Use of the endoscopically applied hemostatic powder TC-325 in cancer-related upper GI hemorrhage: preliminary experience (with video)

o p h a p 4 Upper GI hemorrhage is a common complication of gastroduodenal tumors. Bleeding from these neoplasms s generally difficult to control and is associated with high ebleeding rates. Current modalities for management inlude endoscopy, radiotherapy, interventional angiograhy, and surgery. Hemospray (Cook Medical, Winston-Salem, NC) is an merging endoscopic hemostatic technology that was reently introduced in the management of upper GI bleedng.2 It is composed of a proprietary inorganic powder that, when put in contact with moisture in the GI tract, becomes coherent and adhesive, thus serving as a mechanical barrier for hemostasis. Given its malleable nature, its ability to cover large areas, and especially the lack of direct contact with target tissue as it is sprayed onto the lesion, its use in bleeding gastroduodenal tumors has been suggested.2 Animal studies have demonstrated its safety nd its lack of absorption by the GI tract; it is also elimiated within 48 hours of application with no reported owel obstruction.3 Recently, a prospective, pilot study involving 20 patients with nonmalignant upper GI bleeding showed that the application of Hemospray was associated with a 95% initial hemostasis with no active bleeding seen on repeat EGD at 72 hours, followed by total elimination of the inorganic substance without complications such as intestinal obstruction or embolization.2 To our knowledge, the following describes the first 5 reported cases of upper GI hemorrhage secondary to gas-