We thank Wagner and Gittard1Wagner D.R. Gittard S. Hemostatic powder facts.VideoGIE. 2019; 4: 185Abstract Full Text Full Text PDF Scopus (1) Google Scholar for the opportunity to clarify our statement about known adverse events associated with hemostatic powder. Our VideoGIE abstract details the step-by-step use of hemostatic powder highlighting a case of a bleeding GI stromal tumor recalcitrant to other endoscopic hemostatic techniques, successfully bridged to definitive surgical therapy.2Storm A.C. Sawas T. Higgins T. et al.Step-by-step use of hemostatic powder: treatment of a bleeding GI stromal tumor.VideoGIE. 2019; 4: 5-6Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar The commenters are correct in stating that colonic obstruction has not been reported for the device used in the video (Hemospray; Cook, Winston-Salem, NC, USA). Bowel obstruction has been reported with other surgical hemostatic matrices,3Clapp B. Santillan A. Small bowel obstruction after FloSeal use.JSLS. 2011; 15: 361-364Crossref PubMed Scopus (21) Google Scholar and we, therefore, believe it remains a theoretic risk to consider in the treatment of patients who have recently undergone hemostatic powder treatment. To mitigate this risk, the company recommends limiting the number of devices to 3, or 60 grams of bentonite powder in total, within a single session. It is worth mentioning that 1 study of the device, sometimes with the use of doses more than twice the currently recommended dose, did not report any occurrence of bowel obstruction.4Sung J.J. Luo D. Wu J.C. et al.Early clinical experience of the safety and effectiveness of hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding.Endoscopy. 2011; 43: 291-295Crossref PubMed Scopus (177) Google Scholar As we previously mentioned, biliary obstruction and perforation are adverse events previously reported with the use of hemostatic powder.5Moosavi S. Chen Y.I. Barkun A.N. TC-325 application leading to transient obstruction of a postsphincterotomy biliary orifice.Endoscopy. 2013; 45: E130Crossref PubMed Scopus (19) Google Scholar, 6Smith L.A. Morris A.J. Stanley A.J. The use of hemospray in portal hypertensive bleeding: a case series.J Hepatol. 2014; 60: 457-460Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 7Yau A.H. Ou G. Galorport C. et al.Safety and efficacy of hemospray in upper gastrointestinal bleeding.Can J Gastroenterol Hepatol. 2014; 28: 72-76Crossref PubMed Scopus (60) Google Scholar, 8Hagel A.F. Albrecht H. Nagel A. et al.The application of hemospray in gastrointestinal bleeding during emergency endoscopy.Gastro Res Pract Epub. 2017 Jan 23; Google Scholar As such, we stand by our warning for the theoretic risk of cholangitis, particularly if hemostatic powder is used in or near the biliary orifice, and would advise caution when considering use of the device in these areas. Hemostatic powder factsVideoGIEVol. 4Issue 4PreviewWe read with interest the VideoGIE article by Storm et al1 from Mayo Clinic Rochester. The case shows the unique benefits of Hemospray in offering durable hemostasis for bleeding that is resistant to conventional treatments, even in the setting of dual antiplatelet therapy. We commend the authors for their persistence in providing a positive outcome for this patient. However, we noted several errors that should be corrected because they do not accurately reflect the potential adverse events that may result from Hemospray treatment. Full-Text PDF Open Access