Introduction Hemospray is a novel powder licenced in Europe and Canada for endoscopic hemostasis of non-variceal upper gastrointestinal bleeding. Portal hypertensive gastropathy (PHG), enteropathy or colopathy develop in many patients with portal hypertension. These conditions often present with chronic anaemia. However they can also result in acute blood loss which is difficult to treat due to the diffuse nature of bleeding.
Methods We present data from 4 consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding, which was treated with Hemospray.
Results Patient 1- a 67 year old man with alcoholic liver disease and cirrhosis attended for variceal screening gastroscopy. At the time he was found to have active bleeding from severe PHG. Hemospray was applied to this area achieving hemostasis, with no complications. Elective repeat gastroscopy at 4 weeks showed moderate PHG with no active bleeding and he had no clinical rebleeding by 6 weeks. Patient 2- a 74 year old lady with cryptogenic cirrhosis and transfusion dependent anaemia secondary to PHG despite beta-blockers, presented with an acute upper gastrointestinal bleed. Gastroscopy showed active bleeding from diffuse antral PHG. Argon beam diathermy failed to achieve hemostasis, therefore Hemospray was applied resulting in bleeding cessation. She had self limiting post-procedural abdominal pain but no evidence of perforation on imaging. No clinical rebleeding occurred during the next 6 weeks, although she continued to require 2-weekly transfusions as before for her chronic anaemia. Patient 3- a 72 year old man with advanced hepatocellular carcinoma, cirrhosis due to hemochromatosis, and transfusion dependent anaemia despite beta-blockers, presented with fresh rectal bleeding. Flexible sigmoidoscopy demonstrated severe portal hypertensive colopathy with active bleeding. Hemospray was applied and hemostasis achieved. He had no complications and no further rectal bleeding by 6 weeks. There was evidence of reduced transfusion requirements during this 6 week period. Patient 4 – a 66 year old lady with decompensated alcohol related cirrhosis presented with abdominal pain and melena. Emergency gastroscopy revealed active bleeding from severe proximal PHG. Hemospray was applied leading to hemostasis. Following the procedure the patient developed increasing abdominal pain and imaging showed evidence of free peritoneal air. She was deemed unfit for surgical intervention due to her co-morbidites and died of sepsis secondary to perforated abdominal viscus 4 days following the procedure.
Conclusion Hemospray appears to achieve hemostasis in acute non-variceal portal hypertensive bleeding. Further data are required on the outcome and safety of Hemospray use in this condition.
Disclosure of Interest None Declared.
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