Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy

Abstract

Background and study aims Despite use of various endoscopic therapies in patients with tumor-related bleeding, various rates of successful immediate hemostasis and short-term rebleeding have been reported. We aimed to evaluate preliminary results of use of the EndoClot polysaccharide hemostatic system (PHS) in patients with acute upper gastrointestinal bleeding (UGIB) from a gastric malignancy. Patients and methods We retrospectively analyzed data from a prospectively collected database of 12 patients with acute UGIB from a gastric malignancy who had been treated with EndoClot PHS. The EndoClot air compressor was used to propel 2 g of absorbable modified polymer particles onto the bleeding site. We checked successful immediate hemostasis, rebleeding events and mortality within 30 days. Results Twelve patients were enrolled in the study. The median patient age was 72.5 years (range, 57 – 89). The initial median hemoglobin level was 6.75 g/dL (range, 5.4 – 8.9). The median systolic blood pressure was 114 mmHg (range, 86 – 153). Eleven patients had advanced gastric cancer and one patient had a gastrointestinal stromal tumor. The lower body of the stomach was the most common tumor location (58.3 %), and the median tumor size was 40 mm (range, 15 – 100). Immediate hemostasis was achieved in all patients, and rebleeding developed in 2 of 12 patients (16 %), 3 and 5 days after treatment. There were no significant Endoclot PHS-related adverse events, and there was no all-cause mortality at 30 days after the intervention. Conclusions Endoclot PHS represents a new alternative, complementary, and promising therapy for patients with an acute UGIB from a gastric malignancy.

Hemostatic materials in non-variceal upper gastrointestinal hemorrhage

“…Park et al 10 by propensity score matching, compared to the conventional endoscopic methods, found that there were no significant differences from the immediate hemostasis success rate of the 30 patients treated with EndoClot nor the incidence of rebleeding rate after 7 and 30 days. 11,12 However, Singh et al 13 conducted a study of hemostatic materials showing that the hemostatic success of commercially available microporous polysaccharide hemispheres was much lower than that of bovine-derived gelatin particles.…”

Management of Bleeding from Unresectable Gastric Cancer

“…Literature searches were conducted in PubMed databases published in English for the period since 2013 using related key words, such as ‘GC’, ‘bleeding’ and ‘endoscopic’ (Figure 1). We found five recent studies reporting on the outcomes of endoscopic therapy (ET) for GC bleeding [4,9,10,11,12] (Table 1) and a review article [13]. Four of these five reports were retrospective studies using conventional hemostatic modalities [4,9,10,11], whereas one prospectively investigated the suitability of hemostatic powder application as an initial endoscopic treatment modality [12].…”

“…Previous studies reported a median overall survival (OS) and 30-day mortality rate of approximately 3–6 months and 0–22% after ET, respectively [4,9,10,11,12], although prognosis after ET depends on not only the efficacy of treatment but also tumor progression, the general condition, and concomitant therapy, such as chemotherapy and RT. Koh et al [9] found that the 30-day mortality rates in patients with successful and failed endoscopic hemostasis were 0% and 25.8%, respectively.…”

“…Two studies described the indications of ET for GC bleeding, as Forrest Ia, Ib, IIa, and IIb [10,11]. The Forrest classification in most cases of bleeding GC was shown to be Forrest I (61–100%) [9,10,11,12]. Among them, Forrest Ib in particular accounted for a large portion of endoscopic findings of stigmata.…”

“…Furthermore, recent studies have shown the utility of a topical spray using hemostatic agents for managing acute upper GI hemorrhage [12,15,16]. Kim et al [12] showed that initial hemostasis was successfully achieved using hemostatic powder (EndoClot polysaccharide hemostatic system) with or without conventional hemostatic modalities in all 12 patients with Forrest 1b bleeding from gastric malignancies. In addition, rebleeding occurred in only two cases (16%) without any adverse events, a rate that was lower than that obtained with conventional hemostatic modalities (28–41%) [4,10,11].…”