What is the role of hemostatic powders in the treatment of upper gastrointestinal bleeding (UGIB)?

Updated: Aug 12, 2019
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Hemostatic powders are a novel technique. Thus, data are available data, but no randomized controlled trials evaluating this technique have been conducted yet. [144] These agents have primarily been used as a second-line option when other endoscopic hemostasis techniques have failed. In a literature review of several reported cases, a hemostatic powder spray (Hemospray) was successfully used for hemostasis in 88.5% of 234 cases of UGIB. [145]

The hemosprays have the advantage of excellent initial hemostasis, but they can also obscure the endoscopic views of the underlying lesion. Intuitively, as a purely topical agent, hemosprays would not have the durability of mechanical clips or thermal coactive techniques.

In a retrospective study (2013-2017) that evaluated the effectiveness of a hemospray (Hemospray) for managing diffuse or refractory UGIB in 52 patients treated for peptic ulcer bleeding (n = 18), postinterventional bleeding (n = 13), or other UGIB (n = 21), there was 100% efficacy without adverse effects related to therapy, with immediate hemostasis in 51 patients. [146] Twenty-two patients (43.1%) had recurrent bleeding within 3 days, with a 56.9% overall clinical success, and 25 patients had recurrent bleeding within 7 days (49%), with a 51% overall clinical success. In total, eight patients died (15.4%), two of which were related to bleeding (3.8%). Thus, although these findings indicate a high technical success of the hemospray for treating diffuse or refractory UGIB, the investigators acknowledge there was a high rebleeding risk and further investigation is needed. [146]


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