Comparison of Hemospray^® and Endoclot^™ for the treatment of gastrointestinal bleeding

Abstract

BACKGROUND Gastrointestinal (GI) bleeding is a common indication for endoscopy. For refractory cases, hemostatic powders (HP) represent “touch-free” agents. AIM To analyze short term (ST-within 72 h-) and long-term (LT-within 30 d-) success for achieving hemostasis with HP and to directly compare the two agents Hemospray (HS) and Endoclot (EC). METHODS HP was applied in 154 consecutive patients (mean age 67 years) with GI bleeding. Patients were followed up for 1 mo (mean follow-up: 3.2 mo). RESULTS Majority of applications were in upper GI tract (89%) with following bleeding sources: peptic ulcer disease (35%), esophageal varices (7%), tumor bleeding (11.7%), reflux esophagitis (8.7%), diffuse bleeding and erosions (15.3%). Overall ST success was achieved in 125 patients (81%) and LT success in 81 patients (67%). Re-bleeding occurred in 27% of all patients. In 72 patients (47%), HP was applied as a salvage hemostatic therapy, here ST and LT success were 81% and 64%, with re-bleeding in 32%. As a primary hemostatic therapy, ST and LT success were 82% and 69%, with re-bleeding occurring in 22%. HS was more frequently applied for upper GI bleeding ( P = 0.04) CONCLUSION Both HP allow for effective hemostasis with no differences in ST, LT success and re-bleeding.

Efficacy of Hemospray in non-variceal upper gastrointestinal bleeding: a systematic review with meta-analysis

“…This systematic review and meta-analysis evaluated the efficacy of Hemospray in the management of non-variceal Baracat et al [10] Baracat et al [10] Kwek et al [11] Kwek et al [11] Pittayanon et al [17] Pittayanon et al [17] Pittayanon et al [18] Sinha et al [19] Kwek et al [11] Pittayanon et al [17] Sinha et al [19] Arena et al [6] Cahyadi et al [12] Giles et al [13] Hadara et al [14] Hagel et al [15] Holster et al [16] Sinha et al [19] Sulz et al [20] Vitali et al [22] Yau et al [23] Smith et al [24] Masci et al [25] Alzoubaidi et al [27] Sandiago et al [ upper GIB and demonstrated a high clinical and technical success rate. The early, delayed and aggregate rebleeding rates were comparable to those in the control group.…”

“…The I 2 statistic was used for identifying heterogeneity: I 2 values of 0%, 25%, 50% and 75% were interpreted as absent, low, moderate and high heterogeneity, respectively [8]. Meta-regression analysis was conducted for Baracat et al [10] Kwek et al [11] Pittayanon et al [17] Pittayanon et al [18] Arena et al [6] Cahyadi et al [12] Giles et al [13] Hadara et al [14] Hagel et al [15] Holster et al (16] Sinha et al [19] Sulz et al [20] Vitali et al [22] Yau et al [23] Smith et al [24] Masci et al [25] Alzoubaidi et al [27] Sandiago et al [28] Summary Sung et al [21] Leblanc et al [ Baracat et al [10] Kwek et al [11] Kwek et al [11] Pittayanon et al [17] Pittayanon et al [18] Pittayanon et al [17] Arena et al [6] Cahyadi et al [12] Sinha et al [19] Giles et al [13] Hadara et al [14] Hagel et al [15] Holster et al [16] Sinha et al [19] Sulz et al [20] Vitali et al [22] Yau et al [23] Smith et al [24] Masci et al [25] Alzoubaidi et al [27] Sandiago et al [28] Summary…”

“…1). After a comprehensive review of the published literature, a total of 20 studies met the inclusion and exclusion criteria for this meta-analysis [6,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. All included studies were published between 2011 and 2019.…”

“…Supplementary Supplementary Figure 2 Proportional success of Hemospray by publication year Supplementary Figure 1 Flow diagram representing the selection of studies Supplementary Figure 3 Forest plots with proportional (A) and risk (B) analysis for early rebleeding Author Baracat et al [10] Baracat et al [10] Pittayanon et al [17] Pittayanon et al [17] Pittayanon et al [18] Summary Summary Arena et al [6] Cahyadi et al [12] Holster et al [16] Sulz et al [20] Sung et al [21] Masci et al [25] Sandiago et al [28] Early [10] Baracat et al [10] Pittayanon et al [17] Pittayanon et al [17] Pittayanon et al [18] Summary Summary Arena et al [6] Cahyadi et al [12] Holster et al [16] Santiago et al [28] 3/20 0/10 [10] Arena et al [6] Baracat et al [10] Cahyadi et al [12] Giles et al [13] Hadara et al [14] Hagel et al [15] Holster et al [16] Kwek et al [11] Pittayanon et al [17] Pittayanon et al [18] Sinha et al [19] Sulz et al [20] Sung et al [21] Vitali et al [22] Yau et al [23] Smith et al [24] Masci et al [25] Alzoubaidi et al ...…”

Hemostatic materials in non-variceal upper gastrointestinal hemorrhage

“…Park et al 10 by propensity score matching, compared to the conventional endoscopic methods, found that there were no significant differences from the immediate hemostasis success rate of the 30 patients treated with EndoClot nor the incidence of rebleeding rate after 7 and 30 days. 11,12 However, Singh et al 13 conducted a study of hemostatic materials showing that the hemostatic success of commercially available microporous polysaccharide hemispheres was much lower than that of bovine-derived gelatin particles.…”