Clinical Endoscopy

  • 제57권5호
  • /
  • Pages.620-627
  • /
  • 2024
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
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Current status and clinical outcome of endoscopic hemostatic powder in gastrointestinal bleeding: a retrospective multicenter study

  • Zie Hae Lim (Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Seung In Seo (Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Dae-Seong Myung (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Seung Han Kim (Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Han Hee Lee (Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Selen Kim (Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Bo-In Lee (Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2023.07.14
  • 심사 : 2023.10.12
  • 발행 : 2024.09.30
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초록

Background/Aims: Few multicenter studies have investigated the efficacy of hemostatic powders in gastrointestinal (GI) bleeding. We aimed to investigate the clinical outcomes of hemostatic powder therapy and the independent factors affecting rebleeding rates. Methods: We retrospectively recruited patients who underwent a new hemostatic adhesive powder (UI-EWD; Next-Biomedical) treatment for upper and lower GI bleeding between January 1, 2020 and March 1, 2023. We collected patients' medical records and bleeding lesions. The primary outcomes were clinical and technical success rates, and the secondary outcomes were early and delayed bleeding rates refractory bleeding rate, mortality rate, and factors affecting early rebleeding rates. Results: This study enrolled 135 patients (age: 67.7±13.6 years, male: 74.1%) from five hospitals. Indications for UI-EWD were peptic ulcers (51.1%), post-procedure-related bleeding (23.0%), and tumor bleeding (19.3%). The clinical and technical success rates were both 97%. The early, delayed, and refractory rebleeding rates were 19.3%, 11.1%, and 12.8%, respectively. Initially elevated blood urea nitrogen (BUN) levels (p=0.014) and Forrest classification IA or IB compared with IIA or IIB (p=0.036) were factors affecting early rebleeding. Conclusions: UI-EWD showed high clinical and technical success rates; however, rebleeding after UI-EWD therapy in patients with initially high BUN levels and active bleeding, according to the Forrest classification, should be considered.

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과제정보

This study was supported by a grant from the Korean Gastrointestinal Endoscopy Research Foundation (2022 Investigation Grant).

참고문헌

  1. Bong SH, Tan BW, Yong JM, et al. Bleeding on the edge-the use of hemostatic powder for treating a bleeding hypopharyngeal tumor. Clin Endosc 2021;54:441-442. https://doi.org/10.5946/ce.2020.159
  2. Sung JJ, Chiu PW, Chan FK, et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018. Gut 2018;67:1757-1768. https://doi.org/10.1136/gutjnl-2018-316276
  3. Aziz M, Weissman S, Mehta TI, et al. Efficacy of Hemospray in non-variceal upper gastrointestinal bleeding: a systematic review with meta-analysis. Ann Gastroenterol 2020;33:145-154.
  4. Cha B, Lee D, Shin J, et al. Hemostatic efficacy and safety of the hemostatic powder UI-EWD in patients with lower gastrointestinal bleeding. BMC Gastroenterol 2022;22:170.
  5. Park JS, Bang BW, Hong SJ, et al. Efficacy of a novel hemostatic adhesive powder in patients with refractory upper gastrointestinal bleeding: a pilot study. Endoscopy 2019;51:458-462. https://doi.org/10.1055/a-0809-5276
  6. Park JS, Kim HK, Shin YW, et al. Novel hemostatic adhesive powder for nonvariceal upper gastrointestinal bleeding. Endosc Int Open 2019;7:E1763-E1767. https://doi.org/10.1055/a-0982-3194
  7. Jung DH, Moon HS, Park CH, et al. Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: a randomized controlled trial. Endoscopy 2021;53:994-1002. https://doi.org/10.1055/a-1312-9420
  8. Park JC, Kim YJ, Kim EH, et al. Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: using propensity score matching. J Gastroenterol Hepatol 2018;33:1500-1506.
  9. Bang BW, Lee DH, Kim HK, et al. CEGP-003 spray has a similar hemostatic effect to epinephrine injection in cases of acute upper gastrointestinal bleeding. Dig Dis Sci 2018;63:3026-3032. https://doi.org/10.1007/s10620-018-5208-z
  10. Baracat FI, de Moura DT, Brunaldi VO, et al. Randomized controlled trial of hemostatic powder versus endoscopic clipping for non-variceal upper gastrointestinal bleeding. Surg Endosc 2020;34:317-324. https://doi.org/10.1007/s00464-019-06769-z
  11. Lau JY, Pittayanon R, Kwek A, et al. Comparison of a hemostatic powder and standard treatment in the control of active bleeding from upper nonvariceal lesions: a multicenter, noninferiority, randomized trial. Ann Intern Med 2022;175:171-178. https://doi.org/10.7326/M21-0975
  12. Mutneja H, Bhurwal A, Go A, et al. Efficacy of hemospray in upper gastrointestinal bleeding: a systematic review and meta-analysis. J Gastrointestin Liver Dis 2020;29:69-76. https://doi.org/10.15403/jgld-660
  13. Ofosu A, Ramai D, John F, et al. The efficacy and safety of hemospray for the management of gastrointestinal bleeding: a systematic review and meta-analysis. J Clin Gastroenterol 2021;55:e37-e45. https://doi.org/10.1097/MCG.0000000000001379
  14. Sung JJ, Moreea S, Dhaliwal H, et al. Use of topical mineral powder as monotherapy for treatment of active peptic ulcer bleeding. Gastrointest Endosc 2022;96:28-35. https://doi.org/10.1016/j.gie.2022.01.020
  15. Rodriguez de Santiago E, Burgos-Santamaria D, Perez-Carazo L, et al. Hemostatic spray powder TC-325 for GI bleeding in a nationwide study: survival and predictors of failure via competing risks analysis. Gastrointest Endosc 2019;90:581-590. https://doi.org/10.1016/j.gie.2019.06.008
  16. Shin J, Cha B, Park JS, et al. Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding. BMC Gastroenterol 2021;21:40.
  17. Gralnek IM, Stanley AJ, Morris AJ, et al. Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline: Update 2021. Endoscopy 2021;53:300-332. https://doi.org/10.1055/a-1369-5274
  18. Laine L, Barkun AN, Saltzman JR, et al. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol 2021;116:899-917.
  19. Galloro G, Zullo A, Luglio G, et al. Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment. Clin Endosc 2022;55:339-346.
  20. de Groot NL, van Oijen MG, Kessels K, et al. Reassessment of the predictive value of the Forrest classification for peptic ulcer re-bleeding and mortality: can classification be simplified? Endoscopy 2014;46:46-52.
  21. Bryant RV, Kuo P, Williamson K, et al. Performance of the Glasgow-Blatchford score in predicting clinical outcomes and intervention in hospitalized patients with upper GI bleeding. Gastrointest Endosc 2013;78:576-583. https://doi.org/10.1016/j.gie.2013.05.003
  22. Stanley AJ. Update on risk scoring systems for patients with upper gastrointestinal haemorrhage. World J Gastroenterol 2012;18:2739-2744. https://doi.org/10.3748/wjg.v18.i22.2739
  23. Chang A, Ouejiaraphant C, Akarapatima K, et al. Prospective comparison of the AIMS65 score, Glasgow-Blatchford score, and Rockall score for predicting clinical outcomes in patients with variceal and nonvariceal upper gastrointestinal bleeding. Clin Endosc 2021;54:211-221.