Topical hemostatic agents in endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Ian M. Gralnek; Pradeep Bhandari; Asma Alkandari; Ali Alali; Rehan J. Haidry; Apostolis Papaefthymiou; Franco Radaelli; Sharmila Subramaniam; Lorenzo Fuccio

doi:10.1055/a-2646-7556

Endoscopy, Table of Contents

Endoscopy 2025; 57(10): 1150-1173
DOI: 10.1055/a-2646-7556

Technical Review

Topical hemostatic agents in endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Technical and Technology Review

Authors

Ian M. Gralnek‡

¹Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel (Ringgold ID: RIN61172)

²Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel (Ringgold ID: RIN58880)
Pradeep Bhandari‡

³Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom (Ringgold ID: RIN6698)

⁴Mayo Clinic, London, United Kingdom
Asma Alkandari

⁵Al Jahra Hospital, Kuwait, Kuwait (Ringgold ID: RIN430617)
Ali Alali

⁶Thunayan Alghanim Gastroenterology Center, Amiri Hospital, Sharq, Kuwait

⁷Department of Medicine, Faculty of Medicine, Kuwait University, Jabryah, Kuwait (Ringgold ID: RIN37604)
Rehan J. Haidry

⁸Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, United Kingdom (Ringgold ID: RIN591481)
Apostolis Papaefthymiou

⁸Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, United Kingdom (Ringgold ID: RIN591481)
Franco Radaelli

⁹Gastroenterology Department, Valduce Hospital, Como, Italy (Ringgold ID: RIN9349)
Sharmila Subramaniam

³Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom (Ringgold ID: RIN6698)
Lorenzo Fuccio

¹⁰Department of Medical Sciences and Surgery, University of Bologna, Bologna, Italy (Ringgold ID: RIN9296)

¹¹Gastroenterology Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Ringgold ID: RIN18508)

Abstract

Background

Gastrointestinal (GI) endoscopy has evolved from a diagnostic tool into a therapeutic modality, leading to a higher incidence of bleeding complications during and after procedures. To address this issue, various hemostatic agents have been developed, including injectable, mechanical, thermal, and topical products. Topical hemostatic agents, available in powder or gel forms, can be used as standalone treatments or as adjuncts to traditional hemostatic therapies to control or prevent bleeding.

Methods

This Technical and Technology Review examines the commercially available topical hemostatic agents used in endoscopy, specifically Purastat, TC-325 Hemospray, EndoClot PHS, Nexpowder, Ankaferd Blood Stopper, and CG GEL. A systematic literature review was conducted up to January 2025, focusing on randomized controlled trials (RCTs), meta-analyses, and observational studies. Each product was assessed for its composition, mechanism of action, regulatory status, mode of use, efficacy, safety, and financial considerations.

Results

Purastat showed 94% efficacy in acute GI bleeding, reducing delayed bleeding to 4.3% in endoscopic submucosal dissection (ESD) and endoscopic mucosal resection cases, with significantly lower thermal device usage. TC-325 Hemospray achieved 85%–98.5% primary hemostasis in upper and lower GI bleeding, with pooled hemostasis rates of 93.1% and rebleeding rates of 8.9%. It was also effective in malignancy-related bleeding, with hemostasis success up to 100%. EndoClot PHS demonstrated 76%–100% hemostasis efficacy, comparable with TC-325, with rebleeding rates of 24%–25%. It showed prophylactic potential post-ESD, with rebleeding rates of 7.3%–9.1%. Nexpowder achieved 94% hemostasis in refractory upper GI bleeds and reduced rebleeding in lower GI bleeds to 5.5% at 28 days. Ankaferd Blood Stopper demonstrated 73%–100% hemostasis across various GI bleeding sources, including peptic ulcers and malignancies, though further data on rebleeding are needed.

Conclusion

Topical hemostatic agents offer effective options for managing GI bleeding. Products like Purastat, TC-325 Hemospray, EndoClot PHS, Nexpowder, Ankaferd Blood Stopper, and CG GEL have shown promising results in achieving hemostasis; however, further RCTs and cost-effectiveness analyses are needed to better establish their roles in endoscopic practice.

Full Text

References

References
1 Subramaniam S, Kandiah K, Thayalasekaran S. et al. Haemostasis and prevention of bleeding related to ER: The role of a novel self-assembling peptide. United European Gastroenterol J 2019; 7: 155-162
2 de Nucci G, Reati R, Arena I. et al. Efficacy of a novel self-assembling peptide hemostatic gel as rescue therapy for refractory acute gastrointestinal bleeding. Endoscopy 2020; 52: 773-779
3 Pioche M, Camus M, Rivory J. et al. A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections. Endosc Int Open 2016; 4: E415-E419
4 Uraoka T, Ochiai Y, Fujimoto A. et al. A novel fully synthetic and self-assembled peptide solution for endoscopic submucosal dissection-induced ulcer in the stomach. Gastrointest Endosc 2016; 83: 1259-1264
5 Subramaniam S, Kandiah K, Chedgy F. et al. A novel self-assembling peptide for hemostasis during endoscopic submucosal dissection: a randomized controlled trial. Endoscopy 2021; 53: 27-35
6 Soons E, Turan A, van Geenen E. et al. Application of a novel self-assembling peptide to prevent hemorrhage after EMR, a feasibility and safety study. Surg Endosc 2021; 35: 3564-3571
7 Gomi K, Yamamoto Y, Yoshida E. et al. Using a novel hemostatic peptide solution to prevent bleeding after endoscopic submucosal dissection of a gastric tumor. World J Gastrointest Endosc 2024; 16: 168-174
8 Gopakumar H, Vohra I, Sharma NR. et al. Efficacy of self-assembling peptide in mitigating delayed bleeding after advanced endoscopic resection of gastrointestinal lesions: A meta-analysis. Endosc Int Open 2023; 11: E553-E560
9 Drews J, Zachaus M, Kleemann T. et al. Multicentre randomised controlled trial of a self-assembling haemostatic gel to prevent delayed bleeding following endoscopic mucosal resection (PURPLE Trial). Gut 2025;
10 Yoshida M, Goto N, Kawaguchi M. et al. Initial clinical trial of a novel hemostat, TDM-621, in the endoscopic treatments of the gastric tumors. J Gastroenterol Hepatol 2014; 29: 77-79
11 White K, Henson CC. Endoscopically delivered Purastat for the treatment of severe haemorrhagic radiation proctopathy: a service evaluation of a new endoscopic treatment for a challenging condition. Frontline Gastroenterol 2021; 12: 608-613
12 Branchi F, Klingenberg-Noftz R, Friedrich K. et al. PuraStat in gastrointestinal bleeding: results of a prospective multicentre observational pilot study. Surg Endosc 2022; 36: 2954-2961
13 Ishida Y, Tsuchiya N, Koga T. et al. A novel self-assembling peptide hemostatic gel as an option for initial hemostasis in endoscopic sphincterotomy-related hemorrhage: a case series. Clin J Gastroenterol 2022; 15: 1210-1215
14 Uba Y, Ogura T, Ueno S. et al. Comparison of endoscopic hemostasis for endoscopic sphincterotomy bleeding between a novel self-assembling peptide and conventional technique. J Clin Med 2022; 12: 79
15 Lesmana CRA, Sandra S, Satya Paramitha M. et al. Endoscopic management using novel haemostatic agents for immediate bleeding during endoscopic retrograde cholangio-pancreatography. Can J Gastroenterol Hepatol 2023; 2023: 5212580
16 Kubo K, Hayasaka S, Tanaka I. Endoscopic hemostatic treatment for acute gastrointestinal bleeding by combined modality therapy with PuraStat and endoscopic hemoclips. Case Rep Gastroenterol 2023; 17: 89-95
17 Uraoka T, Uedo N, Oyamma T. et al. Efficacy and safety of a novel hemostatic peptide solution during endoscopic submucosal dissection: a multicenter randomized controlled trial. Am J Gastroenterol 2023; 118: 276-283
18 Dhindsa BS, Min Tun K, Scholten KJ. et al. New alternative? Self-assembling peptide in gastrointestinal bleeding: a systematic review and meta-analysis. Dig Dis Sci 2023; 68: 3694-3701
19 Yang D, Hasan MK, Xiao Y. et al. The use of a self-assembling peptide gel for stricture prevention in the esophagus after endoscopic submucosal dissection: a U.S. multicenter prospective study (with video). Gastrointest Endosc 2024; 100: 213-220
20 Maselli R, Da Rio L, Manno M. et al. Efficacy of novel endoscopic hemostatic agent for bleeding control and prevention: Results from a prospective, multicenter national registry. Endosc Int Open 2024; 12: E1220-E1229
21 Binda C. et al. The use of PuraStat® in the management of walled-off pancreatic necrosis drained using lumen-apposing metal stents: a case series. Medicina (Kaunas) 2023; 59: 750
22 Oza VM, Mittal N, Winchester C. et al. Impact of using self-assembling peptide (PuraStat) on anastomotic ulcers-a multicenter case series. ACG Case Rep J 2024; 11: e01535
23 Becq A, Houdeville C, Tran Minh M-L. et al. Experience with the use of a hemostatic powder in 152 patients undergoing urgent endoscopy for gastrointestinal bleeding. Clin Res Hepatol Gastroenterol 2021; 45: 101558
24 Smith LA, Stanley AJ, Bergman JJ. et al. Hemospray application in nonvariceal upper gastrointestinal bleeding: results of the survey to evaluate the application of hemospray in the luminal tract. J Clin Gastroenterol 2014; 48: e89-e92
25 Antonelli G, Voiosu AM, Pawlak KM. et al. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56: 131-150
26 Holster IL, Kuipers EJ, Tjwa ET. Hemospray in the treatment of upper gastrointestinal hemorrhage in patients on antithrombotic therapy. Endoscopy 2013; 45: 63-66
27 Ibrahim M, El-Mikkawy A, Mostafa I. et al. Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study. Gastrointest Endosc 2013; 78: 769-773
28 Ibrahim M, El-Mikkawy A, Abdalla H. et al. Management of acute variceal bleeding using hemostatic powder. United European Gastroenterol J 2015; 3: 277-283
29 Ibrahim M, El-Mikkawy A, Abdel Hamid M. et al. Early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding: a randomised trial. Gut 2019; 68: 844-853
30 Haddara S, Jacques J, Lecleire S. et al. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the "GRAPHE" registry). Endoscopy 2016; 48: 1084-1095
31 Hagel AF, Albrecht H, Nagel A. et al. The application of hemospray in gastrointestinal bleeding during emergency endoscopy. Gastroenterol Res Pract 2017; 2017: 3083481
32 Kwek BEA, Ang TL, Ong PLJ. et al. TC-325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high-risk bleeding stigmata: A randomized pilot study. J Dig Dis 2017; 18: 323-329
33 Hookey L, Barkun A, Sultanian R. et al. Successful hemostasis of active lower GI bleeding using a hemostatic powder as monotherapy, combination therapy, or rescue therapy. Gastrointest Endosc 2019; 89: 865-871
34 Ramirez-Polo AI, Casal-Sanchez J, Hernandez-Guerrero A. et al. Treatment of gastrointestinal bleeding with hemostatic powder (TC-325): a multicenter study. Surg Endosc 2019; 33: 2349-2356
35 Chen YI, Wyse J, Lu Y. et al. TC-325 hemostatic powder versus current standard of care in managing malignant GI bleeding: a pilot randomized clinical trial. Gastrointest Endosc 2020; 91: 321-328 e1
36 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 e6
37 Baracat FI, Hourneaux de Moura DT, Burnaldi VO. et al. Randomized controlled trial of hemostatic powder versus endoscopic clipping for non-variceal upper gastrointestinal bleeding. Surg Endosc 2020; 34: 317-324
38 Chahal D, Lee JGH, Ali-Mohamad N. et al. High rate of re-bleeding after application of Hemospray for upper and lower gastrointestinal bleeds. Dig Liver Dis 2020; 52: 768-772
39 Hussein M, Alzoubaidi D, O’Donnell M. et al. Hemostatic powder TC-325 treatment of malignancy-related upper gastrointestinal bleeds: International registry outcomes. J Gastroenterol Hepatol 2021; 36: 3027-3032
40 Hussein M, Alzoubaidi D, Lopez M-F. et al. Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer-related bleeding: multicenter international registry. Endoscopy 2021; 53: 36-43
41 Lau JYW, 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
42 Sung JJY, 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 e1
43 Pittayanon R, Khongka W, Linlawan S. et al. Hemostatic powder vs. standard endoscopic treatment for gastrointestinal tumor bleeding: a multicenter randomized trial. Gastroenterology 2023; 165: 762-772 e2
44 Papaefthymiou A, Aslam N, Hussein M. et al. Hemospray® (hemostatic powder TC-325) as monotherapy for acute gastrointestinal bleeding: a multicenter prospective study. Ann Gastroenterol 2024; 37: 418-426
45 Hussein M, Alzoubaidi D, de la Serna A. et al. Outcomes of Hemospray therapy in the treatment of intraprocedural upper gastrointestinal bleeding post-endoscopic therapy. United European Gastroenterol J 2020; 8: 1155-1162
46 Deliwala SS, Chandan S, Mohan BP. et al. Hemostatic spray (TC-325) vs. standard endoscopic therapy for non-variceal gastrointestinal bleeding: A meta-analysis of randomized controlled trials. Endosc Int Open 2023; 11: E288-E295
47 Facciorusso A, Takahashi MS, Postula CE. et al. Efficacy of hemostatic powders in upper gastrointestinal bleeding: A systematic review and meta-analysis. Dig Liver Dis 2019; 51: 1633-1640
48 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
49 Chahal D, Sidhu H, Zhao B. et al. Efficacy of Hemospray (TC-325) in the treatment of gastrointestinal bleeding: an updated systematic review and meta-analysis. J Clin Gastroenterol 2021; 55: 492-498
50 Liu K, Gao L, Bai JW. et al. Efficacy of new hemostatic techniques in nonvariceal gastrointestinal bleeding: A systematic review and network meta-analysis. J Dig Dis 2023; 24: 181-193
51 Facciorusso A, Bertini M, Bertoni M. et al. Efficacy of hemostatic powders in lower gastrointestinal bleeding: Clinical series and literature review. Dig Liver Dis 2021; 53: 1327-1333
52 Ng JL, Marican M, Mathew R. Topical haemostatic powder as a novel endoscopic therapy for severe colonic diverticular bleeding. ANZ J Surg 2019; 89: E56-E60
53 Saeed A, Yousuf S, Hayat MH. et al. Comparison of TC-325 hemostatic powder with standard endoscopic treatments for malignancy-related upper gastrointestinal bleeding: meta-analysis of randomized controlled trials. Dig Dis Sci 2024; 69: 4224-4230
54 Alali AA, Pittayanon R, Martel M. et al. TC-325 superiority in malignant gastrointestinal bleeding: an individual patient data meta-analysis of randomized trials. Am J Gastroenterol 2025; 120: 332-339
55 Martins BC, Machado AA, Scomparin RC. et al. TC-325 hemostatic powder in the management of upper gastrointestinal malignant bleeding: a randomized controlled trial. Endosc Int Open 2022; 10: E1350-E1357
56 Sulz MC, Frei R, Meyenberger C. et al. Routine use of Hemospray for gastrointestinal bleeding: prospective two-center experience in Switzerland. Endoscopy 2014; 46: 619-624
57 Ibrahim M, Mostafa I, Deviere J. New developments in managing variceal bleeding. Gastroenterology 2018; 154: 1964-1969
58 de Rezende DT, Brunalid VO, Bernardo WM. et al. Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E1704-E1713
59 Ahmed K, Abdallah M, Abbas D. et al. Analysis of reported adverse events related to Hemospray: An FDA MAUDE Database Study. J Clin Gastroenterol 2024; 58: 402-406
60 Muller-Gerbes D, Beeck A, Dormann A. [Hamostase mit Pulver – Erfahrungen mit EndoClotTM bei schwierigen oberen GI-Blutungen]. Endoskopie Heute 2013; 26: 4
61 Beg S, Al-Bakir I, Bhuva M. et al. Early clinical experience of the safety and efficacy of EndoClot in the management of non-variceal upper gastrointestinal bleeding. Endosc Int Open 2015; 3: E605-E609
62 Prei JC, Barmeyer C, Burgel N. et al. EndoClot polysaccharide hemostatic system in nonvariceal gastrointestinal bleeding: results of a prospective multicenter observational pilot study. J Clin Gastroenterol 2016; 50: e95-e100
63 Kim YJ, Park JC, Kim EH. et al. Hemostatic powder application for control of acute upper gastrointestinal bleeding in patients with gastric malignancy. Endosc Int Open 2018; 6: E700-E705
64 Vitali F, Naegel A, Atreya R. et al. Comparison of Hemospray® and Endoclot™ for the treatment of gastrointestinal bleeding. World J Gastroenterol 2019; 25: 1592-1602
65 Huang R, Pan Y, Hui N. et al. Polysaccharide hemostatic system for hemostasis management in colorectal endoscopic mucosal resection. Dig Endosc 2014; 26: 63-68
66 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
67 Hahn KY, Park JC, Lee YK. et al. Efficacy of hemostatic powder in preventing bleeding after gastric endoscopic submucosal dissection in high-risk patients. J Gastroenterol Hepatol 2018; 33: 656-663
68 Hagel AF, Raithel M, Hempen P. et al. Multicenter analysis of endoclot as hemostatic powder in different endoscopic settings of the upper gastrointestinal tract. J Physiol Pharmacol 2020; 71: 657-664
69 Jung DH, Park CH, Choi SI. et al. Comparison of a polysaccharide hemostatic powder and conventional therapy for peptic ulcer bleeding. Clin Gastroenterol Hepatol 2023; 21: 2844-2853 e5
70 Jiang SX, Chahal D, Ali-Mohamad N. et al. Hemostatic powders for gastrointestinal bleeding: a review of old, new, and emerging agents in a rapidly advancing field. Endosc Int Open 2022; 10: E1136-E1146
71 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
72 Smith JJ. FDA Pre-market Notification Details for NinesMeasure; K202990. Accessed April 03, 2025 at: https://fda.report/PMN/K202990
73 Bang BW, Lee E, Maeng JH. et al. Efficacy of a novel endoscopically deliverable muco-adhesive hemostatic powder in an acute gastric bleeding porcine model. PLoS One 2019; 14: e0216829
74 Park JS, Kim HK, Shin YW. et al. Novel hemostatic adhesive powder for nonvariceal upper gastrointestinal bleeding. Endosc Int Open 2019; 7: E1763-E1767
75 Shin J, Cha B, Park J-S. et al. Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding. BMC Gastroenterol 2021; 21: 40
76 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
77 Beyazit Y, Kekilli M, Haznedaroglu IC. et al. Ankaferd hemostat in the management of gastrointestinal hemorrhages. World J Gastroenterol 2011; 17: 3962-3970
78 Goker H, Haznedaroglu IC, Ercetin S. et al. Haemostatic actions of the folkloric medicinal plant extract Ankaferd Blood Stopper. J Int Med Res 2008; 36: 163-170
79 Ciftciler R, Ciftciler AE, Malkan UY. et al. Pharmacobiological management of hemostasis within clinical backgrounds via Ankaferd hemostat (Ankaferd blood stopper). SAGE Open Med 2020; 8: 2050312120907811
80 Turhan N, Kurt M, Shorbagi A. et al. Topical Ankaferd blood stopper administration to bleeding gastrointestinal carcinomas decreases tumor vascularization. Am J Gastroenterol 2009; 104: 2874-2877
81 Ozaslan E, Purnak T, Yildiz A. et al. The effect of a new hemostatic agent for difficult cases of non-variceal gastrointestinal bleeding: Ankaferd blood stopper. Hepatogastroenterology 2010; 57: 191-194
82 Purnak T, Ozaslan E, Beyazit Y. et al. Upper gastrointestinal bleeding in a patient with defective hemostasis successfully treated with Ankaferd blood stopper. Phytother Res 2011; 25: 312-313
83 Kurt M, Akdogan M, Onal IK. et al. Endoscopic topical application of Ankaferd Blood Stopper for neoplastic gastrointestinal bleeding: A retrospective analysis. Dig Liver Dis 2010; 42: 196-199
84 Ozaslan E, Purnak T, Yildiz A. et al. A new practical alternative for tumoural gastrointestinal bleeding: Ankaferd blood stopper. Dig Liver Dis 2010; 42: 594-595
85 Ozaslan E, Purnak T, Yildiz A. et al. Bleeding due to slippage of elastic band during variceal ligation: successful use of Ankaferd blood stopper. Indian J Gastroenterol 2010; 29: 166-168
86 Tuncer I, Doganay L, Ozturk O. Instant control of fundal variceal bleeding with a folkloric medicinal plant extract: Ankaferd Blood Stopper. Gastrointest Endosc 2010; 71: 873-875
87 Kurt M, Onal I, Akdogan M. et al. Ankaferd Blood Stopper for controlling gastrointestinal bleeding due to distinct benign lesions refractory to conventional antihemorrhagic measures. Can J Gastroenterol 2010; 24: 380-384
88 Karaman A, Torun E, Gursoy S. et al. Efficacy of Ankaferd Blood Stopper in postpolypectomy bleeding. J Altern Complement Med 2010; 16: 1027-1028
89 Beyazit Y, Koklu S, Akbal E. et al. Successful treatment of endoscopic sphincterotomy-induced early hemorrhage with application of Ankaferd Blood Stopper. Gastrointest Endosc 2010; 72: 1325-1326
90 Kurt M, Kacar S, Onal IK. et al. Ankaferd Blood Stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract. Endoscopy 2008; 40: E262
91 Aslan E, Akyuz U, Pata C. The use of Ankaferd in diverticular bleeding: two case reports. Turk J Gastroenterol 2013; 24: 441-443
92 Ozaslan E, Purnak T, Ozyigit G. et al. No prolonged effect of Ankaferd Blood Stopper on chronic radiation proctitis. Endoscopy 2010; 42: E271-E272
93 Shorbagi A, Sivri B. Successful management of a difficult case of radiation proctopathy with Ankaferd BloodStopper: a novel indication (with video). Gastrointest Endosc 2010; 72: 666-667
94 Batgi H, Akbal E, Kocak E. et al. Treatment of hemorrhagic gastritis by Ankaferd blood stopper versus Omeprazole: experimental randomized rat models. Wien Klin Wochenschr 2016; 128: 559-565
95 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
96 Choi JH, Cho IR, Lee SH. et al. Efficacy and safety of novel hemostatic gel in endoscopic sphincterotomy or endoscopic papillectomy: A multicenter, randomized controlled clinical trial. Dig Liver Dis 2023; 55: 527-533
97 Gungor G, Goktepe MH, Biyik M. et al. Efficacy of ankaferd blood stopper application on non-variceal upper gastrointestinal bleeding. World J Gastrointest Endosc 2012; 4: 556-560
98 Bas B, Ayyildiz T, Avcioglu U. A practical alternative for salvage therapy in gastrointestinal bleeding: Ankaferd blood stopper. J Exp Clin Med (Turk) 2021; 38: 61-64
99 Bas B, Kucukdemirci O, Ustaoglu M. Ankaferd blood stopper: A novel additional strategy for less experienced gastroenterologists in gastrointestinal bleeding treatment. Medicine (Baltimore) 2024; 103: e38319
100 Ozaslan E, Purnak T, Haznedaroglu IC. Ankaferd Blood Stopper in GI bleeding: alternative for everything?. Gastrointest Endosc 2011; 73: 185-186
101 Alali AA, Moosavi S, Martel M. et al. Topical hemostatic agents in the management of upper gastrointestinal bleeding: a meta-analysis. Endosc Int Open 2023; 11: E368-E385
102 Akbal E, Koklu S, Astarci HM. et al. Oral high-dose ankaferd administration effects on gastrointestinal system. Int J Med Sci 2013; 10: 451-456
103 Beyazit Y, Onder FO, Torun S. et al. Topical application of ankaferd hemostat in a patient with gastroduodenal amyloidosis complicated with gastrointestinal bleeding. Blood Coagul Fibrinolysis 2013; 24: 762-765
104 Jung DH, Youn JH, Moon BM. et al. Hemostatic effect and mechanism of epidermal growth factor-hemostatic powder after endoscopic submucosal dissection in a porcine model. Gut Liver 2023; 17: 558-565
105 Bang BW, Maeng JH, Kim M-H. et al. Hemostatic action of EGF-endospray on mucosectomy-induced ulcer bleeding animal models. Biomed Mater Eng 2015; 25: 101-109
106 Barkun AN, Almadi M, Kuipers EJ. et al. Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the International Consensus Group. Ann Intern Med 2019; 171: 805-822
107 Gralnek IM, Duboc MC, Garcia-Pagan JC. et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54: 1094-1120
108 Laine L, Barkun AN, Saltzman JR. et al. ACG Clinical Guideline: Upper gastrointestinal and ulcer bleeding. Am J Gastroenterol 2021; 116: 899-917