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

Abstract

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.

Reply to Xavier S and colleague: “Hemospray use in upper gastrointestinal bleeding from tumor – is it the answer?”

“…We totally agree that Hemospray may be a promising first-line treatment for upper gastrointestinal bleeding from tumor because no other techniques have proven to be effective 1 2. However, presence of blood on the lesion is required to activate Hemospray cohesion 3.…”

“…Hemospray was applied to the blood clot on the lesion and hemostasis was achieved. The duration of hemostasis control was not described; however, we believed that it would be a temporary effect according to our previous experience 1.…”

“…Moreover, the Hemospray powder overlying the surface of the tumor could protect the vulnerable gastric tissue from acid and might provide additional time for tissue healing. In contrast, were a coaptation technic such as bipolar coaptation used, the heat from it could cause further necrosis to the tumor surface, resulting in recurrent bleeding 1. Finally, Hemospray can applied as many times as needed in case of recurrent bleeding.…”

The experience of minimally invasive – endoscopic methods used to stop bleeding in upper sections of the digestive system

“…Засіб Hemospray свідчить про високу ефективність зупинки ургентних кровотеч з органів верхніх відділів травної системи використовуючи Hemospray, як при моногемостазі, так і в комплексі із іншими ендоскопічними методами. [ 1,10]. Hemospray має наступні ключові переваги над іншими ендоскопічними методами : безтермічний -немає термічного контакту із тканинами, що унеможливлює високий ризик ускладнень; нетравматичний -оскільки на місці зупинки кровотечі не прикладається жодна сила зводиться до нуля ризик травми тканин; безконтактний -аерозольна система доставки виключає необхідність прямих механічних та контактних сил; безпечний у вжитку -одноразові канюлі, що йдуть в комплекті -зводять до нуля ризик передачі трансмісивних інфекційних захворювань при контакті з кров'ю; зручність та легкість у використанні -порошок розпорошується до джерела кровотечі, тому він не вимагає підходу in face та точного націлювання зокрема важливо при роботі у важкодоступних місцях [ 2,4,6].…”

Hemospray use in upper gastrointestinal bleeding from tumor: Is it the answer?

“…We read with great interest the article entitled “The efficacy of Hemospray in patients with upper gastrointestinal bleeding from tumor” by Pittayanon et al 1. The authors enrolled 24 patients with upper gastrointestinal bleeding originating from a primary or metastatic upper gastrointestinal tract tumor and compared several outcomes (14-day rebleeding rates, length of hospital stay and mortality rate at 30-day follow up) between the group treated with Hemospray as the first-line hemostatic therapy (n = 14) and a control group treated with conventional endoscopic hemostatic methods (coaptation therapy, argon plasma coagulation, and mechanical hemostasis).…”