Rescue Therapy in Gastric Mucosal Bleed using Haemospray™

Abstract

Abstract Hemostatic agents are used extensively in endoscopic management of gastrointestinal (GI) bleed. Conventional endoscopic techniques such as thermal, mechanical (clipping), and injection treatment fail in up to 5%–10%. These agents are used particularly in anatomically challenging areas, lesions with poor visibility, diffuse bleeding, and friable tissues. We present an endoscopic management of gastric bleed in a 17-year-old male with leukemia (early T-cell precursor acute lymphoblastic leukemia), who underwent haplotransplant. Posttransplant patient developed pneumonia with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support with multiorgan dysfunction syndrome, graft versus host disease. During his hospital stay, he developed persistent GI bleed from multiple large excavating gastric ulcers. Multiple sessions of conventional hemostatic endoscopic procedures such as hemoclips, glue injection, and sclerosants failed to achieve hemostasis. Mucosal surface bleeds are difficult to manage hence we used Hemospray for achieving good hemostasis.