Published online Aug 15, 2014. doi: 10.4291/wjgp.v5.i3.284
Revised: May 16, 2014
Accepted: June 18, 2014
Published online: August 15, 2014
Processing time: 155 Days and 16.1 Hours
Acute gastrointestinal bleeding (AGIB) is a prevalent condition with significant influence on healthcare costs. Endoscopy is essential for the management of AGIB with a pivotal role in diagnosis, risk stratification and management. Recently, hemostatic powders have been added to our endoscopic armamentarium to treat gastrointestinal (GI) bleeding. These substances are intended to control active bleeding by delivering a powdered product over the bleeding site that forms a solid matrix with a tamponade function. Local activation of platelet aggregation and coagulation cascade may be also boosted. There are currently three powders commercially available: hemostatic agent TC-325 (Hemospray®), EndoClot™ polysaccharide hemostatic system, and Ankaferd Bloodstopper®. Although the available evidence is based on short series of cases and there is no randomized controlled trial yet, these powders seem to be effective in controlling GI bleeding from a variety of origins with a very favorable side effects profile. They can be used either as a primary therapy or a second-line treatment, and they seem to be especially indicated in cases of cancer-related bleeding and lesions with difficult access. In this review, we will comment on the mechanism of action, efficacy, safety and technical challenges of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.
Core tip: Hemostatic powders are a new endoscopic therapeutic modality for gastrointestinal bleeding. Based on their characteristics and mechanism of action, they may be very useful in controlling bleeding in some situations. In the last two years, a large number of studies, mainly short series of cases, have been published on this topic but their role in the management algorithm is not yet defined. In this review, we will comment on the efficacy and safety of the use of powders in several clinical scenarios and we will try to define the main current indications of use and propose new lines of research in this area.