Background and aim: Non-variceal upper GI bleeding (NVUGIB) remains a common medical problem with significant associated morbidity and 30-day mortality. Hemospray (HS) (Cook Medical) is an emerging endoscopic hemostatic agent that was recently introduced in the management of NVUGIB. Our aim was to evaluate the use of HS in NVUGIB. Material and methods: 22 patients (8F & 14M; 72.9±12.3yrs) with NVUGIUB underwent endoscopic treatment. HS was used as the primary hemostasis method, followed by secondary methods if needed. There were 5 F1a ulcers, 9 F1b ulcers, 3 post-EBS, 2 Dieulafoy, 1 artero-duodenal fistula (ADF) and 1 after EMR. Of the ulcers 1 were localized in a gastro-jejunal anastomosis (GJA), 2 in the subcardial region, 2 in the stomach and 9 in the duodenum. Results: All 22 NVUGIUB were treated first with HS. We had 17 (77.3%) successfully tretaed patients at the 1st attempt. In 14 (63.6%) patients HS alone was successful in achieving hemostasis. This included 2 F1a ulcers, 7 F1b ulcers, 3 post-EBS, 1 post-EMR and 1 Dieulafoy. Of the ulcers were 6 duodenal ulcers (DU) and 3 gastric ulcers (GU) of which 1 subcardial. In the other three pts was used epinephrine for 2 (11.7%) and epinephrine plus clips in the other one (4.5%): 2 F1a and 1 F1b. In the other 5 pts we had failure (22.7%). These were: a GJA F1a ulcer with first therapy with HS plus clips, reebleding at 36 h treated again with HS plus clips, after undergone total gastrectomy (TG). The second one had a neoplastic recurrence on a GJA with 2 HS treatment to a distance of 48h underwent TG. Third had a gastric Dieulafoy treated with HS plus epinephrine plus clips and after, in the same EGD, by OVESCO clip. The fourth had an F1b DU tretaed two times with HS plus clips to a distance of 24h, than surgical suture. The fifth had an ADF treated two times with HS plus clips to a distance of 24 hours, than radiological hembolization. There was one unusual complication: with the scope in retroflexion, the scope was temporarily adhered to the wall of the distal esophagus by the HS. This was solved manually. Overall, clinical success was achieved with HS alone, or in combination with epinephrine or clips in 17 patients (77.3%). Conclusions: HS seems to be a useful tool as a single modality or in combination with other methods for treatment of NVUGIUB, especially in severe and difficult bleeding. More data are needed to establish the correct use and field of its application in UGIUB.
Use of Hemospray powder in the acute upper gi bleeding.
Mangiavillano B;
2013-01-01
Abstract
Background and aim: Non-variceal upper GI bleeding (NVUGIB) remains a common medical problem with significant associated morbidity and 30-day mortality. Hemospray (HS) (Cook Medical) is an emerging endoscopic hemostatic agent that was recently introduced in the management of NVUGIB. Our aim was to evaluate the use of HS in NVUGIB. Material and methods: 22 patients (8F & 14M; 72.9±12.3yrs) with NVUGIUB underwent endoscopic treatment. HS was used as the primary hemostasis method, followed by secondary methods if needed. There were 5 F1a ulcers, 9 F1b ulcers, 3 post-EBS, 2 Dieulafoy, 1 artero-duodenal fistula (ADF) and 1 after EMR. Of the ulcers 1 were localized in a gastro-jejunal anastomosis (GJA), 2 in the subcardial region, 2 in the stomach and 9 in the duodenum. Results: All 22 NVUGIUB were treated first with HS. We had 17 (77.3%) successfully tretaed patients at the 1st attempt. In 14 (63.6%) patients HS alone was successful in achieving hemostasis. This included 2 F1a ulcers, 7 F1b ulcers, 3 post-EBS, 1 post-EMR and 1 Dieulafoy. Of the ulcers were 6 duodenal ulcers (DU) and 3 gastric ulcers (GU) of which 1 subcardial. In the other three pts was used epinephrine for 2 (11.7%) and epinephrine plus clips in the other one (4.5%): 2 F1a and 1 F1b. In the other 5 pts we had failure (22.7%). These were: a GJA F1a ulcer with first therapy with HS plus clips, reebleding at 36 h treated again with HS plus clips, after undergone total gastrectomy (TG). The second one had a neoplastic recurrence on a GJA with 2 HS treatment to a distance of 48h underwent TG. Third had a gastric Dieulafoy treated with HS plus epinephrine plus clips and after, in the same EGD, by OVESCO clip. The fourth had an F1b DU tretaed two times with HS plus clips to a distance of 24h, than surgical suture. The fifth had an ADF treated two times with HS plus clips to a distance of 24 hours, than radiological hembolization. There was one unusual complication: with the scope in retroflexion, the scope was temporarily adhered to the wall of the distal esophagus by the HS. This was solved manually. Overall, clinical success was achieved with HS alone, or in combination with epinephrine or clips in 17 patients (77.3%). Conclusions: HS seems to be a useful tool as a single modality or in combination with other methods for treatment of NVUGIUB, especially in severe and difficult bleeding. More data are needed to establish the correct use and field of its application in UGIUB.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
