Area Editoriale
GI bleeding (GIB) remains a major cause of morbidity and mortality worldwide. Endoscopic management of GIB could be challenging, despite the existing advancements
in hemostatic techniques; there are unmet needs for the introduction of topical hemostatic agents in management of profound venous or arterial GIB and malignant lesions
with a large surface area that are not quite amenable to traditional endoscopic hemostatic techniques. Many topical hemostatic agents have been developed over the past
50 years with widespread medical applications.1 The introduction of topical hemostatic agents in the modern surgical era can be traced back to 1909, when Bergel first
discussed the use of topical fibrin for hemostasis. This class of preparations, known as fibrin sealants, marked the beginning of wide spectrum of topical hemostatic agents
with various mechanisms of action. Gelatin-based hemostatic agents2 and cyanoacrylate adhesives3 were 2 more common topical hemostatic agents introduced in the 1940s.1 In the 1970s, a new class of agents, namely, microfibrillar collagen products, were synthesized by purifying and processing bovine collagen4; these were then manipulated to different hemostatic agents that were used in various surgical specialties for achieving hemostasis. In 1998, the U.S. Food and Drug Administration approved Tisseel, the first commercial fibrin sealant. These compounds were used as surgical hemostatic and adhesive material.5 Other topical hemostatic agents, including topical thrombin,6 endoscopic spray of clotting factors,7 and topical sucralfate,8 have been introduced in limited clinical data with various outcomes.
More recently, additional agents have been adapted to digestive endoscopy and the management of GIB. We review the mechanisms of action of powderbased
topical hemostatic agents and their efficacy and safety profiles, while attempting to predict their potential utility in digestive endoscopy.
Reviews on topical hemostatic agents as they apply to other clinical applications can be found elsewhere.