HEMOSPRAY FOR GASTROINTESTINAL BLEEDING: EFFECTIVENESS, PREDICTORS OF FAILURE AND SURVIVAL IN A NATIONWIDE STUDY

Aims:

This study aimed to assess the effectiveness, safety and predictors of Hemospray failure in a large real-life cohort.

Methods:

This was a retrospective study conducted at 21 Spanish academic and community centers. All patients receiving Hemospray until September 2018 were included. The primary outcome was treatment failure, defined as failed intraprocedural hemostasis or rebleeding during the first 30 days. Secondary outcomes included safety and survival. Cumulative incidence and predictors of failure were assessed via competing-risks models.

Results:

A total of 261 patients were included, 219 (83.9%) of whom presented with upper gastrointestinal bleeding (GIB). The most common etiologies were peptic ulcer (73, 28%), malignancy (48, 18.4%) and therapeutic endoscopy-related GIB (46, 17.6%). Hemospray was used as salvage therapy in 191 (73.2%) patients and as monotherapy in 96 (36.8%). The rate of intraprocedural hemostasis was 94.1% (95% confidence interval [CI]: 90.5 – 96.4). The risk of Hemospray failure at 3, 7 and 30 days were 21.1% (95% CI: 16.4 – 26.2), 24.6% (95% CI: 19.5 – 29.9), and 27.4 (95% CI: 22.1 – 32.9); respectively. On multivariable analysis, spurting bleeding (P = 0.004), use of vasoactive drugs (P = 0.02), and hypotension (P = 0.008) were independents predictor of failure. Overall 30-day survival was 81.9% (95% CI: 76.5 – 86.1%) and intraprocedural hemostasis was associated with better prognosis (adjusted Hazard Rate: 0.27; P = 0.004). Two potentially-related severe adverse event were noted.

Conclusions:

Hemospray was effective for achieving intraprocedural hemostasis regardless of the etiology, location, and its use as rescue therapy. However, 30-day failure rate was 27.4%. Intraprocedural hemostasis provided a significant benefit on 30-day survival.