P0670 Use of Hemospray in The Treatment of Lower Gastrointestinal Bleeds: Outcomes From The International Multicentre Hemospray Registry

Introduction Lower Gastrointestinal bleeding (LGIB) accounts for approximately 20% of all GI bleeds, with significant mortality in the elderly and those with comorbidities. Common current endoscopic methods for achieving haemostasis include Adrenaline injection, Mechanical clips and thermal therapy. Hemospray (Cook Medical, North Carolina, USA) is a haemostatic powder for GI bleeding. There is a small amount of data on its use in LGIB's. The primary aim was to look at the safety and efficacy of Hemospray in the treatment of LGIBs. Aims & Methods Data was prospectively collected on the use of Hemospray in LGIB's in 16 Centres in the USA, UK, Germany, France and Spain (January 2016 - November 2019). Hemospray was used as a monotherapy, combination therapy with standard haemostatic techniques or rescue therapy. Haemostasis was defined as the cessation of bleeding within 5 minutes of application of Hemospray. Rebleeding was defined as a sustained drop in Hb (>2g/l), haematemesis or melaena with haemodynamic instability following index endoscopy. Results 24 patients with LGIB's were recruited (16 males, 8 females). The causes of bleeding included malignancy (6/24, 25%), post procedure (pol-ypectomy/ESD) (5/24, 21%), inflammation/angiodysplasia (7/24, 29%), rectal ulcer (3/24, 13%) and oozing polyp (2/24, 8%). The median diameter of lesions was 20mm (IQR, 25-50). 9/24 (38%) of patients were on anti-platelets or anticoagulants. Overall immediate haemostasis was achieved in 22/24 (92%) of patients. 2/19 (11%) had a re-bleed within 7 days, 4/19 (21%) had a re-bleed within 30 days. 2/21 (10%) died within 30 days (all cause mortality). The two patients that failed treatment had surgery. There was haemostasis rates of 100% in the monotherapy cohort and 88% in the combination therapy cohort (Table 1). in combination Hemospray was always used as a second or third modality. There was a 78% immediate haemostasis rate in patients on antiocoagulants or antiplatelets. There was no adverse events associated with the use of Hemospray. Conclusion These results show that Hemospray is safe and also effective to use in LGIB's with 92% overall haemostasis rates. There are better outcomes when used as a Monotherapy. Anticoagulants/antiplatelets seem to have an effect on haemostasis rates with Hemospray in LGIBs (78% vs 100%). Lower GI bleeds are particularly difficult to treat. Hemospray is an effective alternative in situations where the bleeding point is difficult to access and where there is a large surface of bleeding. Larger randomised trials are required to validate these results.

Citation

Hussein, M., Alzoubaidi, D., Weaver, M., Makahamadze, C., de la Serna, A., Ortiz-Fernandez-Sordo, J., Rey, J. W., Hayee, B., Despott, E., Murino, A., Moreea, S., Boger, P., Dunn, J., Mainie, I., Graham, D., Mullady, D., Early, D., Ragunath, K., Anderson, J., Bhandari, P., Goetz, M., Rodriguez, E., Gonda, T., Keisslich, R., Coron, E., Lovat, L. B., & Haidry, R. (2020). P0670: Use of Hemospray in the treatment of lower gastrointestinal bleeds: Outcomes from the international multicentre Hemospray registry. United European gastroenterology journal, 8(8_suppl). https://doi.org/10.1177/2050640620927345

DOI

10.1177/2050640620927345

URI

https://hdl.handle.net/20.500.14709/1034