What is the role of Feracryl (Feracrylum) in managing bleeding during endoscopic procedures?

Feracrylum for Endoscopic Bleeding Management

Feracrylum is not recommended as a standard hemostatic agent for endoscopic bleeding management, as it lacks support from major gastroenterology guidelines and has minimal evidence in gastrointestinal endoscopy. The established endoscopic hemostatic methods—epinephrine injection, thermal coagulation, and mechanical clips—remain the evidence-based standard of care 1.

Evidence Base for Feracrylum

• Feracrylum has been studied primarily in endobronchial applications for pulmonary bleeding, not gastrointestinal endoscopy 2
• In bronchoscopy, 1% feracrylum solution (5-10 ml) achieved hemostasis in 69 of 123 cases after biopsy, with moderate bleeding controlled by tampon application in 42 additional cases 2
• No published guidelines from major gastroenterology societies (American College of Gastroenterology, American Society for Gastrointestinal Endoscopy, European Society of Gastrointestinal Endoscopy, or Asian Pacific Association of Gastroenterology) mention feracrylum for endoscopic hemostasis 1

Guideline-Recommended Hemostatic Approaches

First-Line Endoscopic Hemostasis

• Epinephrine injection (1:10,000 dilution) followed by thermal coagulation or mechanical clips is the standard approach for non-variceal bleeding 1
• For patients with coronary heart disease requiring large-volume epinephrine, continuous ECG monitoring is advisable due to 4-5 fold increases in serum epinephrine concentrations 1
• Hemostatic clips are preferred for large polyps (≥20 mm), reducing delayed hemorrhage from 7.2% to 3.7% 3
• Endoscopic band ligation is the standard for variceal bleeding, superior to sclerotherapy with fewer adverse effects 1

Alternative Topical Hemostatic Agents

• Modern topical hemostatic powders (TC-325, Ankaferd Blood Stopper) achieve immediate hemostasis in 93% of cases across various bleeding etiologies 4, 5
• These agents demonstrate superior immediate hemostasis compared to standard endoscopic modalities (OR 3.94), with similar rebleeding rates (OR 1.06) 4
• Topical hemostatic agents are particularly useful for massive bleeding with poor visualization, salvage therapy, and diffuse bleeding from malignancies 5

Clinical Algorithm for Endoscopic Bleeding

For non-variceal upper GI bleeding:

• Inject dilute epinephrine (1:10,000) at bleeding site 1
• Apply thermal coagulation (multipolar cautery) or place hemostatic clips 1
• Consider modern topical hemostatic powders if conventional methods fail 4, 5

For variceal bleeding:

• Perform endoscopic band ligation as primary therapy 1
• Use cyanoacrylate injection for gastric (cardiofundal) varices 1
• Maintain vasoactive drug therapy for 3-5 days post-procedure 1

For post-polypectomy bleeding prevention:

• Apply prophylactic clips for polyps ≥20 mm, especially in proximal colon 3
• Use saline injection with or without dilute epinephrine for large polyps 1

Critical Pitfalls to Avoid

• Do not use feracrylum without established evidence in GI endoscopy—stick to guideline-recommended agents 1
• Avoid prolonged cessation of antiplatelet agents in patients with coronary heart disease, as this increases all-cause mortality despite reducing rebleeding risk 1
• Do not proceed with high-risk endoscopic procedures when platelets are <50,000/μL without transfusion 6
• Avoid excessive epinephrine volumes in patients with known coronary disease without cardiac monitoring 1