Hemospray as Rescue Therapy in Failed Endotherapy in a Patient on Dual Antiplatelet Therapy

Introduction: Upper gastrointestinal (UGI) bleeding secondary to peptic ulcer disease is a common medical condition that results in high patient morbidity. While in majority of patients with bleeding peptic ulcers bleeding will stop spontaneously. A subgroup of patients include heavy drinkers, regular use of dual antiplatelets, smoking cigarettes or chewing tobacco, being very ill, radiation treatments, and stress needs pharmacological and endoscopic intervention. Although several types of endoscopic treatment for bleeding peptic ulcers have been described, including injection therapy, thermal coagulation, the application of various types of through-the-scope (TTS) or over-the-scope clips (OTSC) hemoclips, fibrin sealant (or glue), argon plasma coagulation, and combination therapy (typically injection of epinephrine combined with another treatment modality). Despite advances in pharmacologic and endoscopic therapy, mortality rates have not improved

Case Report: A 73-year-old male known case of CAD on dual antiplatelets, DM, HTN c/o hematemesis 3 days back around 600 mL, endoscopy done in outside hospital showed two ulcer of about 1.5 cm one with clean based and another with adherent clot. Patient underwent endoscopic intervention using inj Adrenaline and hemoclips. Patient readmitted with melena and hematemesis. Relook endoscopy showed fresh and altered blood in stomach with two ulcers about 1.5 cm each, one with clean base and another one with adherent clot. 2cc Inj Adrenaline (1:20,000) injected into four quadrants of each ulcer f/b Hemoclip application to the adherent clot. Hemospray applied into both ulcer base.

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Conclusion: Hemospray enlarges the armament of emergency endoscopists. It is a safe and easy to use device which can be used in upper and lower endoscopy both as first line treatment and as salvage therapy. Hemostatic sprays can be used to control active GI bleeding in a variety of contexts, particularly when traditional endoscopic techniques fail to control massive GI bleeding. Patients treated with hemostatic spray were more likely to have immediate hemostasis (100 vs. 68.6%, p < 0.001) and less likely to experience rebleeding within 30 days.

Publication History

Article published online:
22 April 2024