Efficacy Of Hemostasis Research Articles

The role of in-hospital protocols in diagnosis and treatment of ulcerative gastroduodenal bleeding

To improve immediate results in patients with acute ulcerative gastroduodenal bleeding. The study enrolled 91 patients with ulcerative gastroduodenal bleeding. Diagnostic and curative procedures should be related to hospital's equipment, specialists' qualification and comprehensive development and application of accepted tactical approaches. 20-year development of this protocol which includes original low-temperature irrigator of stomach and duodenal mucous membranes, objective choice of endoscopic hemostasis technique depending on bleeding source in gastroduodenal wall, early administration of proton pump inhibitors significantly increases efficacy and reliability of endoscopic hemostasis. It was followed by improved early outcomes: recurrent bleeding incidence was 4.2%, surgical activity decreased by 68% up to 13.2%, overall and postoperative mortality was 2.2% and 8.3% respectively.

Cost-effectiveness analysis of a sealing hemostat patch (HEMOPATCH) vs standard of care in cardiac surgery

Background: A recent randomized controlled trial showed that patients undergoing ascending aorta surgery treated with HEMOPATCH to control bleeding had a significantly better hemostasis success rate than with dry or wet gauze compression or similar standard of care (SOC).Objective: To compare the cost-effectiveness using two different agents for hemostasis (HEMOPATCH vs dry or wet gauze compression or similar SOC) in cardiac surgery from the European hospital perspective.Methods: A literature-based cost-effectiveness model estimating average cost per successful hemostasis event was developed based on the hemostasis efficacy difference (HEMOPATCH = 97.6%, SOC = 65.8%, p < .001). Additional clinically significant end-points studied in the trial (blood transfusions and surgical revisions) were also analyzed. It was assumed that each surgery utilized two units of HEMOPATCH (dimensions of 4.5 × 9 cm) and two units of SOC. Product acquisition costs for HEMOPATCH and SOC were included along with outcome-related costs derived from the literature and inflation-adjusted to 2017 EUR and GBP. Results are presented for an average hospital with an annual case load of 574 cardiac surgeries. One-way and probabilistic sensitivity analyses were performed.Results: Considering only product acquisition cost, HEMOPATCH had an incremental cost-effectiveness ratio (ICER) of €1,659, €1,519, €1,623, and £1,725 per hemostasis success when compared to SOC for Italy, Spain, France, and the UK, respectively. However, when considering the cost and potential difference in the frequency of transfusions and revisions compared to SOC, the use of HEMOPATCH was associated with an annual reduction of six revisions and 60 transfusions, improving the ICER to €1,440, €1,222, €1,461, and £1,592, respectively. Sensitivity analysis demonstrated model robustness.Conclusions: This analysis supports the use of HEMOPATCH over SOC in cardiac surgery in European hospitals to improve hemostasis success rates and potential cost offsets from reduced transfusions, complications, and surgical revisions.

Experience of application of extraperitoneal pelvic packing in unstable pelvic ring injuries

OBJECTIVE. Clinical efficacy of extraperitoneal pelvic packing for hemostasis was assessed in patients with unstable pelvic ring injuries and signs of unstable hemodynamics. MATERIAL AND METHODS. The results of treatment were analyzed in 19 patients with hemodynamically unstable pelvic ring injuries. Extraperitoneal pelvic packing was applied in order to stop bleeding after mechanical pelvic stabilization. The evaluation of hemostasis efficacy was performed by using computerized helical tomography with intravenous contrast. RESULTS. The extraperitoneal pelvic packing allowed doctors to achieve stop of bleeding in 14 (73,7 %) patients. CONCLUSIONS. Complex of mechanical stabilization and extraperitoneal pelvic packing of damaged pelvic ring could be actively used in cases of severe injuries for victims in critical conditions.

Analysis of the hemostatic potential of modern topical sealants on arterial and venous anastomoses: an experimental porcine study

One of the widely accepted adjunctive agents in the variety of surgical modalities are sealants. Our study aim was to compare four commonly used modern sealants in a standardized experimental setting to assess their feasibility, and hemostatic efficacy in vascular anastomosis. Forty landrace pigs (weight: 24.7 ± 3.8 kg) were randomized into the control (n = 8) and four sealant groups; TachoSil® (n = 8), Tissucol Duo® (n = 8), Coseal® (n = 8), and FloSeal® (n = 8). After doing a portal vein end-to-end anastomosis as well as stitches of aortic incision, the sealants were applied on anastomotic site. The control group was left intact. In portal vein anastomosis, the sealants led to a complete hemostasis significantly better than control group. The mean of blood loss was also significantly reduced. In successful subgroups, there was a difference in the mean-time to reach complete hemostasis ranging from 15 s in Coseal® to 76 s in FloSeal® group (p < 0.05). In aortotomy experiments, except Tissucol Due®, which had insufficient hemostasis, other sealants led to a complete hemostasis. The mean blood loss was significantly reduced in sealants groups as well. The four sealants are effective in reducing the suture-hole bleeding in portal vein anastomosis. However, the hemostatic potential is heterogeneous among sealants. This means that "one-size-fits-all" approach is not appropriate for application of sealants in diversity of vascular surgery and it should be based on the type and the severity of injury and the structure of tissue. Comparison of hemostasis efficacy of four modern sealants (TachoSil®, Tissucol Duo®, Coseal®, and FloSeal®) in vascular anastomosis in porcine model. The figures below show the total blood loss (g) in the control and sealant groups after aortotomy (left) and portal vein anastomosis (right). The mean of blood loss decreased significantly by the usage of sealants in both experiment groups as compared to control group (*: p < 0.05; sealant groups vs. control group). 1. The right column shows the mean of blood loss (g) in all experiments in each group. 2. The middle column presents the subgroup with unsuccessful hemostasis at the end of observation time (Tmax = 20 sec. for aortotmy and 300 sec. for portal vein anastomosis). 3. The left column shows mean of total blood loss in subgroups with successful hemostasis during observation time (20 sec for aortotomy and 300 sec for portal vein).

Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial.

BackgroundArterial access and hemostasis are important processes during percutaneous coronary procedures. In this study, we tested if the use of chitosan-based pads on top of compression devices could improve hemostasis efficacy compared with compression devices alone after transradial coronary angiography or interventions.MethodsThis study was a single-center open-label randomized controlled trial. Patients who underwent coronary angiography or intervention with the transradial approach were randomly assigned to the study (compression device and a chitosan-based pad) or control (compression devices alone) group in a 2:1 fashion. The primary endpoint was time to hemostasis, categorized into ≤5, 6–10, 11–20, and >20 minutes.ResultsBetween April and July 2016, 95 patients were enrolled (59 were assigned to the study arm and 36 to the control arm). Time to hemostasis, the primary endpoint, was significantly lower in the study group than in the control group (p<0.001). Both groups showed low rates of vascular complications.ConclusionsThis study suggests that the use of a hemostasis pad in combination with rotatory compression devices is a safe and effective hemostasis strategy after radial artery access.Trial registrationClinicalTrials.gov NCT02954029

Analysis of clinical efficacy of recombinant activated factor Ⅶ on bleeding in patients with hematologic disorders

目的研究重组人凝血因子Ⅶa（rFⅦa）治疗血液病患者出血的疗效。方法回顾性分析rFⅦa治疗31例血液病患者共38次出血的临床资料。结果rFⅦa治疗获得性血友病A（AHA）/血友病伴抑制物、急性早幼粒细胞白血病（APL）、急性非APL白血病患者出血的总体有效率分别为90%（9/10）、71.4%（5/7）、60.0%（3/5），高于造血干细胞移植后患者（30.8%）；rFⅦa治疗评分为2分出血的有效率（100.0%）高于3分（66.7%）及4分（51.6%）出血；5例次颅内出血中2例次（25.0%）有效；9例次血尿中6例次（66.7%）有效；12例次消化道出血中5例次（41.7%）有效。3例次关节及肌肉出血的疗效均为极好，5例次出血部位为皮肤、鼻黏膜、咽部及齿龈，疗效均为极好；移植后患者在出血评分为4分时，高剂量以及多次使用rFⅦa并不一定能取得好的疗效。AHA/血友病伴抑制物及急性白血病患者合并的出血，在评分为4分时，使用低剂量rFⅦa能取得好的疗效，但最低用药剂量（22.5 µg/kg）的疗效差。结论rFⅦa的止血疗效受疾病类型、出血部位以及严重程度等多个因素的影响。rFⅦa对AHA/血友病伴抑制物以及急性白血病患者的出血具有较好的疗效，但对移植后患者的出血疗效欠佳。出血早期使用rFⅦa对于疗效至关重要。在止血治疗的同时，应积极治疗基础疾病。

Clinical efficacy of recombinant activated factor Ⅶ a for 16 hematonosis with moderate or severe bleeding

目的观察重组人凝血因子Ⅶa（rFⅦa）对血液病及其异基因造血干细胞移植（allo-HSCT）术后出血患者的止血疗效。方法以2013年5月至2016年5月住院治疗的16例合并中至重度出血的血液病患者为观察对象，非移植组及移植组患者各8例，两组患者应用rFⅦa的用法、用量无明显差异。同时，以同期15例allo-HSCT后发生肠道急性移植物抗宿主病（aGVHD）肠出血患者为对照组（未应用rFⅦa），将其与allo-HSCT后肠道aGVHD肠出血应用rFⅦa患者进行生存比较，总结患者应用rFⅦa治疗的临床疗效。结果①非移植组与移植组患者中，rFⅦa止血显效率分别为75.0%（6/8）和37.5%（3/8），显效中位时间分别为38.5和63.0 h，中位总生存（OS）时间分别为201.0和29.0 d，OS率分别为50.0%（4/8）和25.0%（2/8），出血相关死亡率分别为50.0%（2/4）和83.3%（5/6）。②16例患者中显效者9例，无效者7例，显效组与无效组患者中，中位OS时间分别为268.0和24.0 d，OS率分别为66.7%（6/9）和0（0/7）。③同期肠道aGVHD合并肠出血患者，观察组（6例）与对照组（15例）患者的中位OS时间分别为25.5和20.0 d。结论血液病患者尤其是allo-HSCT患者出血相关死亡率高，rFⅦa治疗有一定止血疗效；显效组患者OS率较无效组高；allo-HSCT后肠道出血患者采用rFⅦa治疗止血效果不佳的原因可能与移植后导致出血的并发症控制不佳有关。

Transcatheter embolization in prevention of recurrent bleeding from stomach ulcers

To evaluate an efficacy of endovascular hemostasis in patients with gastric ulcerative bleeding and high risk of recurrent bleeding and death. The work is based on a study of the results in 30 patients with gastric ulcerative bleeding, high risk of recurrent bleeding (rebleeding forecast system (RFS) score over 17) and high risk of death (SAPS II score over 30). We attempted transcatheter embolization of left gastric artery to prevent rebleeding. The control group consisted of 60 patients with gastric ulcerative bleeding and the same RFS and SAPS II values in whom angiography and endovascular hemostasis were not performed. Technical success of endovascular hemostasis was achieved in 25 (83.3%) cases. In 5 cases embolization was not performed. Complications after transcatheter angiography and embolization were absent. Recurrent bleeding after technically successful embolization was observed in 3 (12.0%) patients. In all cases PVA microemboli were used. Mortality was 11.1% (3 patients). Endovascular hemostasis in patients with severe comorbidities (SAPS II score over 30) and high risk of rebleeding (RFS score over 17) reduced incidence of recurrent bleeding from 36.7% to 11.1%.

Clinical features of postoperative anastomotic bleeding after gastrectomy and efficacy of endoscopic hemostasis: a case-control study.

Postoperative anastomotic bleeding (PAB) is relatively rare; however, it can be lethal if not treated immediately. The aim of our study was to investigate the clinical features of PAB and the efficacy of endoscopic hemostasis (EH) for PAB. Between January 2004 and May 2013, 16,591 patients underwent gastrectomy for gastric cancer at Asan Medical Center. Among them, 36 patients who experienced PAB within 2months after the gastrectomy were enrolled as a case group. Each subject was matched at a ratio of 1:5 with randomly selected patients without bleeding during the same period (n=180, control group). The clinical outcomes and risk factors for patients with PAB were compared with those of the control group, and the results of EH were evaluated retrospectively. The incidence of PAB was 0.22% (n=36), and the median duration from gastrectomy to PAB was 34.5h (interquartile range, 12.3-132.8h). EH was attempted in 25 patients (69.4%); surgery was performed in 6 patients (16.7%); and conservative management was applied in 5 patients (13.9%). PAB-related death occurred in three patients (8.3%; one in each treatment modality). Among 25 patients with primary EH, 16 were treated successfully (64%) and hemoclip was the most commonly used endoscopic tool (52%). In the multivariate analysis, the type of gastrectomy was found to be a risk factor for PAB (odds ratio 3.448, 95% confidence interval, 1.138-10.448, p=.029). Although PAB is an infrequent and potentially life-threatening complication, endoscopy can be considered as a useful method to avoid additional surgery in properly selected patients.

Efficacy of Endoscopic Hemostasis with Soft Coagulation Using Hemostatic Forceps for Upper Gastrointestinal Bleeding over a 12-year Period: 2016 ACG Presidential Poster Award

Introduction: The endoscopic submucosal dissection (ESD) technique was introduced to obtain en bloc specimens of early gastric cancer. Endoscopic high-frequency soft coagulation is used to manage visible bleeding and/or nonbleeding vessels during ESD. Upper gastrointestinal bleeding (UGIB) is the most common gastroenterological emergency, and has a considerable morbidity and mortality. This study aimed to compare the etiology and clinical outcome of nonvariceal UGIB between two periods during the last 12 years. Methods: The present retrospectively study evaluated the medical records of patients who underwent emergency endoscopic hemostasis for nonvariceal UGIB from 2003 to 2014. The patients were divided into two periods: the first period was from 2003 to 2008 and the second period was from 2009 to 2014. The study revealed the characteristics of these patients and compared the treatment outcome of endoscopic hemostasis between soft coagulation and other modalities. In addition, endoscopic hemostasis rate was compared between specialists and trainees. The specialists already had the fundamental skills and knowledge needed for ESD, and each specialist assisted more than 40 gastric ESD procedures. Results: 566 patients underwent emergency endoscopy with nonvariceal UGIB. Among the 502 out of 566 patients who underwent endoscopic hemostasis, 197 were in the first period and 305 patients were in the second period. Whereas peptic ulcer lesions were the main cause of bleeding (89.4%) during the whole study period, small and multiple ulcers in addition to duodenal ulcers significantly increased in the second period. Endoscopic hemostasis was successfully performed in 97.0% in the first period and in 95.4% in the second period with no significant difference between the periods. In the modality of hemostasis, the rate of endoscopic hemostasis with soft coagulation using the ESD technique significantly increased in the second period compared to the first period (71.1% vs.11.7%, p < 0.001). The rate of endoscopic hemostasis performed by trainees was significantly higher in the second period than in the first period (76.1% vs.56.3%, p < 0.001). Rebleeding after endoscopic hemostasis decreased in the second period (9.8%) compared to the first period (15.7%). Conclusion: This retrospective study suggested that endoscopic hemostasis with soft coagulation using the ESD technique was safe even performed by trainees and might lead to a lower rebleeding rate after endoscopic hemostasis for UGIB.

Mo1366 Clinical Features of Postoperative Anastomotic Bleeding After Gastrectomy and Efficacy of Endoscopic Hemostasis

Mo1366 Clinical Features of Postoperative Anastomotic Bleeding After Gastrectomy and Efficacy of Endoscopic Hemostasis

Salt stress changes chemical composition in Limonium bicolor (Bag.) Kuntze, a medicinal halophytic plant

In order to understand the response mode of the main chemical compounds to salt-stress, the chemical compositions in leaves and roots of NaCl-treated Limonium bicolor (Bag.) Kuntze, a medicinal halophytic plant with efficacy of blood enriching and hemostasis, were determined by UPLC-Q-TOF-MS2 and HPLC, and compared to the control, the expression analysis of chalcone synthase (CHS) gene under salt-stress was also carried out by quantitative real-time PCR. As a result, eleven chemical constituents including triethyl citrate (1), gallic acid (2), vanillic acid (3), vanillic acid derivative (4), vanillic acid-hexose (5), N-(2-carboxyethyl) iminodiacetic acid (6), epigallocatechin gallate (7), myricetin-3-O-glucoside/galactoside (8), myricetin-3-O-rhamnoside (9), quercetin-3-O-rhamnoside (10) and myricetin-3-O-(O-galloyl)-rhamnoside (11) were identified, and showed that NaCl-stress can induce accumulation changes of these compounds. Among them, compound 9 showed the highest abundance both in leaf and root of L. bicolor, which can be markedly enhanced in root by NaCl-stress. CHS gene was sensitive to NaCl-stress, its expression level was up-regulated in leaf while inhibited in root by NaCl-stress. These results will provide references for further research of the directional induction of medicinal active ingredients and the salt response mechanism of secondary metabolism in medicinal halophyte L. bicolor.

Efficacy of Endoscopic Hemostasis for Upper GI Bleeding in Very Elderly Patients

Efficacy of Endoscopic Hemostasis for Upper GI Bleeding in Very Elderly Patients

PMD79 - Hemostasis efficacy of evarresttm compared to Tachosil® in Liver and other Surgical Bleeding: an indirect comparison

PMD79 - Hemostasis efficacy of evarresttm compared to Tachosil® in Liver and other Surgical Bleeding: an indirect comparison

Comparison of hemostatic forceps with soft coagulation versus argon plasma coagulation for bleeding peptic ulcer--a randomized trial.

Endoscopic high-frequency soft coagulation is used to manage visible bleeding or nonbleeding vessels during endoscopic submucosal dissection. The aim of the present study was to compare the efficacy of hemostasis by soft coagulation (using hemostatic forceps) with argon plasma coagulation (APC), in a prospective randomized trial. From January 2013 to June 2014, 276 patients were randomly assigned into two groups: epinephrine injection plus APC (the APC group); or epinephrine injection plus soft coagulation using hemostatic forceps (the HFSC group). As the primary outcome we compared recurrent bleeding rates within 30 days after initial hemostasis in a noninferiority design. After exclusion, 75 patients in the APC group and 76 in the HFSC group were finally evaluated. In the APC group 72 patients (96 %) were successfully treated with the assigned treatment alone vs. 73 (96 %) in the HFSC group. Initial endoscopic hemostasis using a single or combined modality was achieved in all patients. Recurrent bleeding within 30 days was experienced by five patients (6.7 %) and seven patients (9.2 %) in the AFC and HFSC groups, respectively (P = 0.563), and within 7 days by three patients (4.0 %) and five patients (6.6 %), respectively (P = 0.719). We found no significant difference in the rates of adverse events (1.3 % vs. 2.6 %) or mortality (2.7 % vs. 2.6 %) between the groups. The efficacy and safety of soft coagulation using endoscopic hemostatic forceps is not inferior to APC when used to treat patients with bleeding peptic ulcers. Clinicaltrials.gov NCT02020603.

Protein interaction network analysis of Panax notoginseng saponins

Panax notoginseng (PN) is one of the commonly used clinical medicines for cardiovascular diseases and possesses a variety of pharmacological effects. P. notoginseng saponins (PNS) are the most important bioactive components in PN. The purpose of this study was to explain the mechanism of PNS on molecular network level. 18 targets of the main medicinal ingredients of PNS were gained by virtual screening based on pharmacophores and data mining. A protein interaction network of PNS was constructed with 189 nodes and 721 interactions. By a graph theoretic clustering algorithm Molecular Complex Detection (MCODE), 14 modules were detected. Gene ontology (GO) enrichment analysis of the modules demonstrated that the roles of PNS played in cardiovascular disease related to multiple biological processes, which could represent the characteristics of traditional Chinese medicine (TCM) as a whole to regulate the disease. The results showed that the blood circulation and hemostasis efficacy of PN related with the biological processes such as positive regulation of cAMP metabolic and biosynthetic process, platelet activation and regulation of blood vessel size, regulation of T cell proliferation and differentiation and so on. Therefore, the module-based network analysis will be an effective method for better understanding TCM.

Sa1610 Efficacy of Hemostasis by Soft Coagulation Using Endoscopic Hemostatic Forceps in Comparison With Argon Plasma Coagulation for Acute Peptic Ulcer Bleeding: Preliminary Results of a Prospective Randomized Trial

Endoscopic high-frequency soft coagulation is available for the management of bleeding or nonbleeding visible vessels during endoscopic submucosal dissection. However, its efficacy on peptic ulcer bleeding has not been elucidated so far. The aim of this study was to evaluate the efficacy of hemostasis with soft coagulation using hemostatic forceps by comparing it with argon plasma coagulation (APC) in a prospective, randomized trial.

Platycladus orientalis leaves: a systemic review on botany, phytochemistry and pharmacology.

Platycladus orientalis leaves (Cebaiye) have been used for thousands of years as traditional Chinese medicine (TCM). According to the theory of TCM, they are categorized as a blood-cooling and hematostatic herb. In clinical practice, they were usually prescribed with heat-clearing herbs to reinforce the efficacy of hemostasis. The review provides the up-to-date information from 1980 to present that is available on the botany, processing research, phytochemistry, pharmacology and toxicology of the leaves. The information is collected from scientific journals, books, theses and reports via library and electronic search (Google Scholar, Pubmed and CNKI). Through literature reports, we can find that the leaves show a wide spectrum of pharmacological activities, such as anti-inflammatory, antioxidant, antimicrobial, disinsection, anticancer, diuretic, hair growth-promoting, neuroprotective and antifibrotic activities. Diterpene and flavonoids would be active constituents in P. orientalis leaves. Many studies have provided evidence for various traditional uses. However, there is a great need for additional studies to elucidate the mechanism of blood-cooling and hematostatic activity of the leaves. Therefore, the present review on the botany, traditional uses, phytochemistry and toxicity has provided preliminary information for further studies of this herb.

Efficacy of Hemostasis for Epidural Venous Plexus and Safety for Neural Structure Using Soft Coagulation System in Spinal Surgery

A laboratory investigation using porcine model. To clarify the effectiveness of the soft coagulation system for stopping bleeding from the epidural vein using different outputs and the safety in terms of tissue damage including spinal cord injury. Problems associated with coagulation using an electrosurgical device, such as carbonization of tissue or adhesion to the electrode, have been highlighted. So called "soft coagulation" has been developed to solve these problems. Its' utility as well as the safety of the neural structure in spine surgery has never been reported. A total of 3 animals and 45 spinal segments were used. Total laminectomy was performed to expose the dural tube and epidural venous plexus. Stable bleeding was induced by a 22 G needle puncture. Soft coagulation monopolar output (SCM), soft coagulation bipolar output (SCB), and conventional bipolar output (CB) were used as the coagulators. Valid hemostasis was defined as macroscopically complete bleeding stoppage by coagulation within 3 minutes. The neurological assessment was evaluated by somatosensory evoked potential. Histologic analysis was performed to determine the area of thermal damage. Valid hemostasis ratio was 75.0% of SCM group, 68.8% of SCB group, and 30.8% of CB group. Somatosensory evoked potential monitoring revealed that spinal cord injury was observed in 4 lesions (25%) of the SCM group. Neither bipolar groups (SCB and CB) showed any changes in waveform pattern. Histologic analysis revealed that severe thermal damages were observed in the epidural space of the SCM group. The usefulness of soft coagulation is revealed in terms of bleeding stoppage from epidural vessels and reduced soft-tissue damage compared with the conventional electric device. However, assessing the potential risk of severe neural tissue damage including spinal cord injury, a bipolar soft coagulation is strongly recommended for use in spine surgery.

A multi-centre proof of concept study to assess efficacy and safety of endoscopic hemostasis with combined activated Factors IIa, VIIa, IXa and Xa (Seraseal/Fastact ®) in patients with acute gastrointestinal bleeding

Introduction: Endoscopic treatment of severe gastrointestinal bleeding can be difficult and high technical expertise is required. A simple and effective method of endoscopic hemostasis would have a significant impact on treatment success. Aim of the study is to assess the efficacy and safety of endoscopic hemostasis with combined activated factors IIa/VIIa/IXa/Xa (Seraseal, Wortham Laboratories, USA). Methods: Patients with active gastrointestinal bleeding were included. 5 ml Seraseal was topically applied via a standard delivery catheter to the bleeding site. In group A, Seraseal was applied as intital method for hemostasis. The site was then observed for 5 minutes. If bleeding remained active, the institutional standard of care for hemostasis was applied. In group B, Seraseal was applied after an initial failure of the institutional standard method. If bleeding remained active, alternative methods of hemostasis were applied. After successful hemostasis, patients were monitored for signs of recurrent bleeding or adverse effects for 72 hours. Endoscopy was performed if rebleeding was suspected. Results: 36 patients (mean age 69 y, 26 men) were included. Bleeding was stopped with Seraseal as initial hemostatic procedure in 17 of 24 patients (71%). Institutional standard stopped bleeding in 5 of the remaining 7 patients, 2 patients had to undergo coiling and surgery for definite hemostasis. In group B 12 patients with unsuccessful initial endoscopic treatment approach (clip in 4, suprarenin injection in 2, fibrin glue, band ligation and argon plasma coagulation in 1, combination in 3), addition of Seraseal was able to definitely stop the bleeding in 9 out of 12 patients (75%), in the remaining 3 patients additional endoscopic methods stopped the bleeding. Nine patients received red packed blood cells. No recurrence of bleeding was noted. Conclusion: The topic application of Seraseal on the bleeding site might be a valuable alternative or addition to conventional endoscopic hemostatic strategies.