Comparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal Lesions
Authors: Ashish Agarwal, Ashish Chauhan
Journal: Annals of Internal Medicine (2022)

LettersApril 2022Comparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal LesionsAshish Agarwal, MD, Ashish Chauhan, MDAshish Agarwal, MDDepartment of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IndiaSearch for more papers by this author, Ashish Chauhan, MDDepartment of Gastroenterology, Indira Gandhi Medical College, Shimla, IndiaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L22-0068 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Lau and colleagues (1) have shown that power-sprayed hemostatic powder is not inferior to standard endoscopic treatment in actively bleeding lesions. However, a few points warrant closer consideration.First, Lau and colleagues' study reports that the standard endoscopic treatment group had a much higher incidence of failure to control bleeding at 30 days (1 of 5 patients) than would be expected in a cohort where most lesions were Forrest 1b ulcers. These ulcers are known to have a very low risk for failure of endoscopic therapy (0% to 5%) (2, 3).Second, all methods of endoscopic therapy ...References1. Lau JYW, Pittayanon R, Kwek A, et al. Comparison of a hemostatic powder and standard treatment in the control of active bleeding from upper nonvariceal lesions. A multicenter, noninferiority, randomized trial. Ann Intern Med. 2022;175:171-8. [PMID: 34871051] doi:10.7326/M21-0975 LinkGoogle Scholar2. Jensen DM, Eklund S, Persson T, et al. Reassessment of rebleeding risk of Forrest IB (oozing) peptic ulcer bleeding in a large international randomized trial. Am J Gastroenterol. 2017;112:441-6. [PMID: 28094314] doi:10.1038/ajg.2016.582 CrossrefMedlineGoogle Scholar3. de Groot NL, van Oijen MG, Kessels K, et al. Reassessment of the predictive value of the Forrest classification for peptic ulcer rebleeding and mortality: can classification be simplified. Endoscopy. 2014;46:46-52. [PMID: 24218308] doi:10.1055/s-0033-1344884 CrossrefMedlineGoogle Scholar4. Wedi E, von Renteln, Gonzalez S, et al. Use of the over-the-scope-clip (OTSC) in non-variceal upper gastrointestinal bleeding in patients with severe cardiovascular comorbidities: a retrospective study. Endosc Int Open. 2017;5:E875-82. [PMID: 28924593] doi:10.1055/s-0043-105496 CrossrefMedlineGoogle Scholar5. Chan SM, Lau JY. Can we now recommend OTSC as first-line therapy in case of non-variceal upper gastrointestinal bleeding? [Editorial]. Endosc Int Open. 2017;5:E883-5. [PMID: 28924594] doi:10.1055/s-0043-111722 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, IndiaDepartment of Gastroenterology, Indira Gandhi Medical College, Shimla, IndiaDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L22-0068. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of a Hemostatic Powder and Standard Treatment in the Control of Active Bleeding From Upper Nonvariceal Lesions James Y.W. Lau , Rapat Pittayanon , Andrew Kwek , Raymond S. Tang , Heyson Chan , Rungsun Rerknimitr , June Lee , Tiing Leong Ang , Bing-Yee Suen , Yuan-yuan Yu , Francis K.L. Chan , and Joseph J.Y. Sung Metrics April 2022Volume 175, Issue 4Page: W45KeywordsEndoscopyEsophagogastroduodenoscopyHemostasis ePublished: 19 April 2022 Issue Published: April 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...