Hemostatic Hold-Up: A Rare Case of Endoscopic Retention After Hemostatic Powder Application

ABSTRACT Hemospray (TC-325), a powder-based hemostatic spray, is increasingly used for upper gastrointestinal bleeding but can rarely cause endoscope retention. A 74-year-old woman with chronic kidney disease, atrial fibrillation on warfarin, mechanical heart valves, and prior gastric ulcers presented with melena and large-volume hematemesis causing hemodynamic instability. Laboratory findings revealed hemoglobin 7.3 g/dL and international normalized ratio 7. Esophagogastroduodenoscopy showed multiple bleeding arteriovenous malformations in the cardia and fundus, treated with a synthetic self-assembling peptide gel and subsequently with hemospray applied in retroflexion. Withdrawal of the endoscope was initially unsuccessful due to powder adhesion, but aggressive water irrigation enabled removal after 90 minutes. The patient stabilized with transfusions and octreotide, with no recurrent bleeding. This case underscores the risk of endoscope retention when Hemospray is applied retroflexed and suggests aggressive irrigation as a potential remedy. Further studies are needed to optimize Hemospray dosing and evaluate self-assembling peptide-powder interactions.