How we spray. TC-325 survival guide: Tips and tricks

Aims We aim to present a thorough guide on application of TC-325 hemostatic powder in clinical practice.

Methods We aspire to showcase an assortment of tips and tricks, (modified) techniques and pitfalls to avoid when using TC-325 based on existing literature and our own experience.

Results Phase 1: Endoscopy. Following identification of the bleeding lesion select the appropriate hemostatic method. Malignancy: If no active bleeding at time of endoscopy we water jet the tumor to induce bleeding. If no bleeding occurs, we do not spray. Appropriate selection of catheter: 7fr pros: More controlled delivery – less likely to induce ‘’snowstorm’’ effect.10fr pros: High-volume performance at the cost of control / snowstorm. Phase 2: Suction. Finish up suctioning of content (blood, water etc). Keep lumen semi-deflated to compensate for CO2 insufflation during phase (P)4. Disconnect wall / pump suction to avoid inadvertent suctioning during P3 that could occlude catheter. Phase 3: Preparation. Drying of working channel. Use 2 – 3 x 60cc syringe air for gastroscope and 5 – 6 x 60cc for colonoscopes. AVOID KINKING THE CATHETER AT ALL COSTS (extra care with the 7fr catheter).Uncork or remove completely the instrument channel cap !!Gentle moves – progress catheter very slowly. Apply positive air pressure to the working channel during insertion by blowing gently air from a syringe attached to the catheter. This will ensure that any residual moisture in the working channel will not enter the catheter (other authors connect it to the CO2 pump).Care not to dip the catheter into liquid upon exiting the distal tip. Exit at a safe distance (pre-position accordingly). Phase 4: Spraying Use a maximum of 2-3 devices, less if risk of perforation. If used correctly, the content of a single device should be enough for most clinical scenarios. Take into consideration the working space and adjust spray time / burst control accordingly. Short bursts of<1sec might be ideal in confined spaces (eg linitis plastica). Extra care: Spraying near esophagogastric junction / anal canal especially in retroflexion carries the risk of endoscope impaction!! Minimize retroflexion, we use constant maneuvering of endoscope when spraying near these landmarks. Troubleshooting: Clogged catheter? 1) Use spare (Save previously unused catheters!!) 2) Unclog catheter with air 10cc syringe 3) Cutting-off the distal end of catheter has been described but is not encouraged cause of injury risk.4) In -house makeshift catheters have been proposed.

Conclusions By applying simple tips when using the hemostatic powder, we can improve the effectiveness of this technique and avoid (costly) mistakes [1] [2] [3] [4].

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 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 (03) 762-772.e2
• 2 Chahal D, Sidhu H, Zhao B, Jogendran M, Dahiya M, Tandon P, Donnellan F.. Efficacy of Hemospray (TC-325) in the Treatment of Gastrointestinal Bleeding: An Updated Systematic Review and Meta-analysis. J Clin Gastroenterol 2021; 55 (06) 492-498
• 3 Tetangco EP, Uy PP, Perry I, Ellison SB.. Preventing clogging of hemostatic powder during control of bleeding. VideoGIE 2020; 5 (07) 271-273
• 4 Storm AC, Sawas T, Higgins T. et al. Step-by-step use of hemostatic powder: treatment of a bleeding GI stromal tumor. VideoGIE 2018; 4 (01) 5-6

Publication History

Article published online:
15 April 2024