Introduction Hemospray is an endoscopic haemostatic agent licensed for use in non-variceal upper gastrointestinal bleeding (UGIB). It has been shown to be effective in achieving haemostasis in bleeding peptic ulcers in a pilot study from Hong Kong.1
Methods From June until September 2011 several European hospitals participated in the SEAL dataset. Data on the use of Hemospray, lesions treated and other endoscopic modalities employed were prospectively collected. Rockall score and treatment outcomes were obtained retrospectively. The type of lesion treated and the use of Hemospray as monotherapy or combination therapy was at discretion of the endoscopist.
Results Eighty two patients (57M:25F) were treated across 10 hospitals. Median age was 70 years. Aetiology of UGIB was gastroduodenal ulceration in 52% (n=43), post EMR 9% (n=7), tumour 6% (n=5), oesophageal ulceration 4% (n=3), dieulafoy lesion 4% (n=3), GAVE 2% (n=2), post-polypectomy 2% (n=2) and other causes totalling 21% (n=17). The gastroduodenal ulcers were classified as Forrest 1a (n=19), Forrest 1b (n=21) and unclassified (n=3). Hemospray was used as monotherapy in the majority of patients (57% n=47). In 8 (10%) it was used as first modality followed by additional endoscopic treatment and in 27 (33%) it was used as an adjuvant (rescue) therapy. Primary haemostasis was achieved in 71 patients (87%). Results of therapy for each of the three subgroups are shown in the Abstract OC-142 table 1. There were five deaths none of which were due to bleeding. Cause of death was liver disease in two patients, myocardial infarction, aspiration pneumonia and perforation in the remaining three patients respectively. There were eight technical complications: four blockages of the application catheter, one blockage of the endoscope working channel, on two occasions the endoscope became adherent to the oesophageal mucosa after use in retroflexion and on one occasion the CO2 propellant cartridge failed to operate.
Conclusion Hemospray provides an effective endoscopic modality for achieving primary haemostasis of non variceal UGIB as monotherapy or as first line combination treatment as well as a rescue modality after failed conventional endoscopic treatment.
Competing interests None declared.
Reference 1. Sung JJ, et al. Early clinical experience of the safety and effectiveness of hemospray in achieving hemostasis in patients with acute peptic ulcer bleeding. Endoscopy 2011;43:291–5.