Gastroenterology Unit, Department of Systems Medicine, University Tor Vergata, 00133 Rome, Italy.
Gastroenterology Unit, Department of Medical Sciences, University Tor Vergata Hospital, 00133 Rome, Italy.
Medicina (Kaunas). 2023 Jan 11;59(1):143. doi: 10.3390/medicina59010143.
Hemostatic powder (HP) is a relatively recent addition to the arsenal of hemostatic endoscopic procedures (HEPs) for gastrointestinal bleeding (GIB) due to benign and malignant lesions. Five types of HP are currently available: TC-325 (Hemospray™), EndoClot™, Ankaferd Blood Stopper, and, more recently, UI-EWD (Nexpowder) and CEGP-003 (CGBio™). HP acts as a mechanical barrier and/or promotes platelet activation and coagulation cascade. HP may be used in combination with or as rescue therapy in case of failure of conventional HEPs (CHEPs) and also as monotherapy in large, poorly accessible lesions with multiple bleeding sources. Although the literature on HP is abundant, randomized controlled trials are scant, and some questions remain open. While HP is highly effective in inducing immediate hemostasis in GIB, the rates of rebleeding reported in different studies are very variable, and conditions affecting the stability of hemostasis have not yet been fully elucidated. It is not established whether HP as monotherapy is appropriate in severe GIB, such as spurting peptic ulcers, or should be used only as rescue or adjunctive therapy. Finally, as it can be sprayed on large areas, HP could become the gold standard in malignancy-related GIB, which is often nonresponsive or not amenable to treatment with CHEPs as a result of multiple bleeding points and friable surfaces. This is a narrative review that provides an overview of currently available data and the open questions regarding the use of HP in the management of non-variceal upper GIB due to benign and malignant diseases.
止血粉 (HP) 是最近用于胃肠道出血 (GIB) 的良性和恶性病变的止血内镜程序 (HEPs) 的相对较新的手段。目前有五种类型的 HP：TC-325（Hemospray™）、EndoClot™、Ankaferd Blood Stopper，以及最近的 UI-EWD（Nexpowder）和 CEGP-003（CGBio™）。HP 作为机械屏障和/或促进血小板激活和凝血级联反应。HP 可与传统 HEPs（CHEPs）联合使用或作为其失败时的抢救治疗，也可作为有多个出血源的大而难以到达的病变的单一疗法。尽管有关 HP 的文献很多，但随机对照试验很少，一些问题仍未解决。虽然 HP 在诱导 GIB 立即止血方面非常有效，但不同研究报告的再出血率差异很大，并且影响止血稳定性的条件尚未完全阐明。尚未确定 HP 作为单一疗法是否适用于严重的 GIB，例如喷射性消化性溃疡，或者是否仅应作为抢救或辅助治疗。最后，由于它可以喷在大面积上，因此 HP 可能成为与恶性肿瘤相关的 GIB 的金标准，由于存在多个出血点和脆弱表面，这种疾病通常对 CHEPs 治疗反应不佳或无法治疗。这是一篇叙述性综述，概述了目前关于 HP 在治疗良性和恶性疾病引起的非静脉曲张性上 GIB 方面的应用的现有数据和悬而未决的问题。
