Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study

Background: Current standard of care of acute variceal bleeding (AVB) combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. The latter may be challenging in an emergency setting with active bleeding that interferes with visualization. Objective: To assess the effectiveness of a pre-established delivery protocol of a hemostatic powder to control AVB originating from the esophagus or the gastroesophageal junction. Design: Prospective, 2-center study. Setting: Two tertiary-care referral university hospitals. Patients: Nine patients who received endoscopic hemostatic powder for actively bleeding varices. Interventions: Endoscopic hemostasis. Main Outcome Measurement: Primary hemostasis and rebleeding rates. Results: Nine consecutive patients with confirmed AVB underwent treatment within 12 hours of hospital admission. Bleeding stopped during the endoscopy performed with application of 21 g of hemostatic powder from the cardia up to 15 cm above the gastroesophageal junction. No rebleeding was observed in any of the patients within 24 hours. No mortality was observed at 15-day follow-up. Limitations: Small sample size. Conclusion: Hemostatic powder has the potential to temporarily stop AVB.