Introduction The hemostatic powder Hemospray (Cook Medical, Winston-Selem, NC, USA) is licensed for use in non-variceal upper GI haemorrhage and is now in widespread use in the UK. A prospective study of 101 cases showed a 96% immediate haemostasis rate, with rebleed rates of 26% and 33% at 8 and 10 days respectively.1 We introduced Hemospray to Imperial College Healthcare NHS Trust (ICHT) in January 2014. Here we compare our first 3 years of real-world usage against that reported in the literature.
Method The endoscopy reporting system of ICHT (Scorpio) was interrogated for all gastroscopies for the indication of haematemesis or melaena between the dates of 1/1/14-1/1/17. Variceal bleeds were excluded and cases where hemospray featured on the report selected for further investigation. These were then cross-referenced with the electronic patient records system for date of death, radiological or surgical procedures.
Results 1830 patients underwent OGD for haematemesis or melaena during the study period. 195 were variceal and excluded. 254 (15.5%) had therapy applied. Hemospray was used 32 times (2%). Site: 17 in duodenum, 8 in the oesophagus, 6 in the stomach. The bleeding lesion was identified as an ulcer in 18 (56%), Malignancy 3 (9%), Other 11 (34%, 9 Dieulafoy lesions, 2 generalised erythema). Haemostasis was reported by the endoscopist in 28 cases (88%).
5 were rebleeds with previous procedures, 15 had failed therapy with other haemostatic methods during the same procedure. Hemospray was used on 3 occasions after haemstasis had been already been achieved through other methods.
11 patients rebled following hemospray with a median 2.4 days (range 0.25–10 days). 5 were treated with OGD (1 again with hemospray, unsuccessfully), of whom 2 died. 6 were treated with radiological embolization, of whom 2 died. In total 6 patients died, 3 did not have haemostasis at the time of the OGD. 4 were oesophageal in origin (3 Dieulafoy lesions, 1 erythema), 3 were duodenal ulcers).
Conclusion Hemospray is being used a variety of situations, but mostly after failure of other therapies (62%). Rebleed rates are comparable to those reported previously.1 It worth noting that this study does not include Hemospray application following elective procedures which is relatively common. Hemospray is predictor of mortality (54%), probably reflecting the high risk groups Hemospray is used in.
. Haddara S, et al. A novel hemostatic powder for upper gastrointestinal bleeding: a multicenterstudy (the “GRAPHE” registry). Endoscopy. 2016Dec;48(12):1084–1095
Disclosure of Interest None Declared
- Upper Gastrointestinal Bleeding