Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/Nexpowder™, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB.

We conducted a retrospective cohort study of LGIB at a single tertiary center in south Korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated.

The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded.

Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.

• Hemostatic UI-EWD powder
• Lower gastrointestinal bleeding
• Re-bleeding
• Safety

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.

• endoscopy
• gastrointestinal bleeding
• guidelines
• hemostasis
• non-steroidal anti-inflammatory drugs
• risk factors

Diverticular bleeding accounts for approximately 26%–40% of the cases of lower gastrointestinal bleeding. Rupture of the vasa recta at the neck or dome of the diverticula can be the cause of this bleeding. Colonoscopy aids in not only the diagnosis but also the treatment of diverticular bleeding after a steady bowel preparation. Endoscopic hemostasis involves several methods, such as injection/thermal contact therapy, clipping, endoscopic band ligation (EBL), hemostatic powder, and over-the-scope clips. Each endoscopic method can provide a secure initial hemostasis. With regard to the clinical outcomes after an endoscopic treatment, the methods reportedly have no significant differences in the initial hemostasis and early recurring bleeding; however, EBL might prevent the need for transcatheter arterial embolization or surgery. In contrast, the long-term outcomes of the endoscopic treatments, such as a late bleeding and recurrent bleeding at 1 and 2 years, are not well known for diverticular bleeding. With regard to a cure for diverticular bleeding, there should be an improvement in both the endoscopic methods and the multilateral perspectives, such as diet, medicines, interventional approaches, and surgery.

• Colon
• Diverticulum
• Endoscopic
• Hemostasis

• ABS, Ankaferd blood stopper
• APC, argon plasma coagulation
• ASGE, American Society for Gastrointestinal Endoscopy
• CPT, Current Procedural Terminology
• CSEMS, covered self-expandable metallic stent
• EBL, endoscopic band ligation
• EDP, endoscopic Doppler probe
• GAVE, gastric antral vascular ectasia
• HP, heater probe
• LGIB, lower GI bleeding
• MPEC, multipolar electrocoagulation
• OTSC, over-the-scope clip
• PTFE, polytetrafluoroethylene
• RCT, randomized controlled trial
• TTS, through-the-scope
• U.S. FDA, United States Food and Drug Administration
• UGIB, upper GI bleeding

• UL1 TR001863 NCATS NIH HHS

• bleeding
• cirrhosis
• oesophageal varices
• portal hypertension

• Adult
• Aged
• Drug Administration Schedule
• Esophageal and Gastric Varices/therapy
• Female
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/methods
• Hemostatics/therapeutic use
• Humans
• Male
• Middle Aged
• Minerals/therapeutic use
• Powders
• Treatment Outcome

• Cook Medical
• Erasme Hospital, ULB, Brussels, Belgium

• Endoclot
• Gastrointestinal bleeding
• Haemostasis
• Hemospray
• Hemostatic powder

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Endoscopy, Gastrointestinal/methods
• Female
• Gastrointestinal Hemorrhage/therapy
• Hemostasis, Endoscopic/methods
• Hemostatics/administration & dosage
• Humans
• Male
• Middle Aged
• Minerals/administration & dosage
• Powders
• Recurrence
• Retrospective Studies
• Treatment Outcome
• Young Adult

To investigate the clinical features of acute lower gastrointestinal bleeding and its diagnostic strategy with emergency enteroscopy.

Two hundred and ten patients with acute lower gastrointestinal bleeding at our hospital from January 2014 to December 2017 were selected, and the clinical features of acute lower gastrointestinal bleeding were analyzed. The patients were then divided into two groups based on the bowel preparation method used: a cleansing enema group (169 cases) and an oral cathartic group (41 cases). The influence of intestinal tract cleanliness on emergency enteroscopy diagnosis was then analyzed.

The ratio of males to females in 210 patients was 1.50:1. The elderly, middle-aged, and young patients accounted for 45.71% (96/210), 29.05% (61/210), and 25.24% (53/210), respectively. There were 10.48% of hidden blood loss and 89.52% of overt blood loss. The hemorrhage was mostly common with melena, bright red bloody stools, and dark red bloody stools. The bleeding was mostly caused by intestinal inflammation or infection (35.71%) and polyps of the rectum and colon (20.95%). Colorectal cancer, intestinal inflammation or infection, and polyps of the rectum and colon were main causes in the elderly group. Intestinal inflammation or infection, polyps of the rectum and colon, and colorectal cancer were main causes in the middle-aged group. Intestinal inflammation or infection, polyps of the rectum and colon, and vascular disease were main causes in the young group. The excellent rate of intestinal tract cleanliness in the cleansing enema group was lower than that of the oral cathartic group (P < 0.05). The diagnostic accuracy of enteroscopy with excellent, good, and poor cleanliness was 91.04% (61/67), 80.85% (38/47), and 52.42% (65/124), respectively. The diagnostic accordance rate of enteroscopy with excellent or good cleanliness was higher than that of enteroscopy with poor cleanliness (P < 0.05). There was no statistical difference in the diagnostic accordance rate between enteroscopy with excellent and good cleanliness (P > 0.05).

Acute lower gastrointestinal hemorrhage is common in males and the elderly population. Main causes are intestinal inflammation and polyps of the rectum and colon, and there is certain difference in the causes of bleeding in patients of different ages. Hemorrhage is mostly common with melena, bright red bloody stools, and dark red bloody stools. Good intestinal tract cleanliness can increase the diagnostic rate of emergency enteroscopy, and the intestinal tract cleanliness associated with oral cathartic is better than that of cleansing enema. Therefore, based on patient's hemodynamic stability, using bowel preparation with oral cathartic can improve the diagnostic accordance rate.

• Acute lower gastrointestinal bleeding
• Clinical features
• Emergency enteroscopy
• Intestinal tract cleanliness

Introduction. Gastrointestinal bleeding represents the main indication for emergency endoscopy (EE). Lately, several hemostatic powders have been released to facilitate EE. Methods. We evaluated all EE in which Hemospray was used as primary or salvage therapy, with regard to short- and long-term hemostasis and complications. Results. We conducted 677 EE in 474 patients (488 examinations in 344 patients were upper GI endoscopies). Hemospray was applied during 35 examinations in 27 patients (19 males), 33 during upper and 2 during lower endoscopy. It was used after previous treatment in 21 examinations (60%) and in 14 (40%) as salvage therapy. Short-term success was reached in 34 of 35 applications (97.1%), while long-term success occurred in 23 applications (65.7%). Similar long-term results were found after primary application (64,3%) or salvage therapy (66,7%). Rebleeding was found in malignant and extended ulcers. One major adverse event (2.8%) occurred with gastric perforation after Hemospray application. Discussion. Hemospray achieved short-term hemostasis in virtually all cases. The long-term effect is mainly determined by the type of bleeding source, but not whether it was applied as first line or salvage therapy. But, even in the failures, patients had benefit from hemodynamic stabilization and consecutive interventions in optimized conditions.

• Diverticulum
• Emergency
• Gastrointestinal hemorrhage
• Hemostasis
• Neoplasia

• Hemospray
• gastrointestinal bleeding
• hemostatic powder spray

• Hemospray
• gastrointestinal bleeding
• hemostatic powder spray

• Endoscopic hemostasis
• Endoscopy
• Gastrointestinal hemorrhage
• Powders