PTU-029 The Use Of Endoclot™ Therapy In The Endoscopic Management Of Gastrointestinal Bleeding

Introduction Endoclot™ is a non-toxic topical haemostatic powder consisting of absorbable modified polymers. We previously described our early experience using Endoclot™ as an adjunct haemostatic endoscopic therapy in 6 patients undergoing elective/emergency upper or lower gastrointestinal (GI) endoscopy. 1 We now present the largest case series to date describing the use of Endoclot™ therapy in GI bleeding. Methods Endoclot™ was applied in upper GI bleed cases only when initial treatment with standard endoscopic dual therapies failed to achieve complete haemostasis. It was also applied to control bleeding post endoscopic mucosal resection (EMR) of rectal polyps. Endoclot™ was delivered by a dedicated applicator system onto bleeding areas. Successful Endoclot™ therapy was defined as achieving complete haemostasis during endoscopy, with no further bleeding within 30 days. Results Endoclot™ was utilised for 18 patients (11 men, 7 women, mean age 74; upper GI bleed n = 15, lower GI n = 3). Haemostasis was achieved in 16/18 (89%) patients. Endoclot™ was successful in 13 patients with an upper GI bleed: mallory-weiss tear (n = 2); gastric ulcer, all Forrest classification 1b (n = 2); duodenal ulcer, all Forrest classification 1b (n = 8); duodenal adenoma (n = 1). Prior haemostasis combinations used were: adrenaline injection with diathermy (n = 11); adrenaline injection with clips (n = 1); adrenaline injection, diathermy and clips (n = 1). Endoclot™ was successful in 3 patients with lower GI bleeding after EMR. Prior haemostasis used was argon plasma coagulation (n = 1). Endoclot™ therapy failed in 2 cases. In the first patient, haemostasis was achieved when Endoclot™ was applied to an originally suspected duodenal ulcer that continued to bleed despite adrenaline injection and diathermy. However, the patient developed melaena 2 days later, requiring repeat endoscopic therapy with adrenaline injection, clips and diathermy to regain haemostasis. Ensuing investigations showed an underlying gastrointestinal stromal tumour. The second patient had residual bleeding from a Dieulafoy lesion despite treatment with clips and sclerotherapy. Although Endoclot™ initially achieved haemostasis, the patient had melaena 3 days later. The recurrent bleed was controlled with adrenaline injection and banding of the bleeding vessel. Conclusion Endoclot™ is a potentially effective method of achieving haemostasis in GI bleeding when standard endoscopic therapies have failed. Anecdotally, in this series it was noted to be particularly useful to control oozing. Larger prospective controlled studies are required to further determine its exact role in upper and lower GI bleeding. Reference Halkerston K et al . Early clinical eExperience of endoclot™ in the treatment of acute gastro-intestinal bleeding. Gut 2013;62:A149 Disclosure of Interest None Declared.