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Canadian Journal of Gastroenterology and Hepatology
Volume 28, Issue 2, Pages 72-76
http://dx.doi.org/10.1155/2014/759436
Original Article

Safety and Efficacy of Hemospray® in Upper Gastrointestinal Bleeding

Alan Hoi Lun Yau,1 George Ou,1 Cherry Galorport,2 Jack Amar,2 Brian Bressler,2 Fergal Donnellan,2 Hin Hin Ko,2 Eric Lam,2 and Robert Allan Enns2

1Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
2Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada

Received 17 October 2013; Accepted 3 November 2013

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Hemospray (Cook Medical, USA) has recently been approved in Canada for the management of nonvariceal upper gastrointestional bleeding (UGIB).

OBJECTIVE: To review the authors’ experience with the safety and efficacy of Hemospray for treating UGIB.

METHODS: A retrospective chart review was performed on patients who required endoscopic evaluation for suspected UGIB and were treated with Hemospray.

RESULTS: From February 2012 to July 2013, 19 patients (mean age 67.6 years) with UGIB were treated with Hemospray. A bleeding lesion was identified in the esophagus in one (5.3%) patient, the stomach in five (26.3%) and duodenum in 13 (68.4%). Bleeding was secondary to peptic ulcers in 12 (63.2%) patients, Dieulafoy lesions in two (10.5%), mucosal erosion in one (5.3%), angiodysplastic lesions in one (5.3%), ampullectomy in one (5.3%), polypectomy in one (5.3%) and an unidentified lesion in one (5.3%). The lesions showed spurting hemorrhage in four (21.1%) patients, oozing hemorrhage in 11 (57.9%) and no active bleeding in four (21.1%). Hemospray was administered as monotherapy in two (10.5%) patients, first-line modality in one (5.3%) and rescue modality in 16 (84.2%). Hemospray was applied prophylactically to nonbleeding lesions in four (21.1%) patients and therapeutically to bleeding lesions in 15 (78.9%). Acute hemostasis was achieved in 14 of 15 (93.3%) patients. Rebleeding within seven days occurred in seven of 18 (38.9%) patients. Potential adverse events occurred in two (10.5%) patients and included visceral perforation and splenic infarct. Mortality occurred in five (26.3%) patients but the cause of death was unrelated to gastrointestinal bleeding with the exception of one patient who developed hemoperitoneum.

CONCLUSIONS: The high rates of both acute hemostasis and recurrent bleeding suggest that Hemospray may be used in high-risk cases as a temporary measure or a bridge toward more definitive therapy.