Refractory Gastrointestinal Bleeding due to Gastric Neuroendocrine Tumor Treated with Application of Hemostatic powder

Abstract

Hemostatic powder is a new hemostatic modality that is easy to use and covers a large surface area. It causes hemostasis by mechanical tamponade over the bleeding vessel and increases the concentration of the clotting factor. In this image, we report a case of gastric neuroendocrine bleeding presenting with refractory bleeding and hemostasis achieved with the endoscopic application of hemostatic powder.

Keywords

endoscopy - neuroendocrine tumor - hemoclip

A 64-year-old gentleman, postcoronary artery bypass graft surgery and on antiplatelet therapy, presented with hematemesis and low hemoglobin (10.6 g/dL). Emergency gastroscopy revealed an umbilicated lesion measuring 1.5 cm in the body of the stomach with an active ooze of blood ([Fig. 1]). Hemostasis was achieved with combined hemoclip application and adrenaline saline injection. However, he rebled 24 hours later and computed tomography angiography of the abdominal vessels did not reveal any abnormality. Repeat gastroscopy revealed persistent oozing of blood from the lesion despite the presence of hemoclips ([Fig. 2]). A hemostatic powder (Hemospray; Cook Medical, Winston-Salem, North Carolina, United States) was sprayed over the lesion and hemostasis was achieved ([Fig. 3]). Thereafter, an endoscopic biopsy was taken from the edge of the lesion and histopathological examination revealed a grade II neuroendocrine tumor. There were no further episodes of gastrointestinal bleeding and a week later, the patient underwent a successful surgical resection of the gastric lesion ([Fig. 4]).

Fig. 1 Endoscopy: Actively bleeding umbilicated lesion measuring 1.5 cm in size in the body of the stomach.

Fig. 2 Endoscopy: Persistent oozing of the blood from the lesion despite the presence of hemoclips.

Fig. 3 Hemospray sprayed over the lesion and hemostasis achieved.

Fig. 4 Surgically resected lesion (arrow).

Hemostatic powder is a new hemostatic modality that is easy to use and covers a large surface area. It causes hemostasis by mechanical tamponade over the bleeding vessel and increases the concentration of the clotting factors.[1] It is effective in achieving hemostasis in bleeding ulcers, varices, and cancer-related bleeding.[1]

Conflict of Interest

None declared.

Authors' Contributions

S.A. drafted the manuscript and was involved in data collection. S.H.J. was involved in critical revision of the manuscript for intellectual content. S.V.K.C., R.A., and R.G. were involved in data collection. S.S.R. was involved in collection and interpretation of data and critical evaluation of the manuscript for intellectual content.

• Reference

• 1 Aziz M, Weissman S, Mehta TI. et al. Efficacy of Hemospray in non-variceal upper gastrointestinal bleeding: a systematic review with meta-analysis. Ann Gastroenterol 2020; 33 (02) 145-154

Publication History

Article published online:
25 November 2024