Endoscopy 2019; 51(04): S62
DOI: 10.1055/s-0039-1681353
ESGE Days 2019 oral presentations
Friday, April 5, 2019 14:30 – 16:30: GI bleeding Club C
Georg Thieme Verlag KG Stuttgart · New York

HEMOSPRAY FOR GASTROINTESTINAL BLEEDING: EFFECTIVENESS, PREDICTORS OF FAILURE AND SURVIVAL IN A NATIONWIDE STUDY

Authors

  • E Rodríguez de Santiago

    1   Ramon y Cajal University Hospital, Madrid, Spain
    2   Universisty of Alcala. IRYCIS, Madrid, Spain

  • D Burgos Santamaría

    1   Ramon y Cajal University Hospital, Madrid, Spain

  • L Pérez Carazo

    3   Hospital Gregorio Marañon, Madrid, Spain

  • A Teran Lantaron

    4   Hospital Marques de Valdecilla, Santander, Spain

  • E Brullet

    5   Hospital Parc Tauli de Sabadell, Sabadell, Spain

  • S Prados Leira

    6   Hospital de Sanchinarro, Madrid, Spain

  • F Riu Pons

    7   Hospital del Mar, Barcelona, Spain

  • I Fernández-Urién Sainz

    8   Hospital Universitario de Navarra, Pamplona, Spain

  • I Becerro González

    9   Hospital Universitario De La Princesa, Madrid, Spain

  • M Angel de Jorge Turrión

    10   Hospital Universitario de Cabueñes, Gijón, Spain

  • C Ferre Aracil

    11   Hospital Universitario Puerta de Hierro, Majadahonda, Spain

  • C Rodríguez Escaja

    12   Hospital Universitario Central de Asturias, Oviedo, Spain

  • D Perez Corte

    13   Hospital de Aviles, Aviles, Spain

  • N Volpato Machado

    14   Hospital Universitario de la Paz, Madrid, Spain

  • E Martínez Moneo

    15   Hospital Universitario de Cruces, Bilbao, Spain

  • FJ García Alonso

    16   Hospital Universitario Rio Hortega, Valladolid, Spain

  • CM Chavarría Herbozo

    17   Hospital Universitario del Henares, Madrid, Spain

  • S Sevilla Ribota

    18   Hospital Universitario Quirón Madrid, Madrid, Spain

  • R Borobia Sanchez

    3   Hospital Gregorio Marañon, Madrid, Spain

  • E Martínez Bauer

    5   Hospital Parc Tauli de Sabadell, Sabadell, Spain

  • L Ciriano Hernández

    4   Hospital Marques de Valdecilla, Santander, Spain

  • A Barturen Barroso

    15   Hospital Universitario de Cruces, Bilbao, Spain
    19   Hospital IMQ Zorrotzaurre, Bilbao, Spain

  • C Santander Vaquero

    9   Hospital Universitario De La Princesa, Madrid, Spain

  • A Guerrero García

    1   Ramon y Cajal University Hospital, Madrid, Spain

  • HMM Prieto

    20   Hospital Universitario de Salamanca, Salamanca, Spain

  • A López Serrano

    21   Hospital Universitario Doctor Peset, Valencia, Spain

  • M López Ibañez

    3   Hospital Gregorio Marañon, Madrid, Spain

  • O Murcia Palomares

    22   Hospital de Motril, Motril, Spain

  • G Pagano

    7   Hospital del Mar, Barcelona, Spain

  • D Oyón Lara

    8   Hospital Universitario de Navarra, Pamplona, Spain

  • C Froilan Torres

    14   Hospital Universitario de la Paz, Madrid, Spain

  • D Coto Ugarte

    15   Hospital Universitario de Cruces, Bilbao, Spain

  • M González-Haba Ruíz

    11   Hospital Universitario Puerta de Hierro, Majadahonda, Spain

  • M de Benito Sanz

    16   Hospital Universitario Rio Hortega, Valladolid, Spain

  • C Carbonell Blanco

    3   Hospital Gregorio Marañon, Madrid, Spain

  • O Nogales Rincón

    3   Hospital Gregorio Marañon, Madrid, Spain

  • I Ortiz Polo

    21   Hospital Universitario Doctor Peset, Valencia, Spain

  • D Juzgado de Lucas

    18   Hospital Universitario Quirón Madrid, Madrid, Spain

  • S Parejo Carbonell

    1   Ramon y Cajal University Hospital, Madrid, Spain

  • B Peñas García

    1   Ramon y Cajal University Hospital, Madrid, Spain

  • J Aranda Hernández

    3   Hospital Gregorio Marañon, Madrid, Spain

  • J García Lledó

    3   Hospital Gregorio Marañon, Madrid, Spain

  • A Ibañez Pinto

    17   Hospital Universitario del Henares, Madrid, Spain

  • E Vazquez Sequeiros

    1   Ramon y Cajal University Hospital, Madrid, Spain

  • A Albillos

    1   Ramon y Cajal University Hospital, Madrid, Spain
    2   Universisty of Alcala. IRYCIS, Madrid, Spain
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

This study aimed to assess the effectiveness, safety and predictors of Hemospray failure in a large real-life cohort.

Methods:

This was a retrospective study conducted at 21 Spanish academic and community centers. All patients receiving Hemospray until September 2018 were included. The primary outcome was treatment failure, defined as failed intraprocedural hemostasis or rebleeding during the first 30 days. Secondary outcomes included safety and survival. Cumulative incidence and predictors of failure were assessed via competing-risks models.

Results:

A total of 261 patients were included, 219 (83.9%) of whom presented with upper gastrointestinal bleeding (GIB). The most common etiologies were peptic ulcer (73, 28%), malignancy (48, 18.4%) and therapeutic endoscopy-related GIB (46, 17.6%). Hemospray was used as salvage therapy in 191 (73.2%) patients and as monotherapy in 96 (36.8%). The rate of intraprocedural hemostasis was 94.1% (95% confidence interval [CI]: 90.5 – 96.4). The risk of Hemospray failure at 3, 7 and 30 days were 21.1% (95% CI: 16.4 – 26.2), 24.6% (95% CI: 19.5 – 29.9), and 27.4 (95% CI: 22.1 – 32.9); respectively. On multivariable analysis, spurting bleeding (P = 0.004), use of vasoactive drugs (P = 0.02), and hypotension (P = 0.008) were independents predictor of failure. Overall 30-day survival was 81.9% (95% CI: 76.5 – 86.1%) and intraprocedural hemostasis was associated with better prognosis (adjusted Hazard Rate: 0.27; P = 0.004). Two potentially-related severe adverse event were noted.

Conclusions:

Hemospray was effective for achieving intraprocedural hemostasis regardless of the etiology, location, and its use as rescue therapy. However, 30-day failure rate was 27.4%. Intraprocedural hemostasis provided a significant benefit on 30-day survival.