Use of the haemostatic agent TC-325 in the treatment of bleeding secondary to endoscopic retrograde cholangiopancreatography sphincterotomy

Appleby, VJ; Hutchinson, J.; Beckett, Cheryl; Moreea, Sulleman

doi:10.1093/qjmed/hcu135

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…Hemostatic powder and fibrin glue are other possible rescue therapies, but reported experience is extremely limited [241,242] and they cannot be routinely recommended.…”

Section: Recommendationmentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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Main Recommendations Prophylaxis 1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.Strong recommendation, moderate quality evidence. 2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).Strong recommendation, moderate quality evidence. 3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.Weak recommendation, moderate quality evidence. 4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.Strong recommendation, moderate quality evidence. 5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.Weak recommendation, moderate quality evidence. 6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.Weak recommendation, low quality evidence. Treatment 7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.Weak recommendation, low quality evidence. 8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.Weak recommendation, low quality evidence. 9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.Weak recommendation, low quality evidence.

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“…Hemostatic powder and fibrin glue are other possible rescue therapies, but reported experience is extremely limited [241,242] and they cannot be routinely recommended.…”

Section: Recommendationmentioning

confidence: 99%

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2019

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“…Other smaller studies have shown similar results 101, 102. Use of Hemospray for control of LGIB, early postoperative anastomotic bleeding, and postsphincterotomy bleeding has shown promise in case series and case reports 28, 103, 104, 105…”

Section: Outcomes Datamentioning

confidence: 76%

Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)

et al. 2019

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Background Endoscopic intervention is often the first line of therapy for GI nonvariceal bleeding. Although some of the devices and techniques used for this purpose have been well studied, others are relatively new, with few available outcomes data. Methods In this document, we review devices and techniques for endoscopic treatment of nonvariceal GI bleeding, the evidence regarding their efficacy and safety, and financial considerations for their use. Results Devices used for endoscopic hemostasis in the GI tract can be classified into injection devices (needles), thermal devices (multipolar/bipolar probes, hemostatic forceps, heater probe, argon plasma coagulation, radiofrequency ablation, and cryotherapy), mechanical devices (clips, suturing devices, banding devices, stents), and topical devices (hemostatic sprays). Conclusions Endoscopic evaluation and treatment remains a cornerstone in the management of nonvariceal upper- and lower-GI bleeding. A variety of devices is available for hemostasis of bleeding lesions in the GI tract. Other than injection therapy, which should not be used as monotherapy, there are few compelling data that strongly favor any one device over another. For endoscopists, the choice of a hemostatic device should depend on the type and location of the bleeding lesion, the availability of equipment and expertise, and the cost of the device.

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“…This treatment modality is available in Canada and Europe and was FDA approved in the United States in 2018. In a case of severe PEB, hemostasis was achieved through the application of 4 g of the hemostatic agent, with no evidence of secondary biliary obstruction (Appleby et al, 2015). The use of hemostatic nanopowder should be considered as a possible alternative to standard endoscopic therapy in cases where the position, site or size of the bleeding site makes conventional endoscopic therapy difficult.…”

Section: Hemostatic Nanopowder and Hemostatic Agentsmentioning

confidence: 99%

ERCP-Related Bleeding

Yıldırım¹

2021

J Exp Clin Med

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Clinically significant bleeding is an uncommon complication of diagnostic endoscopic retrograde cholangiopancreatography. But the endoscopists needs to be skilled at prevention and management. Post ERCP bleeding is most often seen following sphincterotomy. The overall risk of bleeding in patients undergoing sphincterotomy is approximately 1-2 percent. Most bleeding episodes are mild to moderate in severity. The risk of bleeding can be minimized by identifying patients at risk, correcting coagulation abnormalities and careful technique by skilled endoscopists in high-volume centers. Post-sphincterotomy bleeding often stops spontaneously and is rarely life-threatening, except in patients with a bleeding diathesis. Most clinically relevant bleedings can be managed with medical treatment and/or endoscopic therapy, which should be performed without delay in patients who have immediate bleeding. Endoscopic therapy options include epinephrine injection, hemostatic clips, thermal therapy and placement of full covered self-expandable metal stents. Angiography or surgery is usually reserved for patients with refractory bleeding and is rarely required.

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Use of the haemostatic agent TC-325 in the treatment of bleeding secondary to endoscopic retrograde cholangiopancreatography sphincterotomy

Cited by 8 publications

References 4 publications

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Devices for endoscopic hemostasis of nonvariceal GI bleeding (with videos)

ERCP-Related Bleeding

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