Gastrointestinal Hemorrhage due to Large B-Cell Lymphoma Treated With Hemospray

Abstract

Gastrointestinal bleeding (GIB) is a common cause of hospitalization and is associated with significant morbidity and mortality. The most frequent causes of nonvariceal upper GIB are peptic ulcers, mucosal erosions, Mallory-Weiss tears, and malignancy. Current endoscopic hemostatic methods, including injections, thermal and mechanical modalities, have a 5%-10% chance of recurrent bleeding. Hemospray (Cook Medical, Winston-Salem, NC, USA) is a recently approved modality and can help treat tumor-related GIB. We present a case of a patient with diffuse large B-cell gastric lymphoma who presented with tumor-related GIB. His clinical course was complicated by gastric perforation and active bleeding which was treated with Hemospray and over-the-scope clips (OTSC, Ovesco, Tübingen, Germany).

Mantle cell lymphoma presenting with severe upper gastrointestinal bleeding

“…One of the newly FDA approved interventions is the Hemospray that begin hemostatis in risky bleeding cases, which provide more time for definitive treatment. [12] The chemotherapy regimen for MCL is mainly a combination regimen of CVP (cyclophosphamide, vincristine, prednisone) and CHOP (cyclophosphamide, hydroxydaunomycin, Oncovin [vincristine], prednisone) regimen, hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin [adriamycin], dexamethasone, methotrexate, and cytarabine) with or without rituximab, hyper-CVAD with autologous stem cell transplantation, R-CHOP (CHOP plus rituximab), and single alkylating agents like chlorambucil. [13] For relapses and refractory cases, Bortezomib, Lenalidomide, and Ibrutinib are used.…”

“…One of the newly FDA approved interventions is the Hemospray that begin hemostatis in risky bleeding cases, which provide more time for definitive treatment. [ 12 ]…”

“…It is usually not easy for GI bleeding to be controlled by endoscopic maneuvers only and it commonly requires surgical or radiological interventions. One of the newly FDA approved interventions is the Hemospray that begin hemostatis in risky bleeding cases, which provide more time for definitive treatment [12] …”