Mo1528 Use of Hemospray in Intractable Upper GI Bleeding: U.S. Single Center Experience

Abstract

endoscopic and fluoroscopic guidance. Symptom response and procedure and stent related outcomes were measured prospectively. Results: 11 patients (9 F, 2 M) were treated with a LAMS from Apr-Nov 2014. 6 pts had GOO (Bn-S Z 1, Mal-S Z 1, IndS Z 4) and 5 had ASs (gastro-jejunal post Roux-en-Y gastric bypass (RYGB) Z 4, gastric post vertical banded gastroplasty (VBG) Z 1). Obstructive symptoms resolved in 10 pts; there was no response in 1 pt with extrinsic duodenal compression from metastatic sarcoma. Stent removal was possible in all 9 pts in whom it was attempted. 4 pts had LAMS placed more than once; LAMSs were removed for stricture re-evaluation and a new LAMS placed simultaneously in 2 pts, and LAMSs were removed and replaced28 days later for symptom recurrence in 2 pts (benign GOO and AS in RYGB). Mean duration of LAMS in-situ (cumulative time used for the 2 pts with simultaneous Ax-Ss) was 62 days (range 11-152). There were no stent related complications including occlusion, migration or perforation. 1 pt with a radiation induced Bn-S with GOO was treated with a LAMS followed by an esophageal FCSEMS through the lumen of the LAMS with the LAMS acting as an anchor for the FCSEMS, without migration at 6 months. In the 4 pts with Ind-Ss with GOO, a Mal-S was confirmed by EUS-FNA in 1 pt and surgery in 1 pt, a peptic stricture in 1 pt and follow-up is pending in 1 pt. Amongst AS pts, the LAMS was removed for persistent pain (onset pre-dated LAMS) in 1 pt, for AS resolution in 2 pts and was left in place long term in 2 pts (one after initial stent removal). Conclusions: LAMS offers a new option for focal strictures causing GOO or occurring after surgery and have the advantages of easy placement and removal, if necessary, with no associated complications on short-term follow-up. Furthermore, the stent offers an easy new option for anchoring FCSEMS in strictures requiring a longer stent.