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Gangu K, Daglilar E, Chela HK. Stuck scope: Tackling the adherent scope situation after hemostatic powder application: A case report and review of literature. World J Gastrointest Endosc 2026; 18(11): 125797 [DOI: 10.4253/wjge.125797]
Karthik Gangu, Department of Internal Medicine, University of Kansas Medical Center, Kansas, KS 66160, United States
Ebubekir Daglilar, Harleen Kaur Chela, Department of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University School of Medicine, Charleston, WV 25304, United States
Author contributions: Gangu K performed the literature review and wrote the paper; Daglilar E and Chela HK performed the endoscopic procedure, collected the clinical data and critically revised the manuscript; all authors approved the final version.
AI contribution statement: We did not use AI.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Harleen Kaur Chela, Assistant Professor, Department of Gastroenterology and Hepatology, Charleston Area Medical Center, West Virginia University School of Medicine, 3110 MacCorkle Ave SE, Charleston, WV 25304, United States. harleen.chela@camc.org
Received: July 16, 2026 Revised: October 16, 2026 Accepted: November 6, 2026 Published online: November 16, 2026 Processing time: 120 Days and 6.6 Hours
Abstract
BACKGROUND
TC-325 (Hemospray) is a mineral-based hemostatic powder that is increasingly used for nonvariceal upper gastrointestinal bleeding, particularly diffuse or malignancy-related bleeding. Adhesion of the powder to the endoscope with inability to withdraw the instrument is a rare but potentially serious adverse event that prompted a manufacturer device-correction notice in 2023, and it has most often been reported when the powder is applied in retroflexion. Descriptions of how to free an entrapped endoscope remain limited.
CASE SUMMARY
An 84-year-old man with metastatic jejunal mucinous adenocarcinoma presented with hematemesis and a hemoglobin of 7.5 g/dL. Upper endoscopy with push enteroscopy identified a 3-cm cratered gastric body ulcer with stigmata of recent bleeding (Forrest class IIc) and the known obstructing jejunal tumor. TC-325 was applied to the ulcer with the endoscope in partial retroflexion. On attempted withdrawal the endoscope was fixed: Hydrated powder had coated the insertion tube and bonded it to the mucosa at the gastroesophageal junction. Water irrigation, viscous lidocaine, gentle torque and forceps clearance through the entrapped endoscope did not release it. A second ultrathin (XP) gastroscope was advanced alongside the entrapped endoscope, and biopsy forceps passed through the ultrathin scope were used to strip the adherent powder from the shaft under direct vision, after which the endoscope was withdrawn without resistance and without mucosal injury. The patient had no further clinically evident bleeding during the admission and was discharged to home hospice in accordance with his goals of care.
CONCLUSION
TC-325 applied in retroflexion can bond the endoscope to the mucosa. Early recognition, avoidance of forceful traction, irrigation, controlled de-retroflexion and, when these fail, rescue with a parallel ultrathin endoscope can free the instrument safely.
Core Tip: Gastrointestinal bleeding can be challenging to treat even in the most experienced hands. The modalities available to gastroenterologists for achieving hemostasis have expanded over the years, and this area continues to evolve. Hemostatic powders are one such valuable innovation; they have become widely popular and are often used. However, awareness of unique risks, such as failure to withdraw the endoscope because of mucosal adherence, and knowledge of how to prevent and overcome this challenge are crucial to continued use.
