EFFICACY OF HEMOSPRAY AND ENDOCLOT IN THE TREATMENT OF GASTROINTESTINAL BLEEDING: RESULTS FROM A TERTIARY REFERRAL CENTER
27 March 2018 (online)
Gastrointestinal (GI) bleeding frequently leads to hospital admission and is associated with relevant morbidity and mortality. Due to the increasing administration of direct oral anticoagulants and the emerging role of antiplatelet agents treatment of GI bleeding may be challenging. Hemostatic powders (HP) represent novel “touch-free” and easy to use items for the management of GI bleeding. Our aim was to analyze the short and long term success for achieving hemostasis with HP and to directly compare the two agents Hemospray (HS) and Endoclot (EC) in their hemostatic efficacy
Data from a prospectively collected database of 154 patients that were treated with HP for emergency bleeding were analyzed regarding short term (ST-within 72 hours-) and long term (LT-within 30 days-) success for achieving hemostasis.
HP was applied in 154 patients with a mean follow-up of 3.2 months and majority of applications in the upper GI tract (n = 138 patients). Overall ST success was achieved in 125 patients (81%) and LT success in 67% of patients. In 72 patients (47%), HP was applied as salvage therapy with ST and LT success of 93% and 64%. In 82 patients (53.2%), HP was administered as a primary therapy with ST and LT success of 81.7% and 69.2%, respectively. In patients under therapeutic anticoagulation ST and LT success were 80% and 61%. Multiple applications of HP were required in 42 patients (27%) and 11 patients received both HS and EC. When directly comparing HS and EC, no differences in their efficacy for bleeding control were found. HP was easy to use with a technical success rate of 100% for both EC and HS; however, 2 perforations occurred during the application of HS.
HS and EC appear to be equally effective for bleeding control as measured by either ST or LT success and rebleeding rate.