Stuck scope: Tackling the adherent scope situation after hemostatic powder application: A case report and review of literature

BACKGROUND TC-325 (Hemospray) is a mineral-based hemostatic powder that is increasingly used for nonvariceal upper gastrointestinal bleeding, particularly diffuse or malignancy-related bleeding.Adhesion of the powder to the endoscope with inability to withdraw the instrument is a rare but potentially serious adverse event that prompted a manufacturer device-correction notice in 2023, and it has most often been reported when the powder is applied in retroflexion.Descriptions of how to free an entrapped endoscope remain limited. CASE SUMMARYAn 84-year-old man with metastatic jejunal mucinous adenocarcinoma presented with hematemesis and a hemoglobin of 7.5 g/dL.Upper endoscopy with push enteroscopy identified a 3-cm cratered gastric body ulcer with stigmata of recent bleeding (Forrest class IIc) and the known obstructing jejunal tumor.TC-325 was applied to the ulcer with the endoscope in partial retroflexion.On attempted withdrawal the endoscope was fixed: Hydrated powder had coated the insertion tube and bonded it to the mucosa at the gastroesophageal junction.Water irrigation, viscous lidocaine, gentle torque and forceps clearance through the entrapped endoscope did not release it.A second ultrathin (XP) gastroscope was advanced alongside the entrapped endoscope, and biopsy forceps passed through the ultrathin scope were used to strip the adherent powder from the shaft under direct vision, after which the endoscope was withdrawn without resistance and without mucosal injury.The patient had no further clinically evident bleeding during the admission and was discharged to home hospice in accordance with his goals of care.CONCLUSION 4 / 32 TC-325 applied in retroflexion can bond the endoscope to the mucosa.Early recognition, avoidance of forceful traction, irrigation, controlled de-retroflexion and, when these fail, rescue with a parallel ultrathin endoscope can free the instrument safely.