Sa1226 USE OF HEMOSTATIC POWDER (TC-325) IN PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING AT A TERTIARY CENTER: A CASE SERIES

Abstract

Upper gastrointestinal bleeding remains an important medical problem nowadays. Despite recent advances in endoscopic treatment, up to 30% of the patients will present treatment failure or recurrence of bleeding, with up to 10% of mortality. The hemostatic powder TC-325 is a novel hemostatic method with good efficacy in previous studies. However, few patients have been treated with TC-325 and the best clinical scenarios for its use are still to be determined. Evaluate the effectiveness of TC-325 by determining the immediate hemostasis rate (IHR) and the early and late rebleeding rates, and associated adverse events in patients with upper gastrointestinal bleeding. This is prospective observational case series. All patients with upper gastrointestinal bleeding treated with TC-325 from December 2015 to September 2017 were included in this study. Immediate hemostasis was defined as complete cessation of the bleeding by the end of the endoscopic procedure. Rebleeding was defined as hematemesis or melena with a hemoglobin loss of at least 3 g/dL compared to the post procedure hemoglobin level. Rebleeding was classified in early (3 days after the procedure) and late (after 3 days). The TC-325 was used as first-line or salvage therapy at the discretion of the endoscopist. The follow-up period was 30 days. Thirty patients werncluded (mean age 55,7 years), including 3 pediatric patients. TC-325 was used as first-line therapy in 17 patients (56,7%) and as salvage therapy in thirteen (43,3%). In twenty-three patients (76,7%) the procedure was performed in the ICU. Twenty-five (83,3%) had bleeding from benign lesions; while five (16,7%) had bleeding tumors. The benign bleeding lesions included 6 duodenal ulcers, 3 gastric ulcers, 2 anastomosis, 2 esophageal ulcers, 1 GAVE, 1 jejunal ulcer in a patient with altered anatomy and 5 post stem cell transplantation patients with graft-versus-host disease (GVHD). The malignant bleeding lesions included 1 gastric adenocarcinoma, 1 duodenal neuroendocrine tumor, 1 metastatic colon adenocarcinoma, 1 duodenal invasion by pancreatic cancer and 1 esophageal squamous cell carcinoma. The immediate hemostasis rate was 100%. The early rebleeding rate was 23,3 %. The late rebleeding rate was 16,7 %. There were no adverse events related to the use of TC-325 hemostatic powder. One patient died due to massive rebleeding (3,3%). TC-325 hemostatic powder achieved primary hemostasis in all patients. Early and late rebleeding rates were 23,3% and 16,7% respectively. This reveals an overall high rebleeding rate. There were no adverse events directly associated with the use of TC-325. Hemostatic powders may play an important role in patients with diffuse, malignant or GVHD associated bleeding.Large duodenal ulcer caused by CMV infection. A - Persistent bleeding after epinephrine injection, electrocoagulation and hemoclip deployment. B- Hemostasis after use of TC-325 .View Large Image Figure ViewerDownload Hi-res image Download (PPT)