Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Paoluzi, Omero Alessandro; Cardamone, Carla; Aucello, Antonio; Neri, Benedetto; Grasso, E.; Giannelli, M.; Iorio, Laura; Monteleone, Giovanni; Blanco, Giovanna Del Vecchio

doi:10.1080/00365521.2021.1974088

Cited by 6 publications

(17 citation statements)

References 25 publications

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“…TC-325 is the most studied and widely used hemostatic powder on the market, with studies on its clinical use in many settings of gastrointestinal bleeding ( Table 2 ). TC-325 has been successfully applied to many etiologies including peptic ulcer disease, malignant gastrointestinal bleeding, post-procedure gastrointestinal bleeding (endoscopic mucosal resection, sphincterotomy, ampullary resection, and polypectomy), variceal bleeding, portal hypertensive gastropathy/colopathy, and diverticular bleeding 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 . Of particular note is successful use in clinical scenarios not amenable to traditional endoscopic methods, such as malignant gastrointestinal bleeding with friable surfaces or diverticular bleeding.…”

Section: Resultsmentioning

confidence: 99%

“…Spray catheter occlusion has been reported in several studies. To prevent this, some operators utilize prolonged insufflation following blood aspiration to dry the working channel prior to powder application 40 .…”

Section: Resultsmentioning

confidence: 99%

“…Observational studies have shown that EndoClot had similar 30 day rebleeding rates compared to conventional treatment, in both primary and combination settings 49 54 . Studies comparing TC-325 and EndoClot have found similar rates of hemostasis and rebleeding, though research with larger sample sizes and randomized design are lacking 39 40 . Similar to TC-325, EndoClot also has limited residence time in the gastrointestinal tract, its application may be limited in lesions at high risk of rebleeding, as evidenced by high rates of recurrent bleeding in 24 to 72 hours.…”

Section: Resultsmentioning

confidence: 99%

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Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field

et al. 2022

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Background and study aims Hemostatic powders are increasingly used to address limitations in conventional endoscopic techniques for gastrointestinal bleeding. Various agents exist with different compositions, characteristics, efficacy, and adverse events (AEs). We sought to review existing hemostatic powders, from preclinical to established agents. Methods A literature review on hemostatic powders for gastrointestinal bleeding was undertaken through a MEDLINE search from 2000–2021 and hand searching of articles. Relevant literature was critically appraised and reviewed for mechanism of action, hemostasis and rebleeding rate, factors associated with hemostatic failure, and AEs. Results The most established agents are TC-325 (Hemospray), EndoClot, and Ankaferd Blood Stopper (ABS). These agents have been successfully applied to a variety of upper and lower gastrointestinal bleeding etiologies, in the form of primary, combination, salvage, and bridging therapy. Few AEs have been reported, including visceral perforation, venous embolism, and self-limited abdominal pain. Newer agents include CEGP-003 and UI-EWD, which have shown results similar to those for the older agents in initial clinical studies. All aforementioned powders have high immediate hemostasis rates, particularly in scenarios not amenable to conventional endoscopic methods, but are limited by significant rates of rebleeding. Other treatments include TDM-621 (PuraStat) consisting of a liquid hemostatic agent newly applied to endoscopy and self-propelling thrombin powder (CounterFlow Powder), a preclinical but promising agent. Conclusions Rapid development of hemostatic powders and growing clinical expertise has established these agents as a valuable strategy in gastrointestinal bleeding. Further research will continue to refine the efficacy and applicability of these agents.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field

et al. 2022

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“…During an emergency endoscopy with active GIB, it is necessary to aspirate blood from the lumen of the digestive tract, and the presence of blood in the working channel may determine the coagulation of HP, causing occlusion of the catheter. This issue may be overcome by a prolonged insufflation following blood aspiration to dry the working channel immediately before the spraying of HP [ 17 ]. Clogging seems to be infrequent (3.6%) with UI-EWD due to the system of delivery adopted [ 18 ].…”

Section: Type Modality Of Action and Application Of Hemostatic Powdermentioning

confidence: 99%

Hemostatic Powders in Non-Variceal Upper Gastrointestinal Bleeding: The Open Questions

et al. 2023

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Hemostatic powder (HP) is a relatively recent addition to the arsenal of hemostatic endoscopic procedures (HEPs) for gastrointestinal bleeding (GIB) due to benign and malignant lesions. Five types of HP are currently available: TC-325 (Hemospray™), EndoClot™, Ankaferd Blood Stopper®, and, more recently, UI-EWD (NexpowderTM) and CEGP-003 (CGBio™). HP acts as a mechanical barrier and/or promotes platelet activation and coagulation cascade. HP may be used in combination with or as rescue therapy in case of failure of conventional HEPs (CHEPs) and also as monotherapy in large, poorly accessible lesions with multiple bleeding sources. Although the literature on HP is abundant, randomized controlled trials are scant, and some questions remain open. While HP is highly effective in inducing immediate hemostasis in GIB, the rates of rebleeding reported in different studies are very variable, and conditions affecting the stability of hemostasis have not yet been fully elucidated. It is not established whether HP as monotherapy is appropriate in severe GIB, such as spurting peptic ulcers, or should be used only as rescue or adjunctive therapy. Finally, as it can be sprayed on large areas, HP could become the gold standard in malignancy-related GIB, which is often nonresponsive or not amenable to treatment with CHEPs as a result of multiple bleeding points and friable surfaces. This is a narrative review that provides an overview of currently available data and the open questions regarding the use of HP in the management of non-variceal upper GIB due to benign and malignant diseases.

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“…Nexpowder in three [74][75][76] and CEGP-003 [77] in one. In addition, two studies included both Hemospray and EndoClot [78,79]. Seven were RCTs, and 15 were prospective while 37 were retrospective cohort studies.…”

Section: Patient and Study Characteristicsmentioning

confidence: 99%

Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis

et al. 2022

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Background Novel topical hemostatic agents have shown promising results in treating patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, data are limited even in published meta-analyses as to their role, especially compared to conventional endoscopic approaches. The aim of this study was to perform a highly comprehensive systematic review assessing the effectiveness of topical hemostatic agents in UGIB in different clinical settings. Methods We performed a literature search of OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases through September 2021. Studies assessing the efficacy of topical hemostatic agents in UGIB were included. Primary outcomes were immediate hemostasis and overall rebleeding. Results A total of 980 citations were identified and 59 studies with a total of 3,417 patients were included in the analysis. Immediate hemostasis was achieved in 93% (91%; 94%), with similar results according to etiology (NVUGIB vs. variceal), topical agent used, or treatment strategy (primary vs. rescue). The overall rebleeding rate was 18% (15%; 21%) with the majority of rebleeds occurring in the first 7 days. Amongst comparative studies, topical agents achieved immediate hemostasis more often than standard endoscopic modalities (OR 3.94 (1.73; 8.96)), with non-different overall rebleeding risks (OR 1.06 (0.65; 1.74)). Adverse events occurred in 2% (1%; 3%). Study quality was overall low to very low. Conclusions Topical hemostatic agents are effective and safe in the management of UGIB with favorable outcomes when compared to conventional endoscopic modalities across a variety of bleeding etiologies. This is especially true in novel subgroup analyses that assessed immediate hemostasis and rebleeding amongst RCTs and in malignant bleeding. Due to methodological limitations of available data, additional studies are needed to more confidently ascertain their effectiveness in patients with UGIB.

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Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Cited by 6 publications

References 25 publications

Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field

Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field

Hemostatic Powders in Non-Variceal Upper Gastrointestinal Bleeding: The Open Questions

Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis

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