Review
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Aug 15, 2014; 5(3): 284-292
Published online Aug 15, 2014. doi: 10.4291/wjgp.v5.i3.284
Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding
Marco Bustamante-Balén, Gema Plumé
Marco Bustamante-Balén, Digestive Endoscopy Unit, Gastroenterology Department, La Fe University Hospital, Valencia 46026, Spain
Gema Plumé, Valencian Institute of Pathology, Universidad Católica de Valencia, Calle Quevedo 2, Valencia 46001, Spain
Author contributions: Bustamante-Balén M and Plumé G designed the study, reviewed the literature, drafted and revised the manuscript and gave final approval of the version to be published; both authors contributed equally to this work.
Correspondence to: Marco Bustamante, MD, PhD, Digestive Endoscopy Unit, Gastroenterology Department, La Fe University Hospital, Avinguda Fernando Abril Martorell, no. 106, Valencia 46026, Spain. bustamante_mar@gva.es
Telephone: +34-67-6092456 Fax: +34-96-1622410
Received: April 1, 2014
Revised: May 16, 2014
Accepted: June 18, 2014
Published online: August 15, 2014
Abstract

Acute gastrointestinal bleeding (AGIB) is a prevalent condition with significant influence on healthcare costs. Endoscopy is essential for the management of AGIB with a pivotal role in diagnosis, risk stratification and management. Recently, hemostatic powders have been added to our endoscopic armamentarium to treat gastrointestinal (GI) bleeding. These substances are intended to control active bleeding by delivering a powdered product over the bleeding site that forms a solid matrix with a tamponade function. Local activation of platelet aggregation and coagulation cascade may be also boosted. There are currently three powders commercially available: hemostatic agent TC-325 (Hemospray®), EndoClot™ polysaccharide hemostatic system, and Ankaferd Bloodstopper®. Although the available evidence is based on short series of cases and there is no randomized controlled trial yet, these powders seem to be effective in controlling GI bleeding from a variety of origins with a very favorable side effects profile. They can be used either as a primary therapy or a second-line treatment, and they seem to be especially indicated in cases of cancer-related bleeding and lesions with difficult access. In this review, we will comment on the mechanism of action, efficacy, safety and technical challenges of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.

Keywords: Gastrointestinal hemorrhage, Endoscopy, Powders, Endoscopic hemostasis

Core tip: Hemostatic powders are a new endoscopic therapeutic modality for gastrointestinal bleeding. Based on their characteristics and mechanism of action, they may be very useful in controlling bleeding in some situations. In the last two years, a large number of studies, mainly short series of cases, have been published on this topic but their role in the management algorithm is not yet defined. In this review, we will comment on the efficacy and safety of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.