PTH-056 Hemospray use in acute gastrointestinal bleeding- A 4 year single centre experience. (8th June 2018)

• Record Type: Journal Article
• Authors: Gupta, Tarun; Leet, Farique; Harborne, Matthew; Shivaji, Uday Nagesh; Awasthi, Ashish
• Is Part Of: Gut. Volume 67(2018)Supplement 1
• Page Start: A39
• Page End: A40
• Publication Date: 2018-06-08
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2018-BSGAbstracts.77
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Upper GI bleeding (UGIB) has a mortality of about 10% in UK despite advances in treatment. The current guidelines recommend dual modality of treatment which could include injection of adrenaline, argon photocoagulation or using endoscopic clips to achieve haemostasis. A recent addition to therapeutic options is Hemospray. Since June 2013, there have been reports from UK that it is useful as an adjunct in treatment of UGIB with most reporting success rates of 77%–85%. It has been suggested that it may not be reliable when used as the only mode of treatment. We report our experience using the product in our centre over 4 years (2013 to 2017). Methods: A retrospective review of patients using trust endoscopy database (Endosoft) between July 2013 &amp July 2017. We looked at electronic records of patients who underwent an endoscopy and needed Hemospray as a mode of treatment for managing an acute gastrointestinal (GI) bleed. Results: 45 consecutive patients (M=31), with median age 72 years (range 35–91 years) were included. The mean haemoglobin prior to endoscopy was 92 g/L. 40% were on anticoagulants or anti-platelets on admission. Of all patients who needed Hemospray, 43 had gastroscopies, 1 ERCP and 1 had colonoscopy. The details of diagnosis are in table 1. 23. 39 (86%) patients had Hemospray as adjunct therapy & all patients had complete haemostasis documented at the end of index procedure. 24. It was used as the only modality of therapy successfully in 6 patients (4 with malignancy and 2 iatrogenic bleeds) 25. Overall, 6/45 patients had a documented rebleed after discharge but within 4 weeks; 4 had bleeding vessels and were on warfarin or Ticagrelor; 2 patients had tumour related recurrent bleeding. 26. Forrest classification applicable to 22 patients –1A (n=3, 15%), 1B (n=10, 46%), 2A (n=3, 15%), 2B (n=3, 15%), 2C (n=2, 9%). 27. 100% (n=7) of UGIB related to malignancy responded to Hemospray (adjunct and monotherapy included) 28. 30 day mortality was 24% (n=11) with 3 deaths directly attributed to GI bleeding (4 palliative secondary to malignancy and 4 multifactorial in elderly patients). Conclusions: Our 4 year experience suggests that Hemospray can be a useful adjunct to conventional endoscopic therapy for acute GI bleed with success rates comparable to previous reports (nearly 85% in our cohort), with a rebleed rate of 14%. Our findings suggest it could be useful as monotherapy for bleeding related to malignancies where other therapy may be impractical. More studies with larger numbers are needed to add to the evidence base.