Ankaferd Blood Stopper in GI bleeding: alternative for everything?

We read with great interest the article by Tuncer et al1 describing a case of fundal variceal hemorrhage that was managed with endoscopic administration of Ankaferd Blood Stopper (ABS). In the discussion section, they also claimed that ABS had an immediate hemostatic effect on arterial bleeding due to gastric polypectomy or spurting bleeding ulcers in cases not responsive to injection therapy or thermocoagulation. We would like to make some comments about their conclusions. The successful use of ABS in mild to moderate GI bleeding cases is increasingly being reported.2-6 Its major advantages as a hemostatic agent are ease of use and no side effects. The rapid formation of a coagulum in a bleeding source just after spraying leads to an initial enthusiastic response for the endoscopist. However, in our experience, in addition to the current literature, it is only partially or not effective in severe or spurting arterial bleeding. First, the cases cited by the authors related to ABS use2-4 could not establish a clear-cut diagnosis for severe or spurting bleeding—as an adjunct to clips in a Dieulafoy lesion,2 in a case of postbiopsy mucosal bleeding in a hepaticojejunal anastomosis,3 and in a mild bleeding caused by postpolypectomy.4 Moreover, we reported the limited effect of ABS in severe bleeding previously.5 Second, we observed the failure of hemostatic effect of ABS in 5 cases of severe arterial bleeding recently. The lesions were Forrest Ia spurting duodenal ulcers (n ! 4) and a severe Mallory-Weiss tear (n ! 1). ABS was selected as a therapeutic choice because of the inappropriateness of bleeding lesions for conventional measures (excessive cough by the patient with a Mallory-Weiss tear, difficulty in positioning, and/or excessive blood in visual field despite irrigation in the ulcer cases). For all patients, written informed consent regarding the off-label use of ABS as a means of attaining hemostasis had been obtained from the