Hemostatic powder TC‐325 treatment of malignancy‐related upper gastrointestinal bleeds: International registry outcomes

Abstract

Background and Aim Upper gastrointestinal tumors account for 5% of upper gastrointestinal bleeds. These patients are challenging to treat due to the diffuse nature of the neoplastic bleeding lesions, high rebleeding rates, and significant transfusion requirements. TC‐325 (Cook Medical, North Carolina, USA) is a hemostatic powder for gastrointestinal bleeding. The aim of this study was to examine the outcomes of upper gastrointestinal bleeds secondary to tumors treated with Hemospray therapy. Methods Data were prospectively collected on the use of Hemospray from 17 centers. Hemospray was used during emergency endoscopy for upper gastrointestinal bleeds secondary to tumors at the discretion of the endoscopist as a monotherapy, dual therapy with standard hemostatic techniques, or rescue therapy. Results One hundred and five patients with upper gastrointestinal bleeds secondary to tumors were recruited. The median Blatchford score at baseline was 10 (interquartile range [IQR], 7–12). The median Rockall score was 8 (IQR, 7–9). Immediate hemostasis was achieved in 102/105 (97%) patients, 15% of patients had a 30‐day rebleed, 20% of patients died within 30 days (all‐cause mortality). There was a significant improvement in transfusion requirements following treatment (P < 0.001) when comparing the number of units transfused 3 weeks before and after treatment. The mean reduction was one unit per patient. Conclusions Hemospray achieved high rates of immediate hemostasis, with comparable rebleed rates following treatment of tumor‐related upper gastrointestinal bleeds. Hemospray helped in improving transfusion requirements in these patients. This allows for patient stabilization and bridges towards definitive surgery or radiotherapy to treat the underlying tumor.

Propensity score matching analysis to evaluate efficacy of polyethylene oxide adhesive on preventing delayed bleeding after gastric endoscopic submucosal dissection

“…As many have reported 22 – 25 , 28 , 30 , 31 , 39 , the noncontact powder application system is easy to use, and little experience or technical expertise is needed. From our experience, only 15–20 min of training is required before the first use of PEO.…”

“…In previous studies, its role in treating gastrointestinal bleeding has been proven valid 22 , 27 – 29 , especially when bleeding sites were located in difficult anatomical positions that conventional instruments could not reach 25 , 28 . Many studies have emphasized the short-term efficacy of haemostatic powder 23 , 25 , 27 , 28 , 31 ; in some cases with massive haemorrhage, haemostatic powder was efficacious as a bridge to surgery. Moreover, a newly published study, which enrolled patients with large lesions and antithrombotic users, demonstrated that EndoClot polysaccharide haemostatic powder (PHP) had a tendency to decrease delayed bleeding in the early postoperative phase in high-risk patients 30 .…”

“…Apart from research on PHP and its preliminary study 25 , 30 , the current clinical experience regarding haemostatic powder mainly focuses on the area of treating gastrointestinal bleeding 22 – 24 , 27 , 28 , 31 . To obtain further information, we conducted this multicentre retrospective study, with the intention of evaluating the efficacy of the newly designed polyethylene oxide (PEO) adhesive on the prevention of delayed bleeding.…”

A Case of Upper Gastrointestinal Bleeding Due to Metastatic High-Grade B-Cell Lymphoma Successfully Treated With Chemotherapy

“…In our case, endoscopic therapy was not pursued as the patient was hemodynamically stable with appropriate incrementation in hemoglobin levels following blood transfusion. If the patient had decompensated, we would have considered hemostatic powder application due to its high success rate in achieving initial hemostasis, although 30-day rebleeding rates remain as high as 15% [ 16 - 19 ]. There is also a risk of hemostatic powder spray obstructing the target lesion if rebleeding occurs, thereby making other endoscopic therapies difficult [ 13 , 20 ].…”

Obere nicht variköse gastrointestinale Blutung

“…[13]). Der Autor sieht einen Hauptnutzen vor allem in der Anwendung ▪ bei der diffusen Tumorblutung, da hier ein breitflächiges Nichtkontaktverfahren vorteilhaft ist [14], sowie ▪ bei aufgrund der Lokalisation (und ggf. auch der Untersucherexpertise) schlecht einseh-und einstellbarer Blutung (z.…”