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Hemostatic powder effectively treats acute variceal bleeding
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A hemostatic powder applied during an upper endoscopy as an early intervention was effective for treating acute variceal bleeding in patients with liver cirrhosis, according to research published in Gut.
Mostafa Ibrahim, MD, of the department of gastroenterology, hepatopancreatology and digestive oncology at Erasmus Hospital in Brussels, and colleagues wrote that using hemostatic powder could change the way these patients are managed, particularly at centers where advanced endotherapy is not available.
“The most life-threatening complication of liver cirrhosis is acute variceal bleeding (AVB), which is associated with increased mortality that, despite recent progress in management, is still around 20% at six weeks,” they wrote. “Data from bleeding registries show that a significant proportion of patients with AVB have a delay of greater than 24 hours before undergoing upper endoscopy, mainly due to the lack of experienced endoscopists.”
Ibrahim and colleagues conducted a study of 86 patients with AVB and treated them with standard medical therapy before randomly assigning them 1:1 to either a treatment group or control group. The treatment group underwent immediate endoscopy using hemostatic powder within 2 hours of admission, followed by early elective endoscopy the next day (n = 43). The control group only received drug therapy on admission followed by elective endoscopy the next day (n = 43).
Clinicians administered the hemostatic powder using the Hemospray device (Cook Medical), which the FDA recently approved for use in some types of gastrointestinal bleeding, but not variceal bleeding in the United States.
The researchers found that 5 patients in the hemostatic powder group required rescue endoscopy compared with 13 patients in the control group (12% vs. 30%; P = .034). They also found that 6-week survival was significantly better in the study group compared with the control group (7% vs. 30%; P = .006).
The investigators wrote that this technique of early endoscopic intervention in AVB could be beneficial to many patients because using the Hemospray device does not require direct visualization of the bleeding site.
“Our study introduces a new concept of early, simple, therapeutic procedure that might be offered in places where expertise in endoscopic therapy is not available 24/7 and that would allow to safely bridge to more definitive therapy with a potential effect on overall outcomes (including mortality), the latter still having to be confirmed,” they concluded. – by Alex Young
Disclosures: The study was funded in part by Cook Medical. Ibrahim reports that he received an educational grant from Cook Medical. Please see the full study for the other authors’ relevant financial disclosures.
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