血粉可以止急性静脉曲张出血？

StephenW

November 21, 2013

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)

StephenW

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

是的，至少在短期的基础上，根据新的试验数据。

标准治疗急性静脉曲张破裂出血（ AVB ）包括血流动力学稳定，药物治疗（包括抗生素） ，及内镜下治疗。内窥镜治疗可以通过活动性出血，而削弱可视或治疗区域的靶向其他因素的阻碍。用止血粉或喷剂早期内镜经验表明承诺在治疗上消化道出血（NEJM JW胃肠病学杂志2013年5月31日） 。现在，研究人员评估了内镜交付止血粉（ TC- 325 ）的疗效出血的表面食管静脉曲张止血和预防再出血。

连续9例AVB在两个叔转诊医院被通过导管喷TC- 325粉末以覆盖食管的远端15厘米处理。额外的1秒至粉2秒阵阵交付，达到止血。区域观察到3分钟。第二次治疗交付，如果需要达到止血，随后观察3分钟。继续出血或再出血24小时内被认为是失败的。内镜重复24小时后，评估出血并提供额外的内镜治疗。

粉末的一种应用是成功的8例，1例患者需要第二个应用程序。 24小时后内镜检查未见在任何患者的出血和无粉末残留在胃肠道上部。在第二内镜检查的时间进行选修套扎并没有受到初步治疗。患者接受血液动力学和药物治疗整个研究。

研究者的结论是交付内镜止血粉的有潜力的AVB提供临时止血。
评论

概念验证的这个小的，不受控制，审判增加了小，但越来越多的证据表明，局部止血喷剂，以提供短期止血，从而可以更好地瞄准随后明确内镜治疗的潜力。
在出版时编辑披露

    在专业协会世界胃肠组织出版的领导职务的披露时间为大卫J.比约克曼，医学博士， MSPH （ HSA ） ， SM （ Epid. ） （司库）

引用（S ） ：

    易卜拉欣M等。一项前瞻性试验研究：通过使用止血粉TC- 325内镜治疗急性静脉曲张出血。内镜2013月; 78:769 。 （ http://dx.doi.org/10.1016/j.gie.2013.07.037 ）

niki_shen

止血还是纤维蛋白原来的更有效果

StephenW

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