Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy
submitted 27 August 2017
accepted after revision 03 January 2018
25 May 2018 (online)
Background and study aims Despite use of various endoscopic therapies in patients with tumor-related bleeding, various rates of successful immediate hemostasis and short-term rebleeding have been reported. We aimed to evaluate preliminary results of use of the EndoClot polysaccharide hemostatic system (PHS) in patients with acute upper gastrointestinal bleeding (UGIB) from a gastric malignancy.
Patients and methods We retrospectively analyzed data from a prospectively collected database of 12 patients with acute UGIB from a gastric malignancy who had been treated with EndoClot PHS. The EndoClot air compressor was used to propel 2 g of absorbable modified polymer particles onto the bleeding site. We checked successful immediate hemostasis, rebleeding events and mortality within 30 days.
Results Twelve patients were enrolled in the study. The median patient age was 72.5 years (range, 57 – 89). The initial median hemoglobin level was 6.75 g/dL (range, 5.4 – 8.9). The median systolic blood pressure was 114 mmHg (range, 86 – 153). Eleven patients had advanced gastric cancer and one patient had a gastrointestinal stromal tumor. The lower body of the stomach was the most common tumor location (58.3 %), and the median tumor size was 40 mm (range, 15 – 100). Immediate hemostasis was achieved in all patients, and rebleeding developed in 2 of 12 patients (16 %), 3 and 5 days after treatment. There were no significant Endoclot PHS-related adverse events, and there was no all-cause mortality at 30 days after the intervention.
Conclusions Endoclot PHS represents a new alternative, complementary, and promising therapy for patients with an acute UGIB from a gastric malignancy.
- 1 Hearnshaw SA, Logan RF, Lowe D. et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327-1335
- 2 Heller SJ, Tokar JL, Nguyen MT. et al. Management of bleeding GI tumors. Gastrointest Endosc 2010; 72: 817-824
- 3 Sung JJ, Luo D, Wu JC. et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011; 43: 291-295
- 4 Beg S, Al-Bakir I, Bhuva M. et al. Early clinical experience of the safety and efficacy of EndoClot in the management of non-variceal upper gastrointestinal bleeding. Endosc Int Open 2015; 3: E605-E609
- 5 Prei JC, Barmeyer C, Bürgel N. et al. Endoclot polysaccharide hemostatic system in nonvariceal gastrointestinal bleeding: results of a prospective multicenter observational pilot study. J Clin Gastroenterol 2016; 50: e95-e100
- 6 Sheibani S, Kim JJ, Chen B. et al. Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy. Alimentary Pharmacol Ther 2013; 38: 144-150
- 7 Park H, Ahn JY, Jung HY. et al. Can endoscopic bleeding control improve the prognosis of advanced gastric cancer patients? a retrospective case-control study. J Clin Gastroenterol 2017; 51: 599-606
- 8 Cook DJ, Guyatt GH, Salena BJ. et al. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis. Gastroenterology 1992; 102: 139-148
- 9 EndoClot Plus, Inc. Polymer Solution for hemostasis. Available from: http://endoclot.com/technology.html [Accessed 2017 Jul 1]
- 10 Huang R, Pan Y, Hui N. et al. Polysaccharide hemostatic system for hemostasis management in colorectal endoscopic mucosal resection. Dig Endosc 2014; 26: 63-68
- 11 Prei JC, Barmeyer C, Burgel N. et al. EndoClot Polysaccharide Hemostatic System in Nonvariceal Gastrointestinal Bleeding: Results of a Prospective Multicenter Observational Pilot Study. J Clin Gastroenterol 2016; 50: e95-e100
- 12 Loftus EV, Alexander GL, Ahlquist DA. et al. Endoscopic treatment of major bleeding from advanced gastroduodenal malignant lesions. Mayo Clinic proceedings 1994; 69: 736-740
- 13 Savides TJ, Jensen DM, Cohen J. et al. Severe upper gastrointestinal tumor bleeding: endoscopic findings, treatment, and outcome. Endoscopy 1996; 28: 244-248
- 14 Kurt M, Akdogan M, Onal IK. et al. Endoscopic topical application of Ankaferd Blood Stopper for neoplastic gastrointestinal bleeding: A retrospective analysis. Dig Liver Dis 2010; 42: 196-199
- 15 Kim YI, Choi IJ, Cho SJ. et al. Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer. J Gastroenterol Hepatol 2013; 28: 1489-1495
- 16 Koh KH, Kim K, Kwon DH. et al. The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer. Gastric Cancer 2013; 16: 397-403
- 17 Maluf-Filho F, Martins BC, de Lima MS. et al. Etiology, endoscopic management and mortality of upper gastrointestinal bleeding in patients with cancer. United European Gastroenterol J 2013; 1: 60-67
- 18 Martins BC, Wodak S, Gusmon CC. et al. Argon plasma coagulation for the endoscopic treatment of gastrointestinal tumor bleeding: A retrospective comparison with a non-treated historical cohort. United European Gastroenterol J 2016; 4: 49-54