Can Hemostatic Powder Stop Acute Variceal Hemorrhage?
David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) Reviewing Ibrahim M et al., Gastrointest Endosc 2013 Nov 78:769
Yes, at least on a short-term basis, according to new pilot data.
Standard therapy for acute variceal bleeding (AVB) includes hemodynamic stabilization, pharmacologic treatment (including antibiotics), and endoscopic therapy. Endoscopic therapy can be hampered by active bleeding and other factors that impair visualization or targeting of the treatment area. Early endoscopic experience with hemostatic powders or sprays has shown promise in treating upper gastrointestinal bleeding (NEJM JW Gastroenterol May 31 2013). Now, investigators have assessed the efficacy of endoscopic delivery of a hemostatic powder (TC-325) to the surface of bleeding esophageal varices for hemostasis and prevention of rebleeding.
Nine consecutive patients with AVB in two tertiary referral hospitals were treated by spraying TC-325 powder through a catheter to cover the distal 15 cm of the esophagus. Additional 1-second to 2-second bursts of powder were delivered to achieve hemostasis. The area was observed for 3 minutes. A second treatment was delivered to achieve hemostasis if needed, followed by 3 more minutes of observation. Continued bleeding or rebleeding within 24 hours was considered failure. Endoscopy was repeated after 24 hours to assess bleeding and provide additional endoscopic therapy.
One application of the powder was successful in 8 patients, and 1 patient required a second application. Endoscopy after 24 hours showed no evidence of bleeding in any patient and no powder remaining in the upper GI tract. Elective band ligation was performed at the time of the second endoscopy and was unaffected by the initial treatment. Patients received hemodynamic and pharmacologic therapy throughout the study.
The investigators concluded that endoscopic delivery of a hemostatic powder has the potential to provide temporary hemostasis for AVB.
Comment
This small, uncontrolled, proof-of-concept trial adds to the small but growing body of evidence showing the potential for topical hemostatic sprays to provide short-term hemostasis, which in turn allows better targeting of subsequent definitive endoscopic therapy.
Editor Disclosures at Time of Publication
Disclosures for David J. Bjorkman, MD, MSPH (HSA), SM (Epid.) at time of publication Leadership positions in professional societies World Gastroenterology Organization (Treasurer)
Citation(s):
Ibrahim M et al. Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: A prospective pilot study. Gastrointest Endosc 2013 Nov; 78:769. (http://dx.doi.org/10.1016/j.gie.2013.07.037) 作者: StephenW 时间: 2013-11-23 14:50
2013年11月21日
可以止血粉停止急性静脉曲张出血？
大卫J.比约克曼，医学博士， MSPH （ HSA ） ， SM （ Epid. ）审查易卜拉欣M等，内镜2013十一月78:769