Subramaniam, Sharmila

Abstract Gastrointestinal (GI) endoscopy has evolved from a diagnostic tool into a therapeutic modality, leading to a higher incidence of bleeding complications during and after procedures. To address this issue, various hemostatic agents have been developed, including injectable, mechanical, thermal, and topical products. Topical hemostatic agents, available in powder or gel forms, can be used as standalone treatments or as adjuncts to traditional hemostatic therapies to control or prevent bleeding. This Technical and Technology Review examines the commercially available topical hemostatic agents used in endoscopy, specifically Purastat, TC-325 Hemospray, EndoClot PHS, Nexpowder, Ankaferd Blood Stopper, and CG GEL. A systematic literature review was conducted up to January 2025, focusing on randomized controlled trials (RCTs), meta-analyses, and observational studies. Each product was assessed for its composition, mechanism of action, regulatory status, mode of use, efficacy, safety, and financial considerations. Purastat showed 94% efficacy in acute GI bleeding, reducing delayed bleeding to 4.3% in endoscopic submucosal dissection (ESD) and endoscopic mucosal resection cases, with significantly lower thermal device usage. TC-325 Hemospray achieved 85%–98.5% primary hemostasis in upper and lower GI bleeding, with pooled hemostasis rates of 93.1% and rebleeding rates of 8.9%. It was also effective in malignancy-related bleeding, with hemostasis success up to 100%. EndoClot PHS demonstrated 76%–100% hemostasis efficacy, comparable with TC-325, with rebleeding rates of 24%–25%. It showed prophylactic potential post-ESD, with rebleeding rates of 7.3%–9.1%. Nexpowder achieved 94% hemostasis in refractory upper GI bleeds and reduced rebleeding in lower GI bleeds to 5.5% at 28 days. Ankaferd Blood Stopper demonstrated 73%–100% hemostasis across various GI bleeding sources, including peptic ulcers and malignancies, though further data on rebleeding are needed. Topical hemostatic agents offer effective options for managing GI bleeding. Products like Purastat, TC-325 Hemospray, EndoClot PHS, Nexpowder, Ankaferd Blood Stopper, and CG GEL have shown promising results in achieving hemostasis; however, further RCTs and cost-effectiveness analyses are needed to better establish their roles in endoscopic practice.

The COVID-19 pandemic has had a profound impact on provision of endoscopy services globally as staff and real estate were repurposed. As we begin to recover from the pandemic, a cohesive international approach is needed, and guidance on how to resume endoscopy services safely to avoid unintended harm from diagnostic delays. The aim of these guidelines is to provide consensus recommendations that clinicians can use to facilitate the swift and safe resumption of endoscopy services. An evidence-based literature review was carried out on the various strategies used globally to manage endoscopy during the COVID-19 pandemic and control infection. A modified Delphi process involving international endoscopy experts was used to agree on the consensus statements. A threshold of 80% agreement was used to establish consensus for each statement. 27 of 30 statements achieved consensus after two rounds of voting by 34 experts. The statements were categorised as pre-endoscopy, during endoscopy and postendoscopy addressing relevant areas of practice, such as screening, personal protective equipment, appropriate environments for endoscopy and infection control precautions, particularly in areas of high disease prevalence. Recommendations for testing of patients and for healthcare workers, appropriate locations of donning and doffing areas and social distancing measures before endoscopy are unique and not dealt with by any other guidelines. This international consensus using a modified Delphi method to produce a series of best practice recommendations to aid the safe resumption of endoscopy services globally in the era of COVID-19.