Hemospray Application in Nonvariceal Upper Gastrointestinal Bleeding

Smith, Lyn; Stanley, Adrian; Bergman, Jacques; Kießlich, Ralf; Hoffman, Arthur; Tjwa, Eric T.; Kuipers, Ernst J.; Holstein, Christer Staël von; Öberg, Stefan; Brullet, Enric; Schmidt, Palle Nordblad; Iqbal, Tariq; Mangiavillano, Benedetto; Masci, E.; Prat, Frédéric; Morris, Allan J.

doi:10.1097/mcg.0000000000000054

Cited by 108 publications

(46 citation statements)

References 14 publications

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“…Hemostatic powder spray provides high rates of initial hemostasis for active non-variceal upper gastrointestinal bleeding, but with relatively high rebleeding rates, suggesting a temporary effect 119120121122123. A systematic review of 195 cases reported initial hemostasis in 92% and a seven day rebleeding rate of 21% 112.…”

Section: Emerging Treatmentsmentioning

confidence: 99%

Management of acute upper gastrointestinal bleeding

Stanley

Laine

2019

BMJ

179

133

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Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

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Section: Emerging Treatmentsmentioning

confidence: 99%

Management of acute upper gastrointestinal bleeding

Stanley

Laine

2019

BMJ

179

133

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“…Recently, Hemospray has been proposed as a novel way of producing endoscopic hemostasis for active gastrointestinal (gastrointestinal) bleeding, mostly for ulcer bleeding 9 . To date, the study of Hemospray in tumor bleeding is limited as results have not focused on this particular patient group 9 10 11 12 13 14 15 . This study aimed to compare the hemostatic efficacy of Hemospray with that of conventional endoscopic treatment in patients who presented with upper gastrointestinal bleeding from tumor.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of Hemospray in patients with upper gastrointestinal bleeding from tumor

2016

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Background and study aims: Currently, conventional endoscopic treatments provide an unsatisfactory hemostatic outcome in upper gastrointestinal bleeding from tumor. Hemospray has been shown to be useful in many active gastrointestinal bleeding conditions. This study aimed to compare the efficacy of Hemospray and conventional endoscopic hemostasis. Patients and methods: Fourteen patients with active upper gastrointestinal bleeding from tumor were recruited. Hemospray was applied at the bleeding site until hemostasis was achieved. Four patients were excluded because they prematurely received definitive therapy to prevent further bleeding within 48 hours. Another 10 patients from historical control were matched based on the type of gastrointestinal tumors. The 14-day rebleeding rates, length of hospital stay (LOS) and mortality rate at 30-day follow up were assessed. Results: Baseline characteristics including age, stage of tumor, and Blatchford score did not differ between the two groups. The 14-day rebleeding rate in the Hemospray group was 3 times lower than the control group but not statistically significant (10 % vs. 30 %; P = 0.60). LOS was no different between the 2 groups (28.2 ± 21.2 vs. 23.8 ± 12.5 days; P = 0.26). The 30-day mortality rate in the Hemospray group was 3 times lower than that of in the conventional therapy group but not significant (10 % vs. 30 %, P = 0.7). Conclusions: Hemospray is a promising therapy for initial hemostasis in upper gastrointestinal bleeding from tumor because it can achieve hemostasis during the first 14 days, thus potentially allowing sufficient time before appropriate definitive intervention is considered.

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“…Hemospray is a highly absorptive inorganic mineral nanopowder that can be sprayed onto the surface of actively bleeding lesions forming a mechanical barrier which can lead to immediate hemostasis and is shown to promote clot formation and shorten coagulation time [20]. The success rate with nanopowder for non-variceal UGIB (including ulcers and other lesions) varies between 75% to 100%, with rebleeding rates between 10% to 49% [21][22][23][24][25][26][27][28][29][30]. Hemospray is also effective for hemostasis of LGIB [29][30][31].…”

Section: Brief Overview Of Common Endoscopic Hemostatic Devicesmentioning

confidence: 99%

Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives

Mujtaba

Chawla

Massaad

2020

JCM

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Non-variceal gastrointestinal bleeding (GIB) is a significant cause of mortality and morbidity worldwide which is encountered in the ambulatory and hospital settings. Hemorrhage form the gastrointestinal (GI) tract is categorized as upper GIB, small bowel bleeding (also formerly referred to as obscure GIB) or lower GIB. Although the etiologies of GIB are variable, a strong, consistent risk factor is use of non-steroidal anti-inflammatory drugs. Advances in the endoscopic diagnosis and treatment of GIB have led to improved outcomes. We present an updated review of the current practices regarding the diagnosis and management of non-variceal GIB, and possible future directions.

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Hemospray Application in Nonvariceal Upper Gastrointestinal Bleeding

Abstract: This multicentre registry identifies potentially useful characteristics of Hemospray (TC-325) when used either as monotherapy or as a rescue therapy in a wide variety of ulcer and nonulcer NVUGIB.

Cited by 108 publications

References 14 publications

Management of acute upper gastrointestinal bleeding

Management of acute upper gastrointestinal bleeding

The efficacy of Hemospray in patients with upper gastrointestinal bleeding from tumor

Diagnosis and Management of Non-Variceal Gastrointestinal Hemorrhage: A Review of Current Guidelines and Future Perspectives

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