TC-325 (HEMOSPRAY) IN NON VARICEAL ACUTE UPPER GASTROINTESTINAL BLEEDING: A SINGLE CENTRE EXPERIENCE

Aims TC-235 (Hemospray) is a haemostatic powder licensed for the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB). The objective of this study was to assess the use and effectiveness of Hemospray at our centre, as well as attempt to establish potential risk factors for failure to achieve haemostasis.

Methods Retrospective single-centre cohort study of all patients treated with Hemospray for NVUGIB between February 2016 and September 2019.

Results 34 patients (male n=23; 67.6%) were treated with Hemospray for NVUGIB.(mean age 61.5). The main causes of gastrointestinal bleeding were duodenal ulcers (n=13; 38.2%), gastric ulcers (n=1; 2.9%), post-sphincterotomy bleeding (n=6; 17.6%), gastrointestinal malignancy (n=7; 20.6%), Mallory-Weiss tear (n=1; 2.9%), portal hypertensive gastropathy (n=2; 5.9%), oesophagitis (n=3; 8.8%) and post-biopsy bleed (n=1; 2.9%). Amongst the 14 gastro-duodenal ulcers, the Forrest classification was as follows: 1A (n=2; 14.2%); 1B (n=10; 71.4%); 2A (n=1; 7.1%); 2B (n=1;7.1%). Hemospray was used as a monotherapy in 21 of 34 cases (61.8%) and as part of combination therapy in 13 (38.2%). The overall rate of initial hemostasis with Hemospray use was 94.1% (32/34 procedures, 20/21 as monotherapy (95.2%)). 6 patients had a bleeding diathesis (raised INR>1.5 and/or platelets < 50 × 109/L) with a reduced initial hemostasis rate of 66.6% (4/6). 3 (9.4%) developed re-bleeding with an average time to re-bleed of 6 days (range 1-10 days). Two cases of re-bleeding had gastro-duodenal ulceration with high-risk features for re-bleeding: Forrest 1A ulcer (n=1) and Forrest 1B (n=1). The overall 30 day mortality was 17.6% (n=6). No complications of Hemospray use were identified.

Conclusions Hemospray was overall safe and effective at achieving haemostasis regardless of aetiology. The only 2 cases that did not achieve initial haemostasis had significant bleeding diathesis outlining the importance of correcting these haematological parameters in conjunction with therapeutic upper GI endoscopy in cases of upper gastrointestinal haemorrhage.