Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Abstract

Background

Hemostatic powder (HP) in gastrointestinal bleeding (GIB) is mainly used as rescue therapy after failure of conventional hemostatic procedures (CHP).

Aim

To define the best field of application and the efficacy of HP as first choice monotherapy or rescue therapy.

Methods

We compared the efficacy of HP monotherapy, HP rescue therapy, and CHP in the management of active GIB due to neoplastic and non-neoplastic lesions.

Results

A total of 108 patients, 43 treated with HP as either first choice or rescue therapy and 65 with CHP, were included in the study. The most frequent sources of bleeding were peptic ulcer and malignancy. Immediate hemostasis rates were: HP monotherapy = 100% in peptic ulcer and 100% in malignancy; HP rescue therapy = 93.2% in peptic ulcer and 85.7% in malignancy; CHP = 77.9% in peptic ulcer and 41.7 in malignancy. Definitive hemostasis rates were: HP monotherapy = 50% in peptic ulcer and 45.5% in malignancy; HP rescue therapy = 73.3% in peptic ulcer and 85.7% in malignancy; CHP = 69.1% in peptic ulcer and 33.3% in malignancy. No difference was found in terms of additional intervention between the three groups.

Conclusions

HP is highly effective as monotherapy and rescue therapy in GIB. GIB related to malignancy may be the best field of application of HP, but confirmatory studies are necessary.

Keywords:

• Endoclot
• endoscopic hemostasis
• gastrointestinal bleeding
• hemospray
• hemostatic powders

Acknowledgments

This investigation was partially presented at the 27th United European Gastroenterology Week 2019, Barcelona, Spain, and accepted as oral presentation at ESGE Days 2020, Dublin, Ireland.

The authors thank all nursing staff of Gastroenterology Unit of the University Hostpital “Tor Vergata” for their cooperation in the research activities.

Disclosure statement

Drs. Omero Alessandro Paoluzi, Carla Cardamone, Antonio Aucello, Benedetto Neri, Enrico Grasso, Mario Giannelli, Laura Di Iorio, Giovanni Monteleone, and Giovanna Del Vecchio Blanco have no conflicts of interest or financial ties to disclose.