Outcomes from an international multicenter registry of patients with acute gastrointestinal bleeding undergoing endoscopic treatment with Hemospray
| Autor: | Johannes W. Rey, Emmanuel Coron, Maxworth Hu, Laurence Lovat, Alberto Murino, Duncan Napier, Ralf Kiesslich, Shraddha Gulati, Bu'Hussain Hayee, Jason M. Dunn, Patricia Duarte, David Graham, Rehan Haidry, Martin Goetz, Radu Rusu, Phil Boger, Selena Dixon, Durayd Alzoubaidi, Edward J. Despott, John McGoran, Martin Dahan, Mohamed Hussein, Sina Jameie-Oskooei, John Anderson, Pradeep Bhandari, Sulleman Moreea, Cora Steinheber, Inder Mainie, Sharmila Subramaniam |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Gastrointestinal bleeding Internationality Combination therapy Administration Topical Risk Assessment Hemostatics 03 medical and health sciences 0302 clinical medicine Recurrence Melena Gastroscopy medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Registries Aged Aged 80 and over Minerals medicine.diagnostic_test business.industry Mortality rate Hemostasis Endoscopic Gastroenterology Middle Aged Bleed medicine.disease Surgery Endoscopy Peptic Ulcer Hemorrhage Treatment Outcome 030220 oncology & carcinogenesis Hemostasis Acute Disease Female 030211 gastroenterology & hepatology medicine.symptom Gastrointestinal Hemorrhage business Rockall score |
| Zdroj: | Digestive Endoscopy. 32:96-105 |
| ISSN: | 1443-1661 0915-5635 |
| Popis: | Background and aim Acute gastrointestinal bleeding carries poor outcomes unless prompt endoscopic hemostasis is achieved. Mortality in these patients remains significant. Hemospray is a novel intervention that creates a mechanical barrier over bleeding sites. We report the largest dataset of patient outcomes after treatment with Hemospray from an international multicenter registry. Patients and methods Prospective data (Jan 2016-May 2018) from 12 centers across Europe were collected. Immediate hemostasis was defined as endoscopic cessation of bleeding within 5 min after application of Hemospray. Rebleeding was defined as subsequent drop in hemoglobin, hematemesis, persistent melena with hemodynamic compromise post-therapy. Results Three hundred and fourteen cases were recruited worldwide (231 males, 83 females). Median pretreatment Blatchford score was 11 (IQR: 8-14) and median complete Rockall score (RS) was 7 (IQR: 6-8) for all patients. Peptic ulcer disease (PUD) was the most common pathology (167/314 = 53%) and Forrest Ib the most common bleed type in PUD (100/167 = 60%). 281 patients (89.5%) achieved immediate hemostasis after successful endoscopic therapy with Hemospray. Rebleeding occurred in 29 (10.3%) of the 281 patients who achieved immediate hemostasis. Seven-day and 30-day all-cause mortality were 11.5% (36/314) and 20.1% (63/314), respectively (lower than the predicted rates as per the RS). Similar hemostasis rates were noted in the Hemospray monotherapy (92.4%), combination therapy (88.7%) and rescue therapy (85.5%) groups. Conclusions These data show high rates of immediate hemostasis overall and in all subgroups. Rebleeding and mortality rates were in keeping/lower than predicted rates. |
| Databáze: | OpenAIRE |
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