High rate of re-bleeding after application of Hemospray for upper and lower gastrointestinal bleeds

Chahal, Daljeet; Lee, Joseph G. H.; Ali-Mohamad, Nabil; Donnellan, Fergal

doi:10.1016/j.dld.2020.01.009

Cited by 21 publications

(20 citation statements)

References 21 publications

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“…The present study confirms that HP is effective in stopping GIB due to neoplastic and non-neoplastic lesions both as monotherapy and rescue therapy. Our findings are in line with the largest studies published to date [12,13,16]. A prospective study of 314 patients treated with Hemospray reported immediate hemostasis in 89.5% of cases, with a re-bleeding rate of 10%, and a definitive hemostasis rate of ∼90% [13].…”

Section: Discussionsupporting

confidence: 90%

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Paoluzi

Cardamone

Aucello³

et al. 2021

Scandinavian Journal of Gastroenterology

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BACKGROUND Hemostatic powder (HP) in gastrointestinal bleeding (GIB) is mainly used as rescue therapy after failure of conventional hemostatic procedures (CHP).AIM To define the best field of application and the efficacy of HP as first choice monotherapy or rescue therapy. METHODSWe compared the efficacy of HP monotherapy, HP rescue therapy, and CHP in the management of active GIB due to neoplastic and non-neoplastic lesions.RESULTS A total of 108 patients, 43 treated with HP as either first choice or rescue therapy and 65 with CHP, were included in the study. The most frequent sources of bleeding were peptic ulcer and malignancy. Immediate hemostasis rates were: HP monotherapy = 100% in peptic ulcer and 100% in malignancy; HP rescue therapy = 93.2% in peptic ulcer and 85.7% in malignancy; CHP = 77.9% in peptic ulcer and 41.7 in malignancy. Definitive hemostasis rates were: HP monotherapy = 50% in peptic ulcer and 45.5% in malignancy; HP rescue therapy = 73.3% in peptic ulcer and 85.7% in malignancy; CHP = 69.1% in peptic ulcer and 33.3% in malignancy. No difference was found in terms of additional intervention between the three groups.CONCLUSIONS HP is highly effective as monotherapy and rescue therapy in GIB. GIB related to malignancy may be the best field of application of HP, but confirmatory studies are necessary.

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Section: Discussionsupporting

confidence: 90%

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Paoluzi

Cardamone

Aucello³

et al. 2021

Scandinavian Journal of Gastroenterology

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“…16 A recent study from Canada on 86 applications of Hemospray could achieve immediate hemostasis in 88.4%, but the rebleeding rate was high at 33.7%. 17 This may be attributed to higher prevalence of Forrest 1A and 1B ulcers in their series. A randomized control trial compared use of Hemospray and endoscopic clip application in patients with nonvariceal UGIB, majority of whom had bleeding from peptic ulcer.…”

Section: Discussionmentioning

confidence: 81%

Endoscopic Treatment of Upper Gastrointestinal Bleeding Using Haemoseal Spray: A Retrospective, Observational Study from a Tertiary Center in North India

Bansal

Gupta

et al. 2020

Journal of Digestive Endoscopy

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Introduction United States Food and Drug Administration recently approved use of Hemospray for the management of gastrointestinal (GI) Bleeding. We report our experience with Haemoseal Spray (HS, Shaili Endoscopy) for the treatment of upper GI bleeding (UGIB). Methods Records of patients who received HS for UGIB from January 2013 to June 2018 were studied retrospectively. Patients with UGIB from focal lesions refractory to conventional endotherapy or those with diffuse/multiple lesions not amenable to conventional endotherapy received 5cc HS spray. Primary end-point studied was clinical success, defined as control of bleeding over 24 hours. Secondary end-points evaluated included recurrence of bleeding within 7 days, in-hospital mortality, and complications secondary to HS. Results Thirty-eight patients were treated with HS. The median age was 57 (range: 5–87) years with 27 males and 11 females. In 24 patients, HS was used as monotherapy, while it was combined with Injection/Clip/Argon Plasma Coagulation in 14. Etiology of bleeding was ulcers or erosions in 22, malignancy in 10, portal hypertensive gastropathy/gastric antral vascular ectasia in 4, and radiation gastropathy in 2. Clinical success was achieved in 32/38 (84%). All six nonresponders had coagulopathy related to chemotherapy/bone marrow transplant. Recurrent bleeding within 7 days was observed in four patients (gastric malignancy 2, radiation gastropathy 2). In-hospital mortality was seen in 8/38 (21%) of which 2(4.8%) were directly related to ongoing GI bleeding. There was no procedure-related complication. Conclusion HS is an effective and safe tool in the endoscopic management of UGIB due to diffuse or multiple focal lesions or focal lesions refractory to conventional endotherapy.

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“…However, the currently available hemostatic powders have poor ability to manage severe UGIB or Forrest Class 1A bleeds [14][15][16], suggesting that their use should be limited to being a bridging therapy to more definitive treatment [17,18]. Rebleeding from these hemostatic powders can occur in 27 % to 49 % of cases within 7 days, which necessitates reapplication and prolongs the treatment time [7,15,17,[19][20][21]. For example, in 296 cases of non-variceal UGIB, a 27 % rebleeding rate occurred, with the majority occurring within 3 days of endoscopy [19].…”

Section: Discussionmentioning

confidence: 99%

Severe upper gastrointestinal bleeding is halted by endoscopically delivered self-propelling thrombin powder: A porcine pilot study

et al. 2021

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Background and study aims Hemostatic powders have emerged recently to treat upper gastrointestinal bleeding (UGIB). Previously, we developed a novel self-propelling thrombin powder (SPTP) that effectively manages external pulsatile arterial bleed without compression, by effervescing and carrying thrombin into the wound. Here, we tested if SPTP, sprayed endoscopically, can manage severe UGIB in a live porcine model. Materials and methods Anesthetized pigs underwent laparotomy to insert the gastroepiploic vascular bundles into the stomach lumen via a gastrotomy. Bleeding was initiated endoscopically in the stomach by needle knife. SPTP was delivered to the site of bleeding from a CO2-powered spray device using a 7 FR catheter. Successful primary hemostasis, time to hemostasis, and the mass of SPTP delivered were measured. Results Hemostasis was achieved at all bleeding sites using SPTP. Mean time to hemostasis was 4.2 ± 0.9 minutes (mean ± standard error of the mean, n = 12). The average mass of SPTP delivered was 2.4 ± 0.6 g. Conclusions In this pilot study, SPTP successfully stopped 12 cases of severe UGIB, demonstrating early promise asa novel hemostatic powder.

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High rate of re-bleeding after application of Hemospray for upper and lower gastrointestinal bleeds

Cited by 21 publications

References 21 publications

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Efficacy of hemostatic powders as monotherapy or rescue therapy in gastrointestinal bleeding related to neoplastic or non-neoplastic lesions

Endoscopic Treatment of Upper Gastrointestinal Bleeding Using Haemoseal Spray: A Retrospective, Observational Study from a Tertiary Center in North India

Severe upper gastrointestinal bleeding is halted by endoscopically delivered self-propelling thrombin powder: A porcine pilot study

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