TC-325 application leading to transient obstruction of a post-sphincterotomy biliary orifice
Bibliographic record
Abstract
TC-325 (Hemospray, Cook Medical Inc., Bloomington, Indiana, USA), a novel endoscopic hemostatic powder has been approved in many countries for nonvariceal gastrointestinal bleeding. It consists of a proprietary inorganic powder, which, when put in contact with moisture, becomes coherent and adhesive, creating a mechanical barrier and effecting hemostasis. Preliminary results in benign and malignant upper and lower gastrointestinal bleeding are promising [ 1 ] [ 2 ] [ 3 ] [ 4 ]. Optimal indications and technical limitations are still being characterized [ 5 ]. We recently treated a patient presenting with hematemesis 12 hours after choledocholithiasis removal, in whom endoscopy confirmed oozing from the sphincterotomy site. Hemostasis occurred immediately following application of 5 g (1/4 canister) Hemospray; however, resulting arrest of bile flow and caking of the orifice with the powder were noted. Biliary patency was quickly restored with vigorous water irrigation and prodding open of the papillotomy orifice with a sphincterotome tip; prolonged hemostasis was achieved with epinephrine injection. Subsequent follow-up at 4 months after the procedure did not reveal any clinical stigmata of gastrointestinal bleeding ([ Fig. 1 ]). Fig. 1 a Endoscopic image of the bleeding site post endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy in a patient presenting with hematemesis after choledocholithiasis removal. Note the bile duct stone in the top right hand corner of the image. b Bleeding obvious at the sphincterotomy site. c Sphincterotomy site covered by TC-325 powder (light is shining off TC-325 laden surface). Note the complete obstruction of the biliary opening with no bile flow. TC-325 appears highly effective in achieving initial hemostasis [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ], yet technical difficulties related to the first-generation delivery system have included blockage of the 10-Fr catheter or the accessory channel of the endoscope if there is premature contact with moisture. Initial flushing of the accessory channel with air using a syringe before introduction of the catheter is thus recommended. Additional limitations include kinking of the delivery system’s soft catheter sheath when the endoscope is looped or positioned over a duodenoscope elevator. Recently, 7-Fr and 10-Fr catheters have been marketed as part of a second-generation delivery system. TC-325 powder application so far appears quite safe, with no reported bowel obstruction or systemic embolization [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ]. Here we have reported transient biliary obstruction following successful use of Hemospray in post-sphincterotomy hemorrhage. Caution should therefore be taken when applying hemostatic powders near small orifices adjacent to the bowel lumen. Endoscopy_UCTN_Code_CPL_1AK_2AI
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".