Hemospray shows high efficacy, but rebleeding concerns remain

Hemospray is highly effective for initial gastrointestinal hemostasis, but not long-term therapy, based on a recent meta-analysis.

Among 814 patients with GI bleeding who were treated with Hemospray, respective rates of clinical success and early rebleeding were 92% and 20%, reported lead author Andrew Ofosu, MD, of the Brooklyn Hospital Center, New York, and colleagues.

“Since its introduction, multiple studies have evaluated the efficacy of Hemospray for endoscopic hemostasis in a wide array of bleeding disorders in either the upper and/or lower GI tract,” the investigators wrote. Their report is in the Journal of Clinical Gastroenterology.

The present review and meta-analysis included 19 of those studies, including randomized controlled trials, case series, and case-control studies.

Of 814 adult patients, 212 were treated with Hemospray as monotherapy, while 602 were treated with Hemospray combined with conventional hemostatic techniques.

“Unlike conventional endoscopic methods currently in use to achieve immediate hemostasis in GI bleeding, Hemospray is noncontact, nonthermal, and nontraumatic,” the investigators noted.

Clinical success, defined by endoscopically observed initial hemostasis, was achieved in 91% of patients who were treated with Hemospray as monotherapy, a rate that did not significantly differ from the 93% success rate achieved by a combination approach.

Early rebleeding, defined by rebleeding within 7 days, was comparable between monotherapy (21%) and combination therapy (20%), a finding that was maintained in subgroup analysis. Similarly, no statistical difference was found between rates of rebleeding within 30 days, which were 22% and 24%, for monotherapy and combination therapy, respectively.

“Our study showed the rate of rebleeding increased with time after the application of Hemospray, likely due to the limited duration of action of the hemostatic powder at the site of bleeding,” wrote Dr. Ofosu and colleagues. “Second-look endoscopy performed in some studies has shown Hemospray is eliminated from the GI tract in as few as 24 hours after use, which potentially increases the risk of recurrent bleeding.”

The investigators suggested that Hemospray is best suited for short-term use because of the rebleeding risk.

“The use of Hemospray offers the potential to control bleeding initially and to optimize positioning or application of other modalities if needed in a more controlled setting,” concluded Dr. Ofosu and colleagues, who noted that this stance aligns with the views of other investigators.

Daljeet Chahal, MD and Fergal Donnellan, MD, of the University of British Columbia, Vancouver, are two such investigators, having just published a retrospective cohort study that involved 86 applications of Hemospray. Their study, which was not included in the present meta-analysis because of recency of publication, revealed that “Hemospray is effective in achieving immediate hemostasis but is plagued by high rates of rebleeding.”

According to Dr. Chahal and Dr. Donnellan, who provided a written comment, the findings of Dr. Ofosu and colleagues are comparable to their own, thereby supporting a similar conclusion.

“Hemospray appears more suited to emergent situations, where it should be used as a last resort; as a bridge therapy to more definitive measures such as embolization or surgery,” they wrote.

Dr. Chahal and Dr. Donnellan also suggested that more work is needed to develop a comprehensive picture of Hemospray outcomes, which could guide usage.

“The meta-analysis does not comment specifically on rates of embolization or surgery after Hemospray use, or whether these rates differ by type of lesion,” they wrote. “These would be interesting measures to explore in future studies to more concretely define appropriate indications for Hemospray use.”

Bilal Toka, MD, of Sakarya University in Serdivan, Turkey, who has previously published research comparing conventional hemostatic techniques, also provided a written comment, in which he advised clinicians to be ready for a combination approach, particularly among high-risk patients.

“This meta-analysis shows that Hemospray is very useful in providing initial hemostasis in patients with GI bleeding,” Dr. Toka wrote. “[However], due to its high early and delayed rebleeding rates, additional mechanical or thermal endoscopic treatment should be applied in high-risk lesions such as actively bleeding peptic ulcers.”

The investigators reported no conflicts of interest.

SOURCE: Ofosu A et al. J Clin Gastroenterol. 2020 Jul 3. doi: 10.1097/MCG.0000000000001379.

Hemospray is highly effective for initial gastrointestinal hemostasis, but not long-term therapy, based on a recent meta-analysis.

Among 814 patients with GI bleeding who were treated with Hemospray, respective rates of clinical success and early rebleeding were 92% and 20%, reported lead author Andrew Ofosu, MD, of the Brooklyn Hospital Center, New York, and colleagues.

“Since its introduction, multiple studies have evaluated the efficacy of Hemospray for endoscopic hemostasis in a wide array of bleeding disorders in either the upper and/or lower GI tract,” the investigators wrote. Their report is in the Journal of Clinical Gastroenterology.

The present review and meta-analysis included 19 of those studies, including randomized controlled trials, case series, and case-control studies.

Of 814 adult patients, 212 were treated with Hemospray as monotherapy, while 602 were treated with Hemospray combined with conventional hemostatic techniques.

“Unlike conventional endoscopic methods currently in use to achieve immediate hemostasis in GI bleeding, Hemospray is noncontact, nonthermal, and nontraumatic,” the investigators noted.

Clinical success, defined by endoscopically observed initial hemostasis, was achieved in 91% of patients who were treated with Hemospray as monotherapy, a rate that did not significantly differ from the 93% success rate achieved by a combination approach.

Early rebleeding, defined by rebleeding within 7 days, was comparable between monotherapy (21%) and combination therapy (20%), a finding that was maintained in subgroup analysis. Similarly, no statistical difference was found between rates of rebleeding within 30 days, which were 22% and 24%, for monotherapy and combination therapy, respectively.

“Our study showed the rate of rebleeding increased with time after the application of Hemospray, likely due to the limited duration of action of the hemostatic powder at the site of bleeding,” wrote Dr. Ofosu and colleagues. “Second-look endoscopy performed in some studies has shown Hemospray is eliminated from the GI tract in as few as 24 hours after use, which potentially increases the risk of recurrent bleeding.”

The investigators suggested that Hemospray is best suited for short-term use because of the rebleeding risk.

“The use of Hemospray offers the potential to control bleeding initially and to optimize positioning or application of other modalities if needed in a more controlled setting,” concluded Dr. Ofosu and colleagues, who noted that this stance aligns with the views of other investigators.

Daljeet Chahal, MD and Fergal Donnellan, MD, of the University of British Columbia, Vancouver, are two such investigators, having just published a retrospective cohort study that involved 86 applications of Hemospray. Their study, which was not included in the present meta-analysis because of recency of publication, revealed that “Hemospray is effective in achieving immediate hemostasis but is plagued by high rates of rebleeding.”

According to Dr. Chahal and Dr. Donnellan, who provided a written comment, the findings of Dr. Ofosu and colleagues are comparable to their own, thereby supporting a similar conclusion.

“Hemospray appears more suited to emergent situations, where it should be used as a last resort; as a bridge therapy to more definitive measures such as embolization or surgery,” they wrote.

Dr. Chahal and Dr. Donnellan also suggested that more work is needed to develop a comprehensive picture of Hemospray outcomes, which could guide usage.

“The meta-analysis does not comment specifically on rates of embolization or surgery after Hemospray use, or whether these rates differ by type of lesion,” they wrote. “These would be interesting measures to explore in future studies to more concretely define appropriate indications for Hemospray use.”

Bilal Toka, MD, of Sakarya University in Serdivan, Turkey, who has previously published research comparing conventional hemostatic techniques, also provided a written comment, in which he advised clinicians to be ready for a combination approach, particularly among high-risk patients.

“This meta-analysis shows that Hemospray is very useful in providing initial hemostasis in patients with GI bleeding,” Dr. Toka wrote. “[However], due to its high early and delayed rebleeding rates, additional mechanical or thermal endoscopic treatment should be applied in high-risk lesions such as actively bleeding peptic ulcers.”

The investigators reported no conflicts of interest.

SOURCE: Ofosu A et al. J Clin Gastroenterol. 2020 Jul 3. doi: 10.1097/MCG.0000000000001379.

Hemospray is highly effective for initial gastrointestinal hemostasis, but not long-term therapy, based on a recent meta-analysis.

Among 814 patients with GI bleeding who were treated with Hemospray, respective rates of clinical success and early rebleeding were 92% and 20%, reported lead author Andrew Ofosu, MD, of the Brooklyn Hospital Center, New York, and colleagues.

“Since its introduction, multiple studies have evaluated the efficacy of Hemospray for endoscopic hemostasis in a wide array of bleeding disorders in either the upper and/or lower GI tract,” the investigators wrote. Their report is in the Journal of Clinical Gastroenterology.

The present review and meta-analysis included 19 of those studies, including randomized controlled trials, case series, and case-control studies.

Of 814 adult patients, 212 were treated with Hemospray as monotherapy, while 602 were treated with Hemospray combined with conventional hemostatic techniques.

“Unlike conventional endoscopic methods currently in use to achieve immediate hemostasis in GI bleeding, Hemospray is noncontact, nonthermal, and nontraumatic,” the investigators noted.

Clinical success, defined by endoscopically observed initial hemostasis, was achieved in 91% of patients who were treated with Hemospray as monotherapy, a rate that did not significantly differ from the 93% success rate achieved by a combination approach.

Early rebleeding, defined by rebleeding within 7 days, was comparable between monotherapy (21%) and combination therapy (20%), a finding that was maintained in subgroup analysis. Similarly, no statistical difference was found between rates of rebleeding within 30 days, which were 22% and 24%, for monotherapy and combination therapy, respectively.

“Our study showed the rate of rebleeding increased with time after the application of Hemospray, likely due to the limited duration of action of the hemostatic powder at the site of bleeding,” wrote Dr. Ofosu and colleagues. “Second-look endoscopy performed in some studies has shown Hemospray is eliminated from the GI tract in as few as 24 hours after use, which potentially increases the risk of recurrent bleeding.”

The investigators suggested that Hemospray is best suited for short-term use because of the rebleeding risk.

“The use of Hemospray offers the potential to control bleeding initially and to optimize positioning or application of other modalities if needed in a more controlled setting,” concluded Dr. Ofosu and colleagues, who noted that this stance aligns with the views of other investigators.

Daljeet Chahal, MD and Fergal Donnellan, MD, of the University of British Columbia, Vancouver, are two such investigators, having just published a retrospective cohort study that involved 86 applications of Hemospray. Their study, which was not included in the present meta-analysis because of recency of publication, revealed that “Hemospray is effective in achieving immediate hemostasis but is plagued by high rates of rebleeding.”

According to Dr. Chahal and Dr. Donnellan, who provided a written comment, the findings of Dr. Ofosu and colleagues are comparable to their own, thereby supporting a similar conclusion.

“Hemospray appears more suited to emergent situations, where it should be used as a last resort; as a bridge therapy to more definitive measures such as embolization or surgery,” they wrote.

Dr. Chahal and Dr. Donnellan also suggested that more work is needed to develop a comprehensive picture of Hemospray outcomes, which could guide usage.

“The meta-analysis does not comment specifically on rates of embolization or surgery after Hemospray use, or whether these rates differ by type of lesion,” they wrote. “These would be interesting measures to explore in future studies to more concretely define appropriate indications for Hemospray use.”

Bilal Toka, MD, of Sakarya University in Serdivan, Turkey, who has previously published research comparing conventional hemostatic techniques, also provided a written comment, in which he advised clinicians to be ready for a combination approach, particularly among high-risk patients.

“This meta-analysis shows that Hemospray is very useful in providing initial hemostasis in patients with GI bleeding,” Dr. Toka wrote. “[However], due to its high early and delayed rebleeding rates, additional mechanical or thermal endoscopic treatment should be applied in high-risk lesions such as actively bleeding peptic ulcers.”

The investigators reported no conflicts of interest.

SOURCE: Ofosu A et al. J Clin Gastroenterol. 2020 Jul 3. doi: 10.1097/MCG.0000000000001379.