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Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 3026–3032 | Cite as

CEGP-003 Spray Has a Similar Hemostatic Effect to Epinephrine Injection in Cases of Acute Upper Gastrointestinal Bleeding

  • Byoung Wook Bang
  • Don Haeng Lee
  • Hyung Kil Kim
  • Kye Sook Kwon
  • Yong Woon Shin
  • Su Jin Hong
  • Jong Ho Moon
Original Article
  • 140 Downloads

Abstract

Background

Endoscopically applicable hemostatic agents have been demonstrated to have high initial hemostasis rates in cases of upper gastrointestinal bleeding (UGIB).

Aims

The authors developed a new hemostatic powder (CEGP-003) and evaluated its hemostatic and ulcer healing effects in UGIB.

Methods

Patients with peptic ulcer or post-endoscopic resection bleeding were randomly assigned to be treated by epinephrine injection or CEGP-003 spray. All patients were placed under observation for 3 days and underwent second-look endoscopy. The primary outcome was initial hemostasis rate, and the secondary outcomes were rebleeding rate and ulcer healing effect.

Results

Seventy-two patients with UGIB were enrolled in this study. Causes of bleeding were peptic ulcer (15, 20.5%), post-endoscopic mucosal resection (11, 15.1%), and post-endoscopic submucosal dissection bleeding (47, 64.4%). Initial hemostasis was achieved in 89.2% (34/37) of patients in the epinephrine group and in 100% (35/35) in the CEGP-003 group (p = 0.115). Rebleeding occurred in 2.7% (1/37) and 8.6% (3/35) in the epinephrine and CEGP-003 groups, respectively (p = 0.35). Three days after endoscopic hemostasis, the ulcer healing effects of epinephrine and CEGP-003 were similar (p = 0.79).

Conclusion

This study shows that CEGP-003 spray has a hemostatic effect similar to epinephrine in terms of initial hemostasis and rebleeding rates. The authors consider CEGP-003 a potential therapeutic tool for UGIB as a definitive or bridge therapy and that it is particularly useful for oozing lesions after endoscopic resection.

Keywords

Gastrointestinal hemorrhage Hemostasis Endoscopic Hemostatic techniques Wound healing 

Notes

Author’s contribution

BWB made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data and was involved in drafting the manuscript or revising it critically for important intellectual content. HKK, KSK, YWS, SJH, and JHM made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data. DHL has been involved in drafting the manuscript or revising it critically for important intellectual content.

Funding

This work was supported by Inha University Research Grant (2017).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. 1.
    Gralnek IM, Barkun AN, Bardou M. Management of acute bleeding from a peptic ulcer. New Engl J Med. 2008;359:928–937.CrossRefGoogle Scholar
  2. 2.
    Asge Technology Committee, Conway JD, Adler DG, et al. Endoscopic hemostatic devices. Gastrointest Endosc. 2009;69:987–996.CrossRefGoogle Scholar
  3. 3.
    Bustamante-Balen M, Plume G. Role of hemostatic powders in the endoscopic management of gastrointestinal bleeding. World J Gastrointest Pathophysiol. 2014;5:284–292.CrossRefGoogle Scholar
  4. 4.
    Sung JJ, Luo D, Wu JC, et al. Early clinical experience of the safety and effectiveness of Hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy. 2011;43:291–295.CrossRefGoogle Scholar
  5. 5.
    Goker H, Haznedaroglu IC, Ercetin S, et al. Haemostatic actions of the folkloric medicinal plant extract Ankaferd blood stopper. J Int Med Res. 2008;36:163–170.CrossRefGoogle Scholar
  6. 6.
    Karaman A, Baskol M, Gursoy S, et al. Endoscopic topical application of Ankaferd blood stopper(R) in gastrointestinal bleeding. J Altern Complement Med. 2012;18:65–68.CrossRefGoogle Scholar
  7. 7.
    Changela K, Papafragkakis H, Ofori E, et al. Hemostatic powder spray: A new method for managing gastrointestinal bleeding. Therap Adv Gastroenterol. 2015;8:125–135.CrossRefGoogle Scholar
  8. 8.
    Haddara S, Jacques J, Lecleire S, et al. A novel hemostatic powder for upper gastrointestinal bleeding: A multicenter study (the “GRAPHE” registry). Endoscopy. 2016;48:1084–1095.CrossRefGoogle Scholar
  9. 9.
    Sakita T, Fukutomi H. Endoscopic diagnosis. In: Yoshitoshi Y, ed. Ulcer of Stomach and Duodenum. 1st ed. Tokyo: Nankodo; 1971:198–208.Google Scholar
  10. 10.
    Lee JW, Park JH, Robinson JR. Bioadhesive-based dosage forms: The next generation. J Pharm Sci. 2000;89:850–866.CrossRefGoogle Scholar
  11. 11.
    Kaehler G, Dutenhoefner C, Magdeburg R. Endoscopic application of polysaccharide powder for hemostasis in anticoagulated pigs (with video). Gastrointest Endosc. 2015;82:161–163.CrossRefGoogle Scholar
  12. 12.
    Jacques J, Legros R, Chaussade S, Sautereau D. Endoscopic haemostasis: An overview of procedures and clinical scenarios. Dig Liver Dis. 2014;46:766–776.CrossRefGoogle Scholar
  13. 13.
    Frenkel JS. The role of hyaluronan in wound healing. Int Wound J. 2014;11:159–163.CrossRefGoogle Scholar
  14. 14.
    Hara-Chikuma M, Verkman AS. Roles of aquaporin-3 in the epidermis. J Investig Dermatol. 2008;128:2145–2151.CrossRefGoogle Scholar
  15. 15.
    Maeng JH, Bang BW, Lee E, et al. Endoscopic application of EGF-chitosan hydrogel for precipitated healing of GI peptic ulcers and mucosectomy-induced ulcers. J Mater Sci Mater Med. 2014;25:573–582.CrossRefGoogle Scholar
  16. 16.
    Bang BW, Maeng JH, Kim MK, Lee DH, Yang SG. Hemostatic action of EGF-endospray on mucosectomy-induced ulcer bleeding animal models. Biomed Mater Eng. 2015;25:101–109.PubMedGoogle Scholar
  17. 17.
    Barkun AN, Bardou M, Kuipers EJ, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152:101–113.CrossRefGoogle Scholar
  18. 18.
    Laine L, McQuaid KR. Endoscopic therapy for bleeding ulcers: An evidence-based approach based on meta-analyses of randomized controlled trials. Clin Gastroenterol Hepatol. 2009;7:33–47.CrossRefGoogle Scholar
  19. 19.
    Oka S, Tanaka S, Kaneko I, et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006;64:877–883.CrossRefGoogle Scholar
  20. 20.
    Park SJ, Park H, Lee YC, et al. Effect of scheduled second-look endoscopy on peptic ulcer bleeding: A prospective randomized multicenter trial. Gastrointest Endosc. 2018;87:457–465.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of Internal Medicine, Inha University HospitalInha University College of MedicineIncheonSouth Korea
  2. 2.Department of Internal Medicine, Digestive Disease Center and Research InstituteSoon Chun Hyang University College of MedicineBucheonSouth Korea

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