Efficacy and safety of TC-325 (HemosprayTM) for non-variceal upper gastrointestinal bleeding at Middlemore Hospital: the early New Zealand experience.

ABSTRACT

AIMS: A case series to review early experiences with HemosprayTM for a variety of non-variceal upper gastrointestinal bleeding (UGIB) at Middlemore Hospital. METHODS: HemosprayTM was administered therapeutically as first line or rescue at the discretion of the endoscopist. All cases of UGIB requiring HemosprayTM at Middlemore Hospital were identified to the investigator who undertook analysis of electronic and hard copy notes. RESULTS: Between October 2013 and July 2016, 36 patients were treated endoscopically with HemosprayTM. Source of bleeding was predominantly gastric in 17, 15 were duodenal and four oesophageal. The majority of lesions were peptic ulcer or post-intervention (78%), with others being Mallory Weiss tear (MWT), gastric mass, Dieulafoy lesion, portal hypertensive gastropathy and post-biopsy. Thirty-one were actively bleeding with mostly oozing haemorrhage (75%). Twenty-three patients were on antithrombotic therapy (ATT), two each on warfarin and low molecular weight heparin (LMWH) and 19 on antiplatelet agents. HemosprayTM was administered therapeutically in all cases, as first line or rescue. Acute haemostasis was achieved in all patients; four (11%) episodes of re-bleeding occurred within seven days, with average follow-up of 16 months. There were no instances of equipment malfunction or adverse events specific to use of HemosprayTM. CONCLUSIONS: Our early experience with HemosprayTM is very promising and there is clear role for HemosprayTM as a rescue therapy when standard methods have failed to achieve haemostasis and possibly as first line in cases of diffuse bleeding not amenable to standard interventions. However, HemosprayTM is not recommended as a standalone therapy for spurting haemorrhage due to the increased frequency of re-bleeding.