Healing of gastrointestinal ulcers after Hemospray application was reported in literature. The pathophysiological mechanism of action of hemostatic powders is not elucidated so far. A prospective animal model was performed to evaluate the effect of Hemospray application on the healing process of artificially induced ulcers of the upper and lower gastrointestinal tract. In 10 pigs, 20 ulcers were created in each the upper and the lower gastrointestinal tract by endoscopic mucosal resection. 50% of the pigs were immediately treated with Hemospray application, the others were not treated. Ulcer size was measured endoscopically on day 0, 2, and 7. On day 7 the ulcers were histopathological evaluated for capillary ingrowth and the thickness of the collagen layer. After 7 days the sizes of the ulcers decreased significantly (stomach: − 22.8% with Hemospray application, − 19% without Hemospray application; rectum: − 50.8% with Hemospray application, − 49.5% without Hemospray application; p = 0.005–0.037), but without significant difference between both groups. This study shows no significant effect of the hemostatic powder Hemospray on ulcer healing in the upper and lower gastrointestinal tract compared with untreated controls, neither harmful nor beneficial. However, some trends merit further trials in patients and may indicate a possible mechanism of accelerated mucosal healing.

• Endoscopic hemostasis
• Pancreatitis
• Peptic ulcer

AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy.

METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group (n = 39) or a control group (n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared.

RESULTS: Successful hemostasis was achieved in 39 (100%) patients of the study group and in 47 (94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups (16.7% vs 35.0%, P = 0.477), but the rates of late bleeding (0% vs 15.8%, P = 0.048) and overall complications (P = 0.032) were significantly lower in the study group.

CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.

• Hemocoagulase
• Digestive endoscopy
• Oozing bleeding
• Spray
• Hemostatic effect

• Administration, Topical
• Batroxobin/therapeutic use
• Endoscopic Mucosal Resection/methods
• Endoscopy, Digestive System/methods
• Female
• Hemostasis, Endoscopic/methods
• Hemostatics/therapeutic use
• Humans
• Intestinal Perforation/epidemiology
• Male
• Middle Aged
• Norepinephrine/therapeutic use
• Postoperative Complications/epidemiology
• Postoperative Hemorrhage/epidemiology
• Treatment Outcome
• Vasoconstrictor Agents/therapeutic use

• Ilaprazole
• intravenous
• pharmacodynamics
• pharmacolinetics
• proton pump inhibitor

Upper gastrointestinal bleeding (UGIB) remains a significant cause of hospital admission. In order to stratify patients according to the risk of the complications, such as rebleeding or death, and to predict the need of clinical intervention, several risk scores have been proposed and their use consistently recommended by international guidelines. The use of risk scoring systems in early assessment of patients suffering from UGIB may be useful to distinguish high-risks patients, who may need clinical intervention and hospitalization, from low risk patients with a lower chance of developing complications, in which management as outpatients can be considered. Although several scores have been published and validated for predicting different outcomes, the most frequently cited ones are the Rockall score and the Glasgow Blatchford score (GBS). While Rockall score, which incorporates clinical and endoscopic variables, has been validated to predict mortality, the GBS, which is based on clinical and laboratorial parameters, has been studied to predict the need of clinical intervention. Despite the advantages previously reported, their use in clinical decisions is still limited. This review describes the different risk scores used in the UGIB setting, highlights the most important research, explains why and when their use may be helpful, reflects on the problems that remain unresolved and guides future research with practical impact.

• Upper gastrointestinal bleeding
• Risk scores
• Risk assessment
• Rockall score
• Glasgow blatchford score

Upper non-variceal gastrointestinal bleeding is a condition that requires immediate medical intervention and has a high associated mortality rate (exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the first-line treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy (within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature.

• Upper gastrointestinal bleeding
• Non-variceal bleeding
• Endoscopic hemostasis
• Endoscopic therapy

• Emergency
• Morbidity
• Pancreatic surgery

• peptic ulcer hemorrhage
• pharmacoepidemiology
• proton pump inhibitors
• retrospective study

• 2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage
• Administration, Intravenous
• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Duodenal Ulcer/complications
• Duodenal Ulcer/drug therapy
• Duodenal Ulcer/surgery
• Endoscopy, Gastrointestinal
• Esomeprazole/administration & dosage
• Female
• Hemostasis, Endoscopic
• Hospitalization
• Humans
• Male
• Middle Aged
• Pantoprazole
• Peptic Ulcer Hemorrhage/drug therapy
• Peptic Ulcer Hemorrhage/mortality
• Peptic Ulcer Hemorrhage/surgery
• Proton Pump Inhibitors/administration & dosage
• Recurrence
• Retreatment
• Retrospective Studies
• Risk Factors
• Treatment Outcome

• Endoscopic haemostasis
• Gastro-intestinal bleeding
• Gastro-intestinal haemorrhage
• Haemostatic powders
• Hemospray
• Over-the-scope clips

• Animals
• Chitosan/administration & dosage
• Disease Models, Animal
• Endoscopy, Gastrointestinal
• Epidermal Growth Factor/administration & dosage
• Female
• Gastric Mucosa/surgery
• Hydrogels
• Peptic Ulcer/physiopathology
• Peptic Ulcer/therapy
• Rabbits
• Swine
• Wound Healing

The purpose of this study was to identify factors associated with the risk of unsustainable hemostasis in patients with gastric and duodenal ulcer bleeding by in vitro assessment of platelet reactivity using artificial neural networks.

Patients with gastroduodenal ulcers complicated by bleeding were studied. Platelet aggregation was measured using aggregometry with adenosine diphosphate 5 μM, epinephrine 2.5 μM, 5-hydroxytryptophan 10 μM, collagen 1 μM, and thrombin 0.06 NIH Unit/mL as agonists. Multiple logistic regression was used to evaluate the independent relationship between demographic, clinical, endoscopic, and laboratory data and in vitro assessment of platelet reactivity and local parameters of hemostasis in patients with ulcer bleeding.

Analysis of platelet aggregation in patients with gastroduodenal ulcer bleeding allowed the variability of platelet response to different agonists used in effective concentration which induces 50% platelet aggregation (EC₅₀) to be established. The relationship between platelet aggregation and the spatial-temporal characteristics of ulcers complicated by bleeding was demonstrated. Adrenoreactivity of platelets was associated with time elapsed since the start of ulcer bleeding and degree of hemorrhage. The lowest platelet response to collagen and thrombin was detected in patients with active bleeding (P < 0.001) and unsustainable recent bleeding (P < 0.01). Decreased adenosine diphosphate-induced platelet aggregation in patients with ulcer bleeding was correlated with the platelet response to thrombin (r = 0.714, P < 0.001) and collagen (r = 0.584, P < 0.01).

Estimation of platelet reactivity in vitro indicates the key mechanisms of failure of hemostasis in patients with ulcer bleeding. In addition to gender, an important determinant of unsustainable hemostasis was a decreased platelet response to thrombin and adenosine diphosphate.

• blood platelets
• hemostasis
• ulcer

• Gastrointestinal ulcers
• acetic acid
• bleeding
• mucosectomy
• rabbit