Management of acute variceal bleeding using hemostatic powder

Background and objectives: This study aimed to test the safety and efficacy of Hemospray (R) for emergency control of acute variceal bleeding (AVB) due to portal hypertension in cirrhotic patients. Patients and methods: This single-arm, prospective trial, conducted at two hospitals in Belgium and Egypt, included patients admitted to the emergency room with hematemesis and/or melena and known or suspected liver cirrhosis. All patients received urgent hemodynamic stabilization, octreotide (50 mcg bolus then 25 mcg/hour for 24 hours) and intravenous ceftriaxone (1 g/hour). Endoscopy to confirm AVB and Hemospray (R) application (if indicated) was performed within six hours of admission. Patients were kept under observation for 24 hours and underwent second endoscopy and definitive therapy (band ligation and/or cyanoacrylate injection in cases of gastric varices) the next day. Results: Thirty-eight patients were admitted for suspected AVB, and 30 of these had confirmed AVB (70% male; mean age 59.5 years (range, 32.0-73 years)). Child-Pugh class C liver disease was present in 53.4%. Esophageal varices were observed in 83.4% of patients, gastric varices in 10%, and duodenal varices in 6.6%. Spurting bleeding at the time of endoscopy was observed in 43.4%. One patient developed hematemesis six hours after Hemospray (R) application and underwent emergency endoscopic band ligation. No major adverse events or mortalities were observed during 15-day follow-up. Conclusion: Hemospray (R) application was safe and effective at short-term follow-up for emergency treatment of AVB in cirrhotic patients.