Ankaferd Blood Stopper as an effective adjunctive hemostatic agent for the management of life-threatening arterial bleeding of the digestive tract.

hospital with rectal bleeding. He had a history of Billroth II surgery for bleeding peptic ulcer disease 30 years ago. He had no other medical problems, and was re− ceiving no medications. His hemoglobin level was 5.6 g/dL. Upper gastrointestinal endoscopy revealed fresh blood and clots in the residual stomach and efferent loop. A Dieulafoy lesion with spurting hemor− rhage was found near the gastrojejunal anastomosis (l" Fig. 1 a). We initially applied three hemoclips to the lesion, but as the bleeding persisted (l" Fig. 1 b), 2 mL epinephrine (1:10 000 dilution) was injected around the bleed− ing site. Mucosal oozing still continued, so 12 mL Ankaferd Blood Stopper (ABS; Ankaferd Health Products Ltd., Istanbul, Turkey) was applied topically using a dis− posable washing pipe. The bleeding was observed to stop within 2 s. The patient’s hemoglobin level subse− quently stabilized at 10.2 g/dL without further transfusion. Three days later, up− per gastrointestinal endoscopy showed the site with hemoclips. There was no fur− ther bleeding (l" Fig. 1 c). ABS is a unique medicinal plant extract which has been approved in the manage− ment of dental surgery bleeding and ex− ternal hemorrhage in Turkey [1]. It induc− es very rapid formation of a unique pro− tein network in the plasma and serum samples [1]. ABS was previously used with success in a patient with bleeding from a hepaticojejunostomy anastomosis refractory to conventional endoscopic in− terventions [2]. Endoscopic therapy is the “standard of care” since the success rate with endoscopically accessible Dieulafoy lesions is about 95% [3± 5]. However, it cannot always stop bleeding completely, and therefore hemorrhagic shock, circu− latory failure, morbidity, and mortality are still important life−threatening prob− lems in this clinical setting. ABS may be useful as an adjunctive agent to mechan− ical intervention in cases of serious arte− rial bleeding. Neither any local adverse effect nor systemic toxicity was observed following the topical application of ABS.