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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(05): E693-E698
DOI: 10.1055/a-1374-5839
Original article

Severe upper gastrointestinal bleeding is halted by endoscopically delivered self-propelling thrombin powder: A porcine pilot study

Nabil Ali-Mohamad
1   The University of British Columbia – Michael Smith Laboratories, Vancouver, British Columbia, Canada
,
Massimo Cau
1   The University of British Columbia – Michael Smith Laboratories, Vancouver, British Columbia, Canada
3   The University of British Columbia – School of Biomedical Engineering, Vancouver, British Columbia, Canada
,
James Baylis
1   The University of British Columbia – Michael Smith Laboratories, Vancouver, British Columbia, Canada
3   The University of British Columbia – School of Biomedical Engineering, Vancouver, British Columbia, Canada
,
Veronika Zenova
1   The University of British Columbia – Michael Smith Laboratories, Vancouver, British Columbia, Canada
,
Hugh Semple
4   Defense Research and Development Canada Suffield Research Centre – Suffield Research Centre, Medicine Hat, Alberta, Canada
,
Andrew Beckett
5   University of Toronto Faculty of Medicine – Department of Surgery, Toronto, Ontario, Canada
,
Andrew McFadden
6   The University of British Columbia Faculty of Medicine – Department of Surgery, Vancouver, British Columbia, Canada
,
Fergal Donnellan
7   The University of British Columbia Faculty of Medicine – Division of Gastroenterology, Vancouver, British Columbia, Canada
,
Christian Kastrup
1   The University of British Columbia – Michael Smith Laboratories, Vancouver, British Columbia, Canada
2   The University of British Columbia Faculty of Medicine, Department of Biochemistry and Molecular Biology, Vancouver, British Columbia, Canada
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Abstract

Background and study aims Hemostatic powders have emerged recently to treat upper gastrointestinal bleeding (UGIB). Previously, we developed a novel self-propelling thrombin powder (SPTP) that effectively manages external pulsatile arterial bleed without compression, by effervescing and carrying thrombin into the wound. Here, we tested if SPTP, sprayed endoscopically, can manage severe UGIB in a live porcine model.

Materials and methods Anesthetized pigs underwent laparotomy to insert the gastroepiploic vascular bundles into the stomach lumen via a gastrotomy. Bleeding was initiated endoscopically in the stomach by needle knife. SPTP was delivered to the site of bleeding from a CO2-powered spray device using a 7 FR catheter. Successful primary hemostasis, time to hemostasis, and the mass of SPTP delivered were measured.

Results Hemostasis was achieved at all bleeding sites using SPTP. Mean time to hemostasis was 4.2 ± 0.9 minutes (mean ± standard error of the mean, n = 12). The average mass of SPTP delivered was 2.4 ± 0.6 g.

Conclusions In this pilot study, SPTP successfully stopped 12 cases of severe UGIB, demonstrating early promise asa novel hemostatic powder.



Publikationsverlauf

Eingereicht: 27. November 2020

Angenommen: 22. Januar 2021

Artikel online veröffentlicht:
22. April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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