Gastrointestinal bleeding (GIB) represents a potentially life-threatening condition and is a main indication for gastrointestinal endoscopy. Its incidence is given with roughly 150 patients per 100000 population and year, with a mortality rate of still 10% [1, 2]. Various bleeding sources may be identified and they may be induced either because of an underlying morbidity with ulcerative and nonulcerative lesions, respectively (e.g., ulcers, esophageal varices, and gastrointestinal vascular malformations), and malignancy or as a consequence of iatrogenic interventions (e.g., postpolypectomy bleeding) [3]. In addition, GIB becomes an emerging issue in the light of increasing numbers of disease entities requiring strict anticoagulant therapy with increasing use of new direct oral anticoagulants (DOAC) [4].

Hemostasis can be achieved according to the type of lesion and extent of bleeding by injection of saline, diluted epinephrine solution, macrogollaurylether (e.g., aethoxysklerol), the application of various types of through-the-scope (TTS) or over-the-scope clips (OTSC), or using argon-plasma-coagulation and other thermic coagulation procedures [5]. Despite these possibilities, 10–30% of all patients remain in which an endoscopic hemostasis cannot be obtained, or in which a prompt recurrence of the bleeding occurs [2, 6–8].

Recently, sprayable powders for induction of immediate bleeding stop were introduced in gastrointestinal endoscopy. The latest innovative system introduced into clinical use is the EndoClot system (EndoClot Plus Inc., Santa Clara, CA, USA) which consists of starch, while the Hemospray (Cook Medical, Winston-Salem, NC, USA) consisting of an inorganic powder is the most widely used chemical in this regard [5]. It exerts multimodal mechanisms to achieve hemostasis, becoming cohesive and adhesive after coming in contact with moisture hence forming a stable mechanical barrier, sealing the bleeding site. Due to its composition, it is neither absorbed nor metabolized within the mucosa, hence minimizing the risk of systemic toxicity [6].