The role of hemospray in the endoscopic treatment of non variceal upper gastrointestinal bleeding; initial experiences in a tertiary centre gastroenterological unit

Introduction: Early endoscopic diagnosis and endoscopic haemostasis are essential tasks in cases with acute upper gastrointestinal bleeding (UGIB). Hemospray is a novel modality in endoscopic treatment of UGIB. The aim of our retrospective analyses was to evaluate the role and efficacy of Hemospray treatment in acute upper non variceal bleeders referred to our tertiary centre gastroenterological and endoscopy unit. Method: Hemospray as an endoscopic haemostatic modality is available in our unit since June 2013. Hemospray powder was sprayed via a 7 or 10 French catheter inserted through the endoscope channel targeting the actively bleeding points. Hemospray was used either as a rescue therapy after failed primary endotherapies or as a first choice intervention. Results: In 20 months period a total of 271 acute UGIB patients were admitted to our department with a mean age of 66.9 ± 13.7. At the emergency endoscopy in 66 patients gastrooesohageal varices or portal gastropathies were detected as bleeding sources. Gastroduodenal ulcers were found in 115 patients and in 90 cases the bleeding originated from other sources like Mallory-Weiss tear, erosive oesophagitis, angiodysplasia. Endoscopic therapy was performed in 56.6% out of the non variceal upper gastrointestinal bleeders (116/205). Combined endotherapies were done in 62 cases while endoscopic monotherapies were performed in 54 cases. In 10 severly bleeding patients Hemospray was used in a total of 11 settings. Hemospray therapy was necessary in 5 cases because of failed primary hemostatic efforts and in other 5 cases Hemospray was used as a first line therapy. In 10 cases out of all non variceal UGIB patients was necessary to act with of Hemospray (4.9%). Out of all endoscopic therapies Hemospray was used as rescue activity in 9.5% of patients (11/116). Primary haemostasis was achieved 9 out of the 10 Hemospray cases. Conclusions: Hemospray endotherapy may support the chance of primary hemostasis in severe acute upper GI bleeders in about one out of every twenty patients. Hemospray rescue therapy proved to be useful in nearly 10% of all endoscopic haemostatic efforts in our practice.