1983 Hemospray® as Bridging Therapy in Acute Esophageal Bleeding Secondary to Varices and Post-Banding Ulcers

Abstract

INTRODUCTION: Hemospray® is a noncontact, nontargeted inorganic powder for endoscopic hemostasis that forms a superficial mechanical barrier over bleeding sites. It is currently approved by the FDA for use in non variceal gastrointestinal bleeding (GIB). However it has been used for variceal bleeding. Here we present our initial experience of using hemospray as salvage therapy in patients with acute bleeding from esophageal varices and post banding ulcers refractory to endoscopic management. CASE DESCRIPTION/METHODS: Four patients with decompensated liver cirrhosis presented with acute upper GIB. The patients underwent emergent esophagogastroduodenoscopy (EGD) after initial resuscitation and medical management. On EGD the patients were found to have GIB secondary to esophageal varices and post banding ulcers. Given unsuccessful attempts at standard hemostatic procedures we opted to use Hemospray® to achieve hemostasis. [Figure 1] Their baseline characteristics and endoscopic findings are summarized in Table 1. Of the 4 patients 2 underwent definitive therapy with repeat EGD and banding 24 and 48 hours post initial procedure. One patient opted to undergo elective banding in 4 weeks and did not have further evidence of bleeding. One of the patient's with bleeding esophageal varices developed rebleeding 8 days after the index procedure; repeat EGD showed multiple clots overlying post banding ulcers without active bleeding. Two patient's died of multisystem organ failure on post procedure days 11 and 18, respectively. There were no Hemospray® related adverse events. DISCUSSION: In our experience Hemospray® seems to provide a safe endoscopic option for temporizing patients with GIB secondary to esophageal varices and post banding ulcers that are not amenable to endoscopic therapy and band ligation due to technical difficulties. It appears to serve as an effective bridge to definitive therapy in these patients.