Advancing Hemostatic Powder Technologies for Management of Gastrointestinal Bleeding: Challenges and Solutions

Hemostatic powder spray (HPS) such as Hemospray or EndoClot is used for endoscopic treatment of both upper and lower Gastrointestinal (GI) bleeding, demonstrating high immediate hemostasis rates across various types, including nonvariceal, variceal, and tumor-related hemorrhages. Compared to conventional therapies, HPS exhibits significantly higher odds of primary hemostasis and is particularly effective in challenging cases such as diffuse hemorrhage, refractory gastric variceal bleeding, and malignant bleeding where there is no single focal area suitable for cauterization or clipping. Despite its clinical effectiveness, several challenges impede its broader application, including moisture-induced powder clumping, limited adhesion in the humid GI environment, transient hemostatic effects, and frequent catheter clogging. Additionally, existing CO₂-propelled delivery systems with fixed mixing ratios restrict adaptability across diverse clinical scenarios. This review systematically examines these limitations and proposes comprehensive solutions to enhance HPS's performance. Key advancements discussed include optimized powder formulations, suspension-based delivery systems, and the utilization of alternative propellant gases to mitigate clumping and improve adhesion. Furthermore, innovative delivery mechanisms such as hybrid mixing systems, adjustable catheter tips, and the integration of real-time feedback mechanisms are explored to increase precision and efficacy. By addressing these technical and operational challenges, this review outlines a strategic pathway for optimizing HPS’s functionality and expanding its clinical utility in managing GI bleeding, aiming to improve patient outcomes and procedural reliability.