Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray

Alzoubaidi, Durayd; Hussein, Mohamed; Rusu, Radu; Napier, Duncan; Dixon, Selena; Rey, Johannes W.; Steinheber, Cora; Jameie‐Oskooei, Sina; Dahan, Martin; Hayee, Bu; Gulati, Shraddha; Despott, Edward J.; Murino, Alberto; Subramaniam, Sharmila; Moreea, Sulleman; Boger, Philip; Hu, Maxworth; Duarte, P.; Dunn, Jason M.; Mainie, Inder; McGoran, John; Graham, David; Anderson, John T.; Bhandari, Pradeep; Goetz, Martin; Kießlich, Ralf; Coron, Emmanuel; Lovat, Laurence; Haidry, Rehan

doi:10.1111/den.13502

Cited by 21 publications

(22 citation statements)

References 25 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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…”

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

“…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.…”

Section: Study Details and Demographicsmentioning

confidence: 99%

“…Baracat et al [10] Pittayanon et al [17] Sinha et al [19] Summary 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] Pittayanon et al [17] Sinha et al [19] Suiz et al [20] Sung et al [21] Yau et al [23] Smith et al [24] Masci et al [25] Alzoubaidi et al [27] Santiago et al [ Baracat et al [10] Kwek et al [11] Pittayanon (1) et al [17] Sinha et al [19] Summary Author…”

Section: Summary Boxmentioning

confidence: 99%

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

Aziz

Weissman

Mehta

et al. 2020

aog

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Background Recently, amongst other hemostatic modalities, Hemospray (TC-325) has emerged as an effective method for managing patients with non-variceal upper gastrointestinal bleeding (GIB). We conducted this systematic review and meta-analysis to assess the efficacy of Hemospray in patients with non-variceal upper GIB. Methods Our primary outcomes were clinical and technical success; secondary outcomes were aggregate rebleeding, early rebleeding, delayed rebleeding, refractory bleeding, mortality, and treatment failure. A meta-analysis of proportions was conducted for all reported primary and secondary outcomes. A relative risk meta-analysis was conducted for studies reporting direct comparisons between Hemospray and other hemostatic measures. Results A total of 20 studies with 1280 patients were included in the final analysis. Technical success of Hemospray was seen in 97% of cases (95% confidence interval [CI] 94-98%, I 2 =52.89%) and a significant trend towards increasing technical success was seen during publication years 2011-2019. Clinical success of Hemospray was seen in 91% of cases (95%CI 88-94%, I 2 =47.72%), compared to 87% (95%CI 75-94%, I 2 =0.00%) for other hemostatic measures. The secondary outcomes of aggregate rebleeding, early rebleeding, delayed rebleeding, refractory rebleeding, mortality and treatment failure following the use of Hemospray were seen in 27%, 20%, 9%, 8%, 8%, and 31% of cases, respectively. Conclusion Hemospray is safe, effective and non-inferior to traditional hemostatic measures for the management of non-variceal upper GIB, and can thus be used as an alternative option.

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Section: Discussionmentioning

confidence: 99%

Section: Data Synthesis and Statistical Analysismentioning

confidence: 99%

Section: Study Details and Demographicsmentioning

confidence: 99%

Section: Summary Boxmentioning

confidence: 99%

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

Aziz

Weissman

Mehta

et al. 2020

aog

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“…Meta-analyses and retrospective case series comparing transcatheter arterial embolization (TAE) and surgery suggest that patient outcomes following either approach are similar [127][128][129]. TAE, however, is associated with a higher failure rate in the control of bleeding [127][128][129] [132]. In the subgroup of peptic ulcer hemorrhage (most common stigmata, FIb), the authors reported an overall hemostasis rate of 86 %, an overall rebleeding rate of 12.7 %, and 7-day and 30-day all-cause mortality of 16.2 % and 24.6 %, respectively.…”

Section: Recommendationmentioning

confidence: 99%

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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MAIN RECOMMENDATIONS 1 ESGE recommends in patients with acute upper gastrointestinal hemorrhage (UGIH) the use of the Glasgow–Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in patients with acute UGIH who are taking low-dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3–5 days.Strong recommendation, moderate quality evidence. 3 ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4 ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5 ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy). Strong recommendation, high quality evidence. 6 ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection. Strong recommendation, high quality evidence. 7 ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered. Weak recommendation, low quality evidence. 8 ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9 ESGE recommends high dose proton pump inhibitor (PPI) therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically. (a) PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (b) High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10 ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.

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Bipolar and Monopolar Cautery, Clips, Bands, Spray, Injections, Embolization, and Minimally Invasive Surgery

Rrapi

Narayan

Siskin

et al. 2021

Clinical Gastroenterology

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Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray

Cited by 21 publications

References 25 publications

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

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

Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Bipolar and Monopolar Cautery, Clips, Bands, Spray, Injections, Embolization, and Minimally Invasive Surgery

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