Hemospray Application in Acute Gastrointestinal Bleeding

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Introduction

Acute upper gastrointestinal bleeding is a common medical emergency that has a ten percent hospital mortality rate (1). Hemospray is a haemostatic powder that is licensed for use in non-variceal upper gastrointestinal bleeding. It has proven effective in achieving haemostasis in bleeding peptic ulcers (2). We investigated the use of hemospray in the Belfast HSC Trust with regard to indications, diagnosis at endoscopy and follow-up endoscopy.

Methods

A comprehensive gastrointestinal bleeding service is provided at two sites. The reporting systems from both locations were analysed for cases where Hemospray was used between January 2014 and May 2015. Thirty seven patients were included in this review. There were multiple indications with 22 of the patients presenting with haematemesis, melena or both. The commonest diagnosis made at endoscopy was a bleeding gastroduodenal ulcer (n=15). Three cases involved lower gastrointestinal bleeds. Additional haemostatic methods were employed in 21 cases, in contrast to the sixteen that received Hemospray alone. Nine patients underwent follow-up endoscopy from 0 to 142 days later to investigate the site of their original bleed with none requiring further haemostasis.

Conclusion

Hemospray has a valid role in improving patient outcomes given its ability in many circumstances to achieve haemostasis where other means fail. Currently it is unclear in which cases and when follow-up endoscopy should be performed to confirm healing. Indicators may include a high prognostic score, the underlying pathology or through the qualitative means of the endoscopist’s experience at that time.

References

1 Acute upper GI bleeding (CG141), National Institute for Health and Care Excellence (NICE) (July 2013)
2 Sung JJ, et al. Early clinical experience of eh safety and effectiveness of hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011;43:291-5.