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“Use of topical mineral powder as monotherapy for treatment of active peptic ulcer bleeding.” The authors noted 2 perforations that were not attributed to the use of topical mineralized powder (TMP) therapies. However, based on the literature and on our own experience, barotrauma is a known risk factor during endoscopy with TMP use. In our case, TMP was used for high-risk duodenal ulcers in an 80-year-old woman during an endoscopy for melena. On withdrawal, barotrauma, owing to rapid insufflation of the stomach, was noted in the lesser curvature (Figs. 1A to 1D).
Figure 1Endoscopic views of barotrauma to lesser curvature caused by insufflation of topical mineral powder.
The risks of barotrauma with TMP should not be ignored. The U.S. Food and Drug Administration notes that TMP can increase bowel lumen volume by 3 liters and that bentonite powder can expand 10% to 15% in the presence of blood.
Therefore, the rapid delivery of carbon dioxide and the gastric insufflation associated with this device are significant, and the literature states that perforations were associated with device use for this exact reason.
The authors did not believe that the device caused the perforation because the target lesion and site of perforation were distant from one another. However, we have noted barotrauma at the lesser curvature even though the target lesion was in the duodenum. The lesser curvature may be at increased risk of barotrauma owing to lower compliance compared with other sites in the foregut.
Hence, the use of TMP devices may cause trauma at the lesser curvature or gastroesophageal junction regardless of the site of the target lesion.
Endoscopists at our institution now routinely evaluate the lesser curvature and the gastroesophageal junction after TMP use to assess for barotrauma. Care should be taken when oxygen is used instead of carbon dioxide for insufflation, during prolonged cases, and in instances where there are concerns about impending perforation.
Disclosure
Dr Marya is a consultant for Boston Scientific. All other authors disclosed no financial relationships.
References
Sung J.J.Y.
Moreea S.
Dhaliwal H.
et al.
Use of topical mineral powder as monotherapy for treatment of active peptic ulcer bleeding.
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