The Role of Hemostatic Powder in Endoscopic Hemostasis of Nonvariceal Upper Gastrointestinal Bleeding

EditorialsFebruary 2022The Role of Hemostatic Powder in Endoscopic Hemostasis of Nonvariceal Upper Gastrointestinal BleedingAlan N. Barkun, MD, MSc, Ali Alali, MB BCh BAOAlan N. Barkun, MD, MScDivision of Gastroenterology, McGill University and McGill University Health Centre, Montreal, Quebec, CanadaSearch for more papers by this author, Ali Alali, MB BCh BAODepartment of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, KuwaitSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4267 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In their article, Lau and colleagues report a study that addresses an important issue in the management of patients with upper gastrointestinal bleeding: the effectiveness of the hemostatic powder TC-325 (Hemospray [Cook Medical]) in nonvariceal upper gastrointestinal bleeding, especially peptic ulcer hemorrhage (1). This randomized controlled trial (RCT) assessed a 1-sided noninferiority comparison of initial TC-325 monotherapy versus standard therapy (mainly endoscopic clipping or thermocoagulation) for bleeding from various causes. These included a greater proportion of tumors than is usually seen in studies about nonvariceal upper gastrointestinal bleeding. Three participating sites in Asia enrolled 224 patients (60.7% with gastroduodenal ulcers, ...References1. Lau JYW, Pittayanon R, Kwek A, et al. Comparison of a hemostatic powder and standard treatment in the control of active bleeding from upper nonvariceal lesions. A multicenter, noninferiority, randomized trial. Ann Intern Med. 2022;175:171-178. doi:10.7326/M21-0975 Google Scholar2. Barkun AN, Moosavi S, Martel M. Topical hemostatic agents: a systematic review with particular emphasis on endoscopic application in GI bleeding. Gastrointest Endosc. 2013;77:692-700. [PMID: 23582528] doi:10.1016/j.gie.2013.01.020 CrossrefMedlineGoogle Scholar3. Chahal D, Sidhu H, Zhao B, et al. Efficacy of Hemospray (TC-325) in the treatment of gastrointestinal bleeding: an updated systematic review and meta-analysis. J Clin Gastroenterol. 2021;55:492-8. [PMID: 34049382] doi:10.1097/MCG.0000000000001564 CrossrefMedlineGoogle Scholar4. Chen YI, Wyse J, Lu Y, et al. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc. 2020;91:321-328.e1. [PMID: 31437456] doi:10.1016/j.gie.2019.08.005 CrossrefMedlineGoogle Scholar5. Baracat FI, de Moura, Brunaldi VO, et al. Randomized controlled trial of hemostatic powder versus endoscopic clipping for non-variceal upper gastrointestinal bleeding. Surg Endosc. 2020;34:317-24. [PMID: 30927124] doi:10.1007/s00464-019-06769-z CrossrefMedlineGoogle Scholar6. Chen YI, Barkun A, Nolan S. Hemostatic powder TC-325 in the management of upper and lower gastrointestinal bleeding: a two-year experience at a single institution. Endoscopy. 2015;47:167-71. [PMID: 25264762] doi:10.1055/s-0034-1378098 CrossrefMedlineGoogle Scholar7. Barkun AN, Almadi M, Kuipers EJ, et al. Management of nonvariceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med. 2019;171:805-22. [PMID: 31634917] doi:10.7326/M19-1795 LinkGoogle Scholar8. Kwek BEA, Ang TL, Ong PLJ, et al. TC-325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high-risk bleeding stigmata: a randomized pilot study. J Dig Dis. 2017;18:323-9. [PMID: 28485544] doi:10.1111/1751-2980.12481 CrossrefMedlineGoogle Scholar9. Ofosu A, Ramai D, John F, et al. The efficacy and safety of Hemospray for the management of gastrointestinal bleeding: a systematic review and meta-analysis. J Clin Gastroenterol. 2021;55:e37-e45. [PMID: 33470608] doi:10.1097/MCG.0000000000001379 CrossrefMedlineGoogle Scholar10. Martins BDC, Corsato Scomparin R, Batista Pires C, et al. Preliminary results of a randomized controlled trial comparing hemostatic powder versus optimal clinical treatment in the management of gastrointestinal bleeding from malignancy. United European Gastroenterol J. 2019;8S:A175-A176. Google Scholar Author, Article, and Disclosure InformationAffiliations: Division of Gastroenterology, McGill University and McGill University Health Centre, Montreal, Quebec, CanadaDepartment of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, KuwaitDisclosures: The authors have reported no disclosures of interest. The forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4267.Corresponding Author: Alan N. Barkun, MD, MSc, Division of Gastroenterology, McGill University Health Centre, 1650 Cedar Avenue, Room D7-346, Montreal, QC H3G 1A4, Canada; e-mail, alan.[email protected]mcgill.ca.This article was published at Annals.org on 7 December 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal Lesions James Y.W. Lau , Rapat Pittayanon , Andrew Kwek , Raymond S. Tang , Heyson Chan , Rungsun Rerknimitr , June Lee , Tiing Leong Ang , Bing-Yee Suen , Yuan-yuan Yu , Francis K.L. Chan , and Joseph J.Y. Sung Metrics February 2022Volume 175, Issue 2Page: 289-290KeywordsEndoscopyEtiologyHemorrhageHemostasisPeptic ulcersUlcers ePublished: 7 December 2021 Issue Published: February 2022 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...