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Chiang HC, Chen PJ, Yang EH, Hsieh MT, Shih IC, Cheng HC, Chang WL, Chen WY, Chiu HC, Kuo HY, Tsai WC, Lo YN, Yang KC, Chiang CM, Chen WC, Huang KK, Tseng HH, Chen CY, Lin XZ, Chuang CH. Precise application of topical tranexamic acid to enhance endoscopic hemostasis for peptic ulcer bleeding: a randomized controlled study (with video). Gastrointest Endosc 2023; 98:755-764. [PMID: 37356632 DOI: 10.1016/j.gie.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND AIMS Peptic ulcer recurrent bleeding occurs in 20% to 30% of patients after standard endoscopic hemostasis, particularly within 4 days after the procedure. The application of additional tranexamic acid (TXA) to the ulcer may enhance hemostasis. This study investigated the effectiveness of TXA powder application on bleeding ulcers during endoscopic hemostasis. METHODS This study enrolled patients who had peptic ulcer bleeding between March 2022 and February 2023. After undergoing standard endoscopic therapy, the patients were randomly assigned to either the TXA group or the standard group. In the TXA group, an additional 1.25 g of TXA powder was sprayed endoscopically on the ulcer. Both groups then received 3 days of high-dose (8 mg/h) continuous infusion proton pump inhibitor therapy. Second-look endoscopy was conducted on days 3 to 4. The primary end point of early treatment failure was defined as ulcer recurrent bleeding within 4 days or major stigmata of recent hemorrhage on the second-look endoscopy. RESULTS Sixty patients (30 in each group) with peptic ulcer bleeding and balanced baseline characteristics were randomly assigned to a treatment group. The early treatment failure rate was lower in the TXA group (6.7%) than in the standard group (30%) (P = .042). The freedom from treatment failure periods for 4 and 28 days was significantly longer in the TXA group than in the standard group (P = .023). No adverse events from TXA were recorded. CONCLUSIONS The precise delivery of topical TXA alongside standard endoscopic hemostasis reduced the early treatment failure rate in patients with bleeding peptic ulcers. (Clinical trial registration number: NCT05248321.).
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Affiliation(s)
- Hsueh-Chien Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Jun Chen
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Er-Hsiang Yang
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Ming-Tsung Hsieh
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - I-Cheng Shih
- Department of Internal Medicine, National Cheng Kung University Hospital; Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Hsiu-Chi Cheng
- Department of Internal Medicine, National Cheng Kung University Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ying Chen
- Department of Internal Medicine, National Cheng Kung University Hospital; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Chih Chiu
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chu Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Yi-Ning Lo
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Kai-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Chien-Ming Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Wei-Chih Chen
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Kuan-Kai Huang
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Hsu-Huan Tseng
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Chiung-Yu Chen
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Xi-Zhang Lin
- Department of Internal Medicine, National Cheng Kung University Hospital
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Tau JA, Imam Z, Bazerbachi F. Bone wax-tipped catheter and 3-way stopcock to optimize hemostatic powder deployment. VideoGIE 2021; 6:387-389. [PMID: 34527832 PMCID: PMC8430276 DOI: 10.1016/j.vgie.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- J Andy Tau
- Austin Gastroenterology PA, Austin, Texas
| | - Zaid Imam
- Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Fateh Bazerbachi
- CentraCare, Interventional Endoscopy Program, St. Cloud Hospital, St. Cloud, Minnesota
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