Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1592
Peer-review started: December 25, 2018
First decision: February 21, 2019
Revised: March 6, 2019
Accepted: March 11, 2019
Article in press: March 12, 2019
Published online: April 7, 2019
Gastrointestinal (GI) bleeding is a common indication for endoscopy. For refractory cases, hemostatic powders (HP) represent “touch-free” agents.
To analyze short term (ST-within 72 h-) and long-term (LT-within 30 d-) success for achieving hemostasis with HP and to directly compare the two agents Hemospray (HS) and Endoclot (EC).
HP was applied in 154 consecutive patients (mean age 67 years) with GI bleeding. Patients were followed up for 1 mo (mean follow-up: 3.2 mo).
Majority of applications were in upper GI tract (89%) with following bleeding sources: peptic ulcer disease (35%), esophageal varices (7%), tumor bleeding (11.7%), reflux esophagitis (8.7%), diffuse bleeding and erosions (15.3%). Overall ST success was achieved in 125 patients (81%) and LT success in 81 patients (67%). Re-bleeding occurred in 27% of all patients. In 72 patients (47%), HP was applied as a salvage hemostatic therapy, here ST and LT success were 81% and 64%, with re-bleeding in 32%. As a primary hemostatic therapy, ST and LT success were 82% and 69%, with re-bleeding occurring in 22%. HS was more frequently applied for upper GI bleeding (P = 0.04)
Both HP allow for effective hemostasis with no differences in ST, LT success and re-bleeding.
Core tip: Hemostatic powders represent “touch-free” hemostatic agents for the treatment of gastrointestinal bleeding. Within this study, we analyzed the hemostatic efficacy of hemostatic powders as first line or salvage therapy in several clinical scenarios in a large cohort of prospectively included patients. As shown in our report, both hemostatic powders allow for excellent short term bleeding control while at the same time, long term efficacy over a period of 4 wk is maintained in a considerable amount of patients. No differences were observed between Hemospray and Endoclot in their hemostatic efficacy.