Hemostatic Spray: What’s the Most Current Evidence?

Abstract

Introduction: At times, either because of location, extent or lesion features, hemostasis can be difficult to achieve. We aimed to analyze the clinical outcomes of patients who were treated with hemospray either for primary hemostasis or when bleeding was refractory or not amenable to well establish therapy. Methods: To identify pertinent case reports, case series and clinical trials, we searched the abstracts presented at Digestive Disease Week 2014 and the PubMed database using the keywords hemospray, hemostatic spray, TC-325, and spray until June 2014. The demographic information, location and type of lesion, effectiveness, rate of recurrence and complications were extracted and recorded. Results: A total of 18 studies were identified and provided data on 206 patients. The mean age of the patients was 59.39 years and 74.2% were males. Following lesions were treated: varices n=2, esophageal ulcers n=8, peptic ulcers n=114, portal hypertensive gastropathy n=4, Dieulafoy lesions n=4, tumors n=10, Iatrogenic: post polypectomy bleed n=6, post-endoscopic mucosal resection n=16, post banding ulcers n=2, post sclerotherapy ulceration n=1, post spinterotomy n=5, anastomosis n=1, others (MWT, arteriovenous malformation, GAVE, diverticular, fistula, colonic ulcers, Post halo therapy and proctitis) n= 15 and unidentified or not reported (NR) n=18. Of the lesion treated (actively bleeding 96.2%) 10.6% were in the esophagus, 28% were in the stomach, 41.3% in the small intestine and 12.1% in the colon. Hemospray was used as first-line therapy in 58.7% of the case and as salvage therapy in 39% of the patients (NR in 2.3%). The immediate hemostasis was achieved 89.4 % of the patients (93.1 % for the salvage procedures). Recurrent bleeding within 7 days was reported in 15.3% of the patients. Complication were noted in 2.1% of the patients and included possible splenic infarct, perforation and transient obstruction of biliary obstruction. Mortality in the perioperative period (mostly thought to be unrelated to the procedure itself) was reported in 2.9% patients. Conclusion: Our review of literature showed that hemospray is safe and effective. As it is easy to use, doesn’t need direct targeting and can cover a large surface area, it might have an advantage over routinely used hemostatic therapies in situations like tumor bleed, post EMR bleeding and posterior duodenal blub ulcers. However, prospective randomized trials are needed before routine use of hemospray can be recommended.