Post written by Eula Plana Tetangco, MPH, MD, from the Digestive Health Center, Augusta University, Augusta, Georgia, USA.

Our video demonstrates successful hemostasis of bleeding gastric fundus varices in a 71-year-old male. This was achieved with hemostatic powder TC-325 (Hemospray) using a novel technique that employs continuous flow of carbon dioxide through the catheter before deployment of the powder. This temporizing measure enabled the patient to undergo definitive surgical intervention for the bleeding varices.

One of the most common challenges is the catheter being clogged during Hemospray application, as the powder reacts with moisture to form a gel. It is so common that the manufacturer includes 2 catheters in each kit. We describe a technique that prevents clogging of the Hemospray catheter by using a truly continuous flow of CO2 through the catheter prior to deployment of the hemostatic powder. Even when using a water jet to clear the site of bleeding and gain a better field of view, the catheter remained dry owing to the constant stream of CO2.

By avoiding clogging, we also avoid the resulting need for catheter exchange, and minimize the time required for successful hemostasis. We hope that this step-by-step video helps other gastroenterologists and endoscopists.

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