Experience with the use of a hemostatic powder in 152 patients undergoing urgent endoscopy for gastrointestinal bleeding.

Autor: Becq A; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France. Electronic address: aymeric.becq@aphp.fr., Houdeville C; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France., Tran Minh ML; Paris VII University, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France., Steuer N; Paris XIII University, Avicennes Hospital, Assistance Publique Hôpitaux de Paris (APHP), Bobigny, France., Danan D; Paris V Descartes University, HEGP, Assistance Publique Hôpitaux de Paris (APHP), Paris, France., Guillaumot MA; Paris V Descartes University, Cochin Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France., Abou Ali E; Paris V Descartes University, Cochin Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France., Barret M; Paris V Descartes University, Cochin Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France., Amiot A; Paris XII University, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (APHP), Créteil, France., Carbonell N; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France., Marteau P; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France., Chaput U; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France., Dray X; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France., Camus M; Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France.
Jazyk: angličtina
Zdroj: Clinics and research in hepatology and gastroenterology [Clin Res Hepatol Gastroenterol] 2021 Sep; Vol. 45 (5), pp. 101558. Date of Electronic Publication: 2020 Nov 07.
DOI: 10.1016/j.clinre.2020.10.003
Abstrakt: Background and Study Aims: In the recent years, topical hemostatic powders have been used for the management of upper gastrointestinal bleeding. The aim of this study was to report on the use of an hemostatic powder (Hemospray®), outside regular hours, by on-call endoscopists during urgent endoscopic procedures.
Material and Methods: In this retrospective multicenter cohort study, consecutive patients having undergone an urgent endoscopy with the use of Hemospray® from November 2015 to December 2018 in the Paris and suburbs area were included. We collected clinical, biological and endoscopic variables. The outcomes such as the recurrence, repeat endoscopy and hemostatic treatment need, complications and survival were also collected.
Results: A total of 152 patients (mean 65 years old, 70.4% male) were included. Amongst the 31 endoscopists, 11 were "more experienced", and performed 48% of the endoscopies. The most common causes of bleeding were peptic ulcer (47.7%), malignancy (22.2%) and esophagitis (12.4%). Most bleedings originated from the upper GI tract (95.0%). Hemospray® was used as a salvage therapy in 60.8% of cases. Other hemostatic techniques were used in 52.9% of cases. Immediate bleeding cessation was noted in 79.0% of cases, recurrence in 39.9% of cases, and 26.4% of patients benefited from a repeat endoscopic hemostasis. 34 (23.0%) patients required a non-endoscopic treatment. At day 30, the survival rate was 71.6%. One complication was reported (perforation).
Conclusions: Hemostatic powder application by on-call endoscopists outside regular hours is technically feasible, but comes with a high risk of rebleeding in severely ill patients.
(Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: