethyl chitosan	Absorbs liquid and activates intrinsic coagulation factors	Air compressor	Absorbable	Rapid hemostasis; simple operation	Catheter clogging reported

EGF: Epidermal growth factor; RBC: Red blood cell; CO₂: Carbon dioxide; CaCO₃: Calcium carbonate.