REAL LIFE EXPERIENCE WITH THE USE OF A HEMOSTATIC POWDER IN 152 PATIENTS UNDERGOING URGENT ENDOSCOPY FOR GASTROINTESTINAL BLEEDING

Aims In the recent years, topical hemostatic powders have been used for the management of upper gastrointestinal bleeding (UGIB). The aim of this study was to report on the use of an hemostatic powder (TC-325) in a non-working hour context by an on-call endoscopist during urgent endoscopic procedures.

Methods In this retrospective multicenter cohort study, consecutive patients having undergone an urgent endoscopy with the use of TC-325 from November 2015 to December 2018 in the Paris region were included. We collected clinical and biological data, as well as endoscopic findings. The outcomes such as the recurrence rate, repeat endoscopy and hemostatic treatment need, complications and survival were collected as well.

Results A total of 152 patients (mean 65 year-old, 70.4% male) were included. Amongst the 31 endoscopists, 11 were “more experienced”, and performed 48% of the endoscopies. The most common causes of bleeding were peptic ulcers (52.0%), malignancy (22.4%) and esophagitis (12.5%). Most bleedings originated from the upper GI tract (95.0%). TC-325 was used as a salvage therapy in 60.8% of cases. Other hemostatic techniques where used in 52.9% of cases. Immediate bleeding cessation was noted in 79.0% of cases, recurrence in 39.9% of cases, and 26.4% of patients benefited from a repeat endoscopic hemostasis treatment. A total of 34 (23.0%) patients required a non-endoscopic treatment. At day 30, the survival rate was 71.6%. Only one complication was reported (perforation).

Conclusions Hemostatic powder application by an on-call endoscopist during non-working hours is feasible, with satisfactory outcomes given the severity of the illness of these patients.