Precise application of topical tranexamic acid to enhance endoscopic hemostasis for peptic ulcer bleeding: a randomized controlled study (with video)

Hsueh Chien Chiang, Po Jun Chen, Er Hsiang Yang, Ming Tsung Hsieh, I. Cheng Shih, Hsiu Chi Cheng, Wei Lun Chang, Wei Ying Chen, Hung Chih Chiu, Hsin Yu Kuo, Wei Chu Tsai, Yi Ning Lo, Kai Chun Yang, Chien Ming Chiang, Wei Chih Chen, Kuan Kai Huang, Hsu Huan Tseng, Chiung Yu Chen, Xi Zhang Lin, Chiao Hsiung Chuang

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

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.)

Original languageEnglish
Pages (from-to)755-764
Number of pages10
JournalGastrointestinal Endoscopy
Volume98
Issue number5
DOIs
Publication statusPublished - 2023 Nov

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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