Use of the haemostatic agent TC-325 in the treatment of bleeding secondary to endoscopic retrograde cholangiopancreatography sphincterotomy.

A 71-year-old man presented to secondary care with a 2-week history of right upper quadrant pain associated with rigors. Obstructive jaundice was demonstrated on blood sampling, and subsequent magnetic resonance cholangiopancreatography imaging revealed an 8-mm obstructing calculus within the common bile duct. An endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and balloon trawl was subsequently performed. Twenty-four hours post-ERCP the patient was diagnosed with an upper gastrointestinal haemorrhage characterized by passage of melaena, haemodynamic compromise and a 50 g/l drop in haemoglobin. An emergency gastroscopy was performed, which identified an active bleeding point in the region of the previous sphincterotomy site. This site could not be adequately visualized using the gastroscope. A side viewing duodenoscope was then used and the bleeding was confirmed to be at the sphincterotomy site (Figure 1a). Haemostasis was instantaneously achieved through the application of 4 g of Hemospray (TC-325; Cook Medical Inc., Winston-Salem, NC) via the duodenoscope (Figure 1b). Furthermore there was no evidence of biliary obstruction, with clear bilious fluid draining out of the ampulla of Vater immediately after TC325 application, and continued improvement of the patient’s biochemical liver parameters over the ensuing course of his inpatient stay. Acute upper gastrointestinal haemorrhage is a medical emergency with an associated mortality rate of between 6 and 13%. Bleeding post-ERCP