Retrospective Cohort Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2019; 25(13): 1592-1602
Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1592
Comparison of Hemospray® and Endoclot™ for the treatment of gastrointestinal bleeding
Francesco Vitali, Andreas Naegel, Raja Atreya, Steffen Zopf, Clemens Neufert, Juergen Siebler, Markus F Neurath, Timo Rath
Francesco Vitali, Andreas Naegel, Raja Atreya, Steffen Zopf, Clemens Neufert, Juergen Siebler, Markus F Neurath, Timo Rath, Ludwig Demling Endoscopy Center of Excellence, Division of Gastroenterology, Friedrich-Alexander-University, Erlangen 91054, Germany
Author contributions: Rath T designed the study; Vitali F, Naegel A, Atreya R, Neufert C and Rath T participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Vitali F wrote the article; Siebler J and Neurath MF revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by ethical committee of the Friedrich-Alexander-University Erlangen- Nuernberg, Germany. The scanned copy of ethical committee approval of the research protocol was attached in submitted files to the journal.
Informed consent statement: As retrospective cohort study informed patients’ consent was waived from the ethic committee
Conflict-of-interest statement: There are no conflicts of interest to report.
STROBE statement: The authors have read the STROBE Statement- checklist of items and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Timo Rath, MD, PhD, Full Professor, Ludwig Demling Endoscopy Center of Excellence, Division of Gastroenterology, Friedrich-Alexander-University, FAU Erlangen-Nuremberg, Ulmenweg 18, Erlangen 91054, Germany. timo.rath@uk-erlangen.de
Telephone: +49-9131-8535000 Fax: +49-9131-8535252
Received: December 22, 2018
Peer-review started: December 25, 2018
First decision: February 21, 2019
Revised: March 6, 2019
Accepted: March 11, 2019
Article in press: March 12, 2019
Published online: April 7, 2019
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.

Keywords: Hemostatic powder, Gastrointestinal bleeding, Hemospray, Endoclot, Haemostasis

Core tip: Hemostatic powders represent “touch-free” hemostatic agents for the treatment of gastrointestinal bleeding. Within this study, we analyzed the hemostatic efficacy of hemostatic powders as first line or salvage therapy in several clinical scenarios in a large cohort of prospectively included patients. As shown in our report, both hemostatic powders allow for excellent short term bleeding control while at the same time, long term efficacy over a period of 4 wk is maintained in a considerable amount of patients. No differences were observed between Hemospray and Endoclot in their hemostatic efficacy.