Just Because Something Is New, Does It Mean It Works?

The development of hemostatic powders has increased the tools in our armamentarium to treat GI bleeding. However, data on their utility in peptic ulcer bleeding (PUB), compared with conventional therapy, have yet to be provided. This prospective, multicenter (4 institutions), randomized, open-label, controlled trial investigates the noninferiority of a polysaccharide hemostatic powder (PHP) versus conventional endoscopic treatments for PUB. 

The investigators consecutively enrolled 216 patients who presented with PUB. Participants were randomly assigned to either the PHP or conventional-treatment group (PHP group, 105 patients; control group, 111 patients). The PHP group received injected diluted epinephrine and sprayed application of the powder. Conventional endoscopic treatment included injection of diluted epinephrine followed by the use of electrical coagulation or hemoclipping. All patients were treated with intravenous proton pump inhibitors 24 hours after the endoscopy and 40 mg of pantoprazole daily for 28 days. 

There was no difference in initial hemostasis between the groups (92 of 105 patients [87.6%] in the PHP group and 96 of 111 patients [86.5%] in the conventional-treatment group). Additionally, rebleeding was similar between the two groups. However, in subgroup analysis, there was a significant increase in the initial hemostasis failure rate in Forest lla cases in the conventional-treatment group versus in the PHP group (13.6% vs 0%; P=.023). Large ulcer size (≥15 mm) and chronic kidney disease with dialysis were independent risk factors for rebleeding at 30 days.