Introduction to Endoscopic Hemostatic Powders
For decades, endoscopists have relied on a range of techniques to control gastrointestinal (GI) bleeding, from injection therapy to mechanical clipping. However, some cases of diffuse, non-specific bleeding or hemorrhage in hard-to-reach areas pose significant challenges. The introduction of hemostatic powders (HP) has provided a valuable tool for addressing these difficult bleeding scenarios. These powders, such as Hemospray and Endoclot, offer a 'touch-free' method to rapidly cover bleeding sites. While serving a similar purpose, it is crucial to understand that Is Endoclot the same as Hemospray? is a question with a clear answer: No. They are distinct products with different properties and methods of application.
What is Hemospray (TC-325)?
Hemospray, also known as TC-325, is manufactured by Cook Medical. It is an inorganic, inert mineral powder, specifically bentonite. This powder is delivered using a catheter and a compressed carbon dioxide (CO2) canister.
- Mechanism of Action: When the powder contacts blood, it rapidly absorbs water, concentrating platelets and clotting factors at the bleeding site. This creates a stable mechanical barrier or gelled matrix that seals the actively bleeding area.
- Delivery System: Hemospray's system uses high-pressure CO2 to propel the powder, allowing for a non-contact application that can cover a large area quickly. The high pressure, however, requires careful handling to avoid potential complications like perforation in delicate tissues.
- Pharmacokinetics: The powder is not absorbed or metabolized by the body. Instead, it naturally sloughs off the mucosa after some time and is eliminated through the GI tract.
What is Endoclot (PHS)?
Endoclot Polysaccharide Hemostatic System (PHS), made by EndoClot Plus, Inc., is a separate product based on a different pharmacological principle. The powder is composed of Absorbable Modified Polymer (AMP) particles, which are absorbable polysaccharides derived from plant starch.
- Mechanism of Action: Similar to Hemospray, Endoclot's particles absorb water upon contact with blood, leading to a high concentration of platelets and coagulation proteins. This accelerates the body's natural clotting cascade and forms a gelled matrix that creates a mechanical barrier.
- Delivery System: The Endoclot system uses a separate air compressor to provide a consistent, lower-pressure airflow to deploy the powder. This system allows for a more controlled, gradual application, which some endoscopists find preferable. However, it may have a steeper learning curve due to the need for manual modulation.
- Pharmacokinetics: The AMP particles in Endoclot are 100% bioabsorbable and are naturally degraded by the body over time.
Head-to-Head Comparison: Endoclot vs. Hemospray
| Feature | Endoclot (PHS) | Hemospray (TC-325) |
|---|---|---|
| Composition | Plant-based, absorbable polysaccharides (starch). | Inorganic mineral powder (bentonite). |
| Delivery System | Air compressor provides controlled, lower-pressure deployment. | High-pressure CO2 canister propels the powder. |
| Deployment Pressure | Lower (2.17–3.4 psi). | Higher (37 psi). |
| Absorptivity | Bioabsorbable, degraded by the body. | Non-absorbed; sloughs off and passes through the GI tract. |
| Application Control | More modifiable rate and volume, but potentially steeper learning curve. | High-pressure bursts, covering large areas rapidly. |
| Associated Risks | Potential for catheter occlusion if not properly handled. | Small risk of perforation due to high pressure, especially in delicate tissue. |
| Clinical Efficacy | Found to be equally effective as Hemospray in comparative studies. | Widely studied with robust clinical evidence. |
Clinical Applications and Practical Considerations
Both hemostatic powders have demonstrated high efficacy in achieving initial hemostasis for a variety of non-variceal GI bleeds. They are particularly useful in situations where conventional endoscopic methods are challenging or have failed. Clinical scenarios where these agents are valuable include:
- Diffuse oozing bleeding: Especially from large areas like ulcers or tumors.
- Friable tissue: Bleeding from malignant tumors where conventional therapy may cause more damage.
- Difficult-to-access sites: Bleeding locations with complex anatomy.
- High-risk patients: Patients on anticoagulant therapy where standard techniques are less effective or risky.
Choosing between the two may come down to the specific clinical situation, the endoscopist's familiarity with the delivery system, and institutional availability. The gentler, more controlled application of Endoclot's air compressor system may be preferred in certain cases, while Hemospray's rapid, forceful burst can quickly cover a large, actively bleeding area. Some studies suggest Hemospray was used more frequently in upper GI bleeding, but overall efficacy between the two appears comparable based on current evidence. For definitive guidelines, clinicians should consult updated recommendations from gastroenterology societies, such as those published in the Gastrointestinal Endoscopy journal.
Conclusion
In summary, while both Endoclot and Hemospray are vital, non-contact endoscopic hemostatic powders, they are not the same product. Their fundamental differences lie in their material composition (plant-based vs. mineral), delivery mechanism (air compressor vs. CO2 canister), and absorption profile (bioabsorbable vs. non-absorbed). Despite these distinctions, clinical studies have shown them to be comparably effective in achieving bleeding control. The choice between the two often depends on the endoscopist's expertise with the specific delivery system and the characteristics of the bleeding lesion. Regardless of the agent used, hemostatic powders have firmly established themselves as a crucial part of the therapeutic armamentarium for emergency GI bleeding.
