Multicenter Analysis of EndoClot as Hemostatic Powder in Different Endoscopic Settings of the Upper GI Tract

Hagel, Alexander; Raithel, Martin; Albrecht, Heinz; Hempen, Philipp; Preclik, G.; Dauth, Wolfgang; Neurath, Markus F.; Gschossmann, Juergen M.

doi:10.14309/00000434-201710001-00582

Cited by 2 publications

(5 citation statements)

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“…Multiple studies have demonstrated that the risk of rebleeding is highest within the first week following TC-325 application, likely due to sloughing off the protective seal, thus limiting its efficacy in high-risk lesions that are prone to rebleeding. Multiple prognosticators for rebleeding have been identified including high-risk stigmata (Forrest 1a lesion) 8 23 31 43 , use as salvage therapy 8 22 23 , and clinical indicators of more severe gastrointestinal bleeding such as syncope, hypotension, and higher Blatchford Score ( Table 3 ).…”

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%

“…Similar to TC-325, EndoClot has been applied to a variety of upper and lower gastrointestinal bleed settings, including malignant bleeding, peptic ulcer disease, varices, and radiation injury. As primary or secondary treatment, EndoClot has immediate hemostasis rates of 83 % to 100 % and recurrent bleeding rates of 11 % to 23 % 43 50 51 .…”

Section: Resultsmentioning

confidence: 99%

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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“…Overall, 59 studies were included (n = 3417 patients). Hemospray (TC-325) was the sole intervention in 44 studies 15 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 , EndoClot in five 65 66 67 68 69 , PuraStat in four 70 71 72 73 , Nexpowder in three 74 75 76 and CEGP-003 77 in one. In addition, two studies included both Hemospray and EndoClot 78 79 .…”

Section: Resultsmentioning

confidence: 99%

Section: Patient and Study Characteristicsmentioning

confidence: 99%

“…Overall, 59 studies were included (n = 3417 patients). Hemospray (TC-325) was the sole intervention in 44 studies [15,, EndoClot in five [65][66][67][68][69], PuraStat in four [70][71][72][73], Nexpowder in three [74][75][76] and CEGP-003 [77] in one. In addition, two studies included both Hemospray and EndoClot [78,79].…”

Section: Patient and Study Characteristicsmentioning

confidence: 99%

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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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Multicenter Analysis of EndoClot as Hemostatic Powder in Different Endoscopic Settings of the Upper GI Tract

Cited by 2 publications

References 0 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

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

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