964 HEMOSPRAY IN THE TREATMENT OF VARICEAL BLEEDS: OUTCOMES FROM THE INTERNATIONAL HEMOSPRAY REGISTRY

Abstract

Early treatment for variceal bleeding is recommended within 12 hours to improve outcomes. Endoscopic therapy in acute variceal bleeding can be technically difficult and is not always successful and therefore a bridge is sometimes required towards definitive endoscopic therapy or Trans jugular intrahepatic portosystemic shunt (TIPS). Hemospray (Cook Medical, North Carolina, USA) is an endoscopic haemostatic powder for Gastrointestinal (GI) bleeding. The aim of this study was to look at outcomes in patients with upper gastrointestinal bleeds (UGIB’s) secondary to varices. Data was collected prospectively (January 2016- November 2019) from 16 centres in the USA, UK, Germany, France and Spain. Hemospray was used during emergency endoscopy for a variceal UGIB as a monotherapy, dual therapy with standard haemostatic techniques or rescue therapy once standard methods have failed. Haemostasis was defined as cessation of bleeding within 5 minutes of hemospray application. Rebleeding was defined as a sustained drop in Hb (>2g/l), haematemesis or melaena with haemodynamic instability following index endoscopy. 12 patients had Hemospray treatment following a variceal upper GI bleed (10 males, 2 female). 10 were oesophageal varices and 2 gastric varices. The median Rockall score was 8 (IQR, 7-8). The median Blatchford score was 15 (IQR, 13-17). There was an immediate haemostasis rate of 75%. There were no re-bleeds following treatment with Hemospray. 4 patients were treated with Hemospray monotherapy, 3 with combination therapy and 5 with rescue therapy (table 1). Hemospray was always given after oesophageal banding or injection sclerotherapy in the combination/rescue therapy cohorts. 4/9 patients died within 7 days, 3 out of these 4 patients did not achieve initial haemostasis with Hemospray. The outcomes from the registry showed an immediate haemostasis rate of 75% in variceal UGIBs following treatment with Hemospray. In those cohort of patients there is no re-bleeding. This suggests that Hemospray may play a potential role as a bridging therapy in variceal bleeds which are difficult to control, towards repeat definitive endoscopic therapy or TIPS. Larger trials are required to validate these results.