Tu1512 ASSESSING THE UTILIZATION AND EFFICACY OF HEMOSTATIC POWDER IN TREATING NON-VARICEAL GASTROINTESTINAL HEMORRHAGES

Abstract

In 2018, the FDA approved hemostatic powder as a therapeutic instrument to treat non-variceal gastrointestinal bleeding. Since this treatment modality has now been in use for approximately 12 months in the US we evaluated several aspects of its application, such as pattern of utilization, efficacy, trends in hemostasis techniques and patient outcomes. To assess the last 12 months of hemostatic powder utilization, and determine its efficacy of treating non-variceal gastrointestinal hemorrhages as compared to the current hemostatic modalities used in endoscopic procedures at a tertiary medical center. In a retrospective review of our endoscopic procedural database we identified 251 cases of suspected upper gastro-intestinal bleeding (UGIB) between 11/2018 and 11/2019. Cases with confirmed malignancies and those with low risk lesions that did not require endoscopic intervention were excluded. We collected data on immediate cessation of bleeding, as well as re-bleed rates at 24 hours and 7 days after procedure. Etiology was also noted, with Forrest classifications being attributed to peptic ulcers. We identified 74 patients with UGIB requiring endotherapy. Of those cases, hemostatic powder was applied in 23 (31%); in 17 (73%) as an upfront intervention prior to other therapies or as a single modality, and 6 (27%) in combination following other hemostatic interventions (epinephrine injection, hemostatic clips, thermal probe, and over-the-scope clips). Cases in which hemostatic powder was used had a 95.6% success rate of immediate hemostasis. This was not significantly different then in those when hemostatic powder was not used (95% success rate; N.S). There was a significant decrease in 7 day rebleed rates in the hemostatic powder group (26 vs 33%; p<0.05). Peptic ulcers accounted for 52.7% of the UGIB cases seen with intervention. Within that group, hemostatic powder application carried an immediate success rate of 90.9%, and a within 7-day rebleed rate of 18.1%; whereas UGIB cases without hemostatic powder intervention carried rates of 96.4% and 28.5% respectively (p<0.05). Our study shows that hemostatic powder is being used in close to 1/3 of high risk GI bleeding cases. Although in cases when hemostatic powder was used the immediate hemostasis was not different than in other cases, we did demonstrate a lower rebleed rate in benign non-variceal upper GI bleeds.