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

E Rodríguez de Santiago; D Burgos Santamaría; L Pérez Carazo; A Teran Lantaron; E Brullet; S Prados Leira; F Riu Pons; I Fernández-Urién Sainz; I Becerro González; M Angel de Jorge Turrión; C Ferre Aracil; C Rodríguez Escaja; D Perez Corte; N Volpato Machado; E Martínez Moneo; FJ García Alonso; CM Chavarría Herbozo; S Sevilla Ribota; R Borobia Sanchez; E Martínez Bauer; L Ciriano Hernández; A Barturen Barroso; C Santander Vaquero; A Guerrero García; HMM Prieto; A López Serrano; M López Ibañez; O Murcia Palomares; G Pagano; D Oyón Lara; C Froilan Torres; D Coto Ugarte; M González-Haba Ruíz; M de Benito Sanz; C Carbonell Blanco; O Nogales Rincón; I Ortiz Polo; D Juzgado de Lucas; S Parejo Carbonell; B Peñas García; J Aranda Hernández; J García Lledó; A Ibañez Pinto; E Vazquez Sequeiros; A Albillos

doi:10.1055/s-0039-1681353

Endoscopy, Table of Contents

Endoscopy 2019; 51(04): S62
DOI: 10.1055/s-0039-1681353

ESGE Days 2019 oral presentations

Friday, April 5, 2019 14:30 – 16:30: GI bleeding Club C

Georg Thieme Verlag KG Stuttgart · New York

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

Authors

E Rodríguez de Santiago

¹Ramon y Cajal University Hospital, Madrid, Spain

²Universisty of Alcala. IRYCIS, Madrid, Spain
D Burgos Santamaría

¹Ramon y Cajal University Hospital, Madrid, Spain
L Pérez Carazo

³Hospital Gregorio Marañon, Madrid, Spain
A Teran Lantaron

⁴Hospital Marques de Valdecilla, Santander, Spain
E Brullet

⁵Hospital Parc Tauli de Sabadell, Sabadell, Spain
S Prados Leira

⁶Hospital de Sanchinarro, Madrid, Spain
F Riu Pons

⁷Hospital del Mar, Barcelona, Spain
I Fernández-Urién Sainz

⁸Hospital Universitario de Navarra, Pamplona, Spain
I Becerro González

⁹Hospital Universitario De La Princesa, Madrid, Spain
M Angel de Jorge Turrión

¹⁰Hospital Universitario de Cabueñes, Gijón, Spain
C Ferre Aracil

¹¹Hospital Universitario Puerta de Hierro, Majadahonda, Spain
C Rodríguez Escaja

¹²Hospital Universitario Central de Asturias, Oviedo, Spain
D Perez Corte

¹³Hospital de Aviles, Aviles, Spain
N Volpato Machado

¹⁴Hospital Universitario de la Paz, Madrid, Spain
E Martínez Moneo

¹⁵Hospital Universitario de Cruces, Bilbao, Spain
FJ García Alonso

¹⁶Hospital Universitario Rio Hortega, Valladolid, Spain
CM Chavarría Herbozo

¹⁷Hospital Universitario del Henares, Madrid, Spain
S Sevilla Ribota

¹⁸Hospital Universitario Quirón Madrid, Madrid, Spain
R Borobia Sanchez

³Hospital Gregorio Marañon, Madrid, Spain
E Martínez Bauer

⁵Hospital Parc Tauli de Sabadell, Sabadell, Spain
L Ciriano Hernández

⁴Hospital Marques de Valdecilla, Santander, Spain
A Barturen Barroso

¹⁵Hospital Universitario de Cruces, Bilbao, Spain

¹⁹Hospital IMQ Zorrotzaurre, Bilbao, Spain
C Santander Vaquero

⁹Hospital Universitario De La Princesa, Madrid, Spain
A Guerrero García

¹Ramon y Cajal University Hospital, Madrid, Spain
HMM Prieto

²⁰Hospital Universitario de Salamanca, Salamanca, Spain
A López Serrano

²¹Hospital Universitario Doctor Peset, Valencia, Spain
M López Ibañez

³Hospital Gregorio Marañon, Madrid, Spain
O Murcia Palomares

²²Hospital de Motril, Motril, Spain
G Pagano

⁷Hospital del Mar, Barcelona, Spain
D Oyón Lara

⁸Hospital Universitario de Navarra, Pamplona, Spain
C Froilan Torres

¹⁴Hospital Universitario de la Paz, Madrid, Spain
D Coto Ugarte

¹⁵Hospital Universitario de Cruces, Bilbao, Spain
M González-Haba Ruíz

¹¹Hospital Universitario Puerta de Hierro, Majadahonda, Spain
M de Benito Sanz

¹⁶Hospital Universitario Rio Hortega, Valladolid, Spain
C Carbonell Blanco

³Hospital Gregorio Marañon, Madrid, Spain
O Nogales Rincón

³Hospital Gregorio Marañon, Madrid, Spain
I Ortiz Polo

²¹Hospital Universitario Doctor Peset, Valencia, Spain
D Juzgado de Lucas

¹⁸Hospital Universitario Quirón Madrid, Madrid, Spain
S Parejo Carbonell

¹Ramon y Cajal University Hospital, Madrid, Spain
B Peñas García

¹Ramon y Cajal University Hospital, Madrid, Spain
J Aranda Hernández

³Hospital Gregorio Marañon, Madrid, Spain
J García Lledó

³Hospital Gregorio Marañon, Madrid, Spain
A Ibañez Pinto

¹⁷Hospital Universitario del Henares, Madrid, Spain
E Vazquez Sequeiros

¹Ramon y Cajal University Hospital, Madrid, Spain
A Albillos

¹Ramon y Cajal University Hospital, Madrid, Spain

²Universisty of Alcala. IRYCIS, Madrid, Spain

Abstract

Full Text

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.