Comparison of a Polysaccharide Hemostatic Powder and Conventional Therapy for Peptic Ulcer Bleeding

Jung, Da Hyun; Park, Chan-Hyuk; Choi, Soo In; Kim, Hye Rim; Lee, Myeongjee; Moon, Hee Seok; Park, Jun Chul

doi:10.1016/j.cgh.2023.02.031

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Although in our study most failed TTS clip cases were Forrest IIa peptic ulcers, which are not actively bleeding at the time of the index EGD, our definition of "successful initial hemostasis" is in line with previously published recommendations on methodology for RCTs on NVUGIB, stating that "prevention of further bleeding is the primary clinical goal in patients with NVUGIB" and that "therapy is required for patients with ulcers with active bleeding or nonbleeding visible vessels" [21]. Furthermore, the terminology of our outcome definition and our inclusion criteria are in keeping with recently published RCTs on endoscopic treatment of NVUGIB [15,16,25]. Most cases of unsuccessful hemostasis with TTS clips occurred either in fibrotic or posterior duodenal bulb wall peptic ulcers, both representing well-established issues for TTS clip application.…”

Section: Discussionmentioning

confidence: 58%

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study)

Soriani,

Biancheri,

Bonura

et al. 2024

Endoscopy

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Background: First-line over-the-scope-clip (OTSC) treatment has shown higher efficacy than standard endoscopic therapy in acute non-variceal upper gastrointestinal bleeding (UGIB) from different causes. We performed a head-to-head randomized controlled trial (RCT) comparing OTSC vs through-the-scope-clip (TTSC) as first-line mechanical treatment in the specific setting of peptic ulcer (PU) bleeding. Methods: We conducted an international, multicenter RCT on consecutive patients with suspected UGIB. In case of Forrest Ia-IIb gastroduodenal PU, patients were randomized 1:1 to OTSC or TTSC treatment. The primary outcome was the rate of 30-day rebleeding after successful initial hemostasis. Secondary outcomes included successful initial hemostasis and overall clinical success rates, defined as the composite of successful initial hemostasis and no evidence of 30-day rebleeding. Results: 251 patients were screened and 112 patients were finally randomized to OTSC (n=61) or TTSC (n=51) treatment. 30-day rebleeding rates were 1.6% (1/61) and 3.9% (2/51) for OTSC- and TTSC-treated patients, respectively (Kaplan-Meier log-rank, p = 0.458). Successful initial hemostasis rates were 98.4% (60/61) in the OTSC group and 78.4% (40/51) in the TTSC group (p=0.001). Eventually, overall clinical success rates were 96.7% (59/61) in the OTSC group and 74.5% (38/51) in the TTSC group (p=0.001). Conclusions: Low rates of 30-day rebleeding were observed after first-line endoscopic treatment of acute PU bleeding with either OTSC or TTSC. However, OTSC showed higher efficacy than TTSC in achieving successful initial hemostasis and overall clinical success.

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Section: Discussionmentioning

confidence: 58%

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study)

Soriani,

Biancheri,

Bonura

et al. 2024

Endoscopy

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“…Most available data on the transendoscopic application of polysaccharide‐based powders concerns peptic ulcer bleeding, for which haemostatic powder treatment is considered safe and effective (Alali et al., 2023). Having ulcers larger than 1.5 cm in diameter is considered a risk factor for rebleeding, however (Jung et al., 2023). Polysaccharide‐based powders also featured by less postoperative complications and infections compared to other haemostatic powders in two studies investigating their use in abdominal and pelvic surgery as well as cardiac implantable electronic device implantation (O'Hanlan & Bassett, 2022; Reynbakh et al., 2018).…”

Section: Discussionmentioning

confidence: 99%

Intraluminal administration of a carboxymethyl‐starch powder for bladder haemorrhage treatment in two adult horses

Memoli,

Fontana,

Basano

et al. 2024

Equine Veterinary Education

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SummaryInternal bleeding and mucosal bleeding in hollow organs are uncommon conditions in equine medicine and endoscopy. Most of the time, they respond to treatment of the underlying primary condition. However, there are cases in which a rapid and effective control of blood loss is required and the animal is not suited for surgery or general anaesthesia. We report two cases referred to our Veterinary Teaching Hospital with signs of urinary disease and bladder haemorrhage identified by cystoscopy which were successfully managed with topical application of a haemostatic carboxymethyl‐starch powder. The product was applied directly on the bleeding mucosa after bladder emptying either under endoscopic guidance or blindly, through a urinary catheter. The application of the haemostatic powder appears to be easy to perform, safe and helpful in controlling mucosal bleeding in hollow organs in a short time, with no adverse reactions noticed. This approach should be considered in cases where mucosal bleeding can be identified by endoscopy and a prompt control of blood loss is required, also in the field.

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“…Another commonly used hemostatic dressing is hemostatic powder, which has been clinically proven as an ideal engineering material for treating wounds and tissue [22].…”

Section: Introductionmentioning

confidence: 99%

Hydrogel-Transformable Antioxidant Poly-γ-Glutamic Acid/Polyethyleneimine Hemostatic Powder for Efficient Wound Hemostasis

Li,

Han,

et al. 2024

Gels

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Hemostatic powder, which can absorb large amounts of water and tends to produce repeated hydration with tissue, has been clinically proven as an ideal engineering material for treating wounds and tissues. We herein designed a polypeptide-based hemostatic powder. A water-soluble polypeptide, γ-polyglutamic acid (γ-PGA), was mixed with the polyethyleneimine (PEI), N-hydroxysuccinimide, and 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide. The solution of these polymers was lyophilized to harvest the γ-PGA/PEI powder (PP hemostatic powder). When deposited on a bleeding wound, the PP hemostatic powder can quickly absorb a large amount of blood and interstitial fluid, concentrate coagulation factors, coagulate blood cells, and eventually form a stable mechanical hydrogel. The wound bleeding time of the PP hemostatic powder group was 1.8 ± 0.4 min, significantly lower than that of the commercial chitosan hemostatic powder group (2.8 ± 0.4 min). The PP hemostatic powder was endowed with antioxidant capacity by introducing protocatechuic aldehyde, which can effectively inhibit inflammation and promote wound healing. Therefore, via preparation through a facile lyophilization method, the PP hemostatic powder is expected to find a wide application prospect as a qualified hemostatic powder.

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Comparison of a Polysaccharide Hemostatic Powder and Conventional Therapy for Peptic Ulcer Bleeding

Cited by 6 publications

References 20 publications

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study)

Over-the-scope clip as first-line treatment of peptic ulcer bleeding: a multicenter randomized controlled trial (TOP Study)

Intraluminal administration of a carboxymethyl‐starch powder for bladder haemorrhage treatment in two adult horses

Hydrogel-Transformable Antioxidant Poly-γ-Glutamic Acid/Polyethyleneimine Hemostatic Powder for Efficient Wound Hemostasis

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