Comparison of Hemospray® and Endoclot™ for the treatment of gastrointestinal bleeding

doi:10.3748/wjg.v25.i13.1592

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Apr 7, 2019; 25(13): 1592-1602
Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1592

Table 1 Clinical characteristics of the total patient cohort treated with hemostatic powders for gastrointestinal bleeding n (%)

	HS and EC n = 154	Hemospray n = 111	Endoclot n = 32	P value
Sex (M)	101 (65.6)	76 (68.5)	17 (53.1)	NS
Age, yr
mean ± SD	66.6 ± 14	67 ± 13.8	67.4 ± 15.1	NS
range	11-93	29-93	11-89
Rockall risk score
median ± SD	7.1 ± 1.7	7.1 ± 1.7	7.1 ± 1.8	NS
range	2-10	2-10	2-10
Comorbidities
Coagulopathy	48 (31.2)	36 (32.4)	6 (18.8)	NS
Renal insufficiency	74 (48.1)	53 (47.7)	15 (46.9)	NS
Hemodialysis	35 (22.7)	26 (23.4)	5 (15.6)	NS
Liver cirrhosis	40 (26)	32 (28.9)	5 (15.6)	NS
Bleeding locale
upper GI bleeding	137 (89)	102 (91.8)	25 (78.1)	0.04
lower GI bleeding	17 (11)	8 (8)	7 (21)	NS
Application as
Primary therapy	82 (53.2)	64 (57.7)	14 (43.8)	NS
Salvage therapy	72 (46.8)	47 (42)	18 (56)	NS
Multiple applications of HP	42 (27.3)	27 (24.3)	5 (15.6)	NS
Definite hemostatic therapies after HP failure
Coiling	13 (8.4)	11 (9.9)	1 (3.1)	NS
Surgery	9 (5.8)	7 (6.3)	1 (3.1)	NS
Short term success (total)	125 (81.2)	92 (82.9)	26 (81.2)	NS
Primary therapy	67/82 (81.7)	53/64 (82.8)	11/14 (78.6)
Salvage therapy	58/72 (80.6)	39/47 (82.9)	15/18 (83.3)
Long term success	81/121 (66.9)	59 (69.4)	18 (66.7)	NS
Primary therapy	45/65 (69.2)	35/49 (71.4)	8/13 (61.5)
Salvage therapy	36/56 (64.3)	24/36 (66.7)	10/14 (71.4)
Re-bleeding rate	41 (26.6)	27 (24.3)	8 (25)	NS
Primary therapy	18/82 (21.9)	13/64 (20.3)	3/14 (21.4)
Salvage therapy	23/72 (31.9)	14/47 (29.8)	5/18 (27.8)

HS: Hemospray; EC: Endoclot; HP: Hemostatic powders; HS and EC: Including patients who received both Hemospray and Endoclot at different time points; NS: Not specified; GI: Gastrointestinal.

Table 2 Clinical characteristics of the patients with upper gastrointestinal bleeding and efficacy of hemostatic powders in the treatment of upper gastrointestinal bleeding n (%)

	HS and EC (n = 137)	Hemospray (n = 102)	Endoclot (n = 25)	P value
Sex (M)	86 (62.8)	68 (66.7)	11 (44)	0.04
Age, yr
mean ± SD	66.4 ± 14.2	66.4 ± 14.0	67.9 ± 16.5	NS
range	(11-93)	29-93	11-89
Rockall risk score				NS
median ± SD	7.1 ±1.7	7.1 ± 1.7	7.1 ± 1.8
range	2-10	2 -10	2 - 10
Comorbidities
Coagulopathy	45 (32.8)	34 (33)	5 (2)
Renal insufficiency	68 (49.6)	59 (49)	12 (48)
Hemodialysis	32 (23.4)	24 (23)	12 (48)
Liver cirrhosis	38 (27.7)	30 (29.4)	5 (20)
Therapeutic anticoagulation	35 (25.5)	28 (27.5)	6 (24)
Dual antiplatet therapy	7 (5.1)	5 (5)	2 (8)
Vitamin K antagonists	14 (10.2)	11 (11)	3 (12)
DOAC	8 (5.8)	7 (7)	1 (4)
Antiaggregation therapy	29 (21.2)	21 (20.6)	7 (28)
Application as				NS
Primary Therapy	72 (52.6)	59 (58)	10 (40)
Salvage Therapy	65 (47.4)	43 (42)	15 (60)
Multiple Applications of				NS
HS	37 (27)	24 (23)	3 (0.12)
Definite hemostatic therapies after HP failure				NS
Coiling	13 (9.5)	11 (11)	1 (4)
Surgery	8 (5.8)	7 (6.9)	0
Short term success (total)	113/137 (82.5)	68/102 (66.6)	21/25 (84)	NS
Primary therapy	60/72 (83.3)	50/59 (84.7)	8/10 (80)
Salvage therapy	53/65 (81.5)	36/43 (83.7)	13/15 (86.6)
Long term success	71/108 (65.7)	53/78 (67.9)	15/22 (68.2)	NS
Primary therapy	39/57 (68.4)	32/45 (71)	6/10 (60)
Salvage therapy	32/51 (62.7)	21/33(63.6)	9/12 (75)
Re-bleeding rate	34/137 (24.8)	24/102 (23.5)	4/25 (16)	NS
Primary therapy	15/72 (20.8)	11/59 (18.6)	2/10 (20)
Salvage therapy	19/65 (29.2)	13/43 (30.2)	2/15 (13)

DOAC: Direct acting oral anticoagulant; HS: Hemospray; EC: Endoclot; HP: Hemostatic powders; NS: Not specified; HS and EC: Including patients who received both Hemospray and Endoclot at different time points.

Table 3 Etiology of upper gastrointestinal bleeding and success in bleeding management (short term, long term, re-bleeding rate)

	HS and EC (n = 137)	Hemospray (n = 102)	Endoclot (n = 25)
Reflux esophagitis, n	17	16	1
Overall ST, LT, RBR (%)	92, 60, 0	100, 33, 0	100, 0, 0
Primary ST, LT, RR (%)	100, 100, 0	100, 100, 0	0
Salvage ST, LT, RR (%)	100, 100, 0	100, 100, 0	100, 0, 0
OG variceal disease, n	13	11	2
Overall ST, LT, RBR (%)	85, 56, 38	91, 50, 45	100, 100, 0
Primary ST, LT, RBR (%)	75, 25, 75	66, 66, 100	100, 100, 0
Salvage ST, LT, RBR (%)	100, 80, 22	100, 80, 25	100, 0, 0
Peptic ulcer disease, n	49	34	12
Overall ST, LT, RBR (%)	80, 57, 34	80, 59, 29	84, 50, 31
Primary ST, LT, RBR (%)	79, 67, 21	81, 71, 18	75, 50, 25
Salvage ST, LT, RBR (%)	81, 67, 46	78, 40, 50	90, 62,3 0
Angiodysplasia, -ectasia, n	8	6	1
Overall ST, LT, RBR (%)	75, 85, 0	66, 80, 0	100, 100,0
Primary ST, LT, RBR (%)	75, 100, 0	75, 100, 0	0
Salvage ST, LT, RBR (%)	75, 75, 0	50, 50, 0	100, 100, 0
Diffuse bleeding and erosions, n	22	16	4
Overall ST, LT, RBR (%)	77, 72, 36	87, 84, 25	66, 66, 33
Primary ST, LT, RBR (%)	78, 67, 33	100, 100, 0	75, 50, 25
Salvage ST, LT, RBR (%)	66, 70, 58	71, 66, 57	100, 50, 50
Cancer bleeding, n	15	12	1
Overall ST, LT, RBR (%)	81, 85, 10	85, 92, 10	100, 100, 0
Primary ST, LT, RBR (%)	100, 100, 0	100, 100, 0	100, 100, 0
Salvage ST, LT, RRB (%)	67, 50, 0	67, 75, 17	0
Other bleeding sources, n	13	7	4
Overall ST, LT, RBR (%)	70, 70, 40	75, 58, 58	86, 75, 28
Primary ST, LT, RBR (%)	62, 60, 50	50, 43, 62	80, 67, 20
Salvage ST, LT, RBR (%)	77, 69, 36	100, 100, 0	100, 75, 30

Other bleeding sources: Mallory Weiss lesions, aortoduodenal fistula, posttraumatic, bleeding after surgery, anastomosis bleeding. ST: Short term success; LT: Long term success; RBR: Re-bleeding rate; OG: Oesophageal and gastric; HS and EC: Including patients who received both Hemospray and Endoclot at different time points.

Table 4 Clinical characteristics of the patients treated with Hemospray and Endoclot for lower gastrointestinal bleeding n (%)

	HS and EC (n = 17)	Hemospray (n = 9)	Endoclot (n = 7)	P value
Sex (M)	15	8	6	ns
Age, yr				0.007
mean ± SD	67.8 ± 12.2	72.9 ± 9.2	65.6 ± 9.2
range	37-81	51-81	37-76
Application as				ns
Primary therapy	10 (59)	5 (55)	4 (57.1)
Salvage therapy	7 (41.2)	4 (44)	3 (56)
Definite therapy after HP failure				ns
Coiling	0	0	0
Surgery	1 (5.9)	0	1 (14)
Comorbidities
Coagulopathy	3 (17.6)	2 (22)	1 (14)
Renal insufficiency	6 (35.3)	3 (33)	3 (43)
Hemodialysis	3 (17.6)	2 (22)	1 (14)
Liver cirrhosis	2 (11.8)	2 (22)	0
Therapeutic anticoagulation	10 (59)	3 (33)	6 (86)
Dual antiplatet therapy	1 (5.9)	0	1 (43)
Vitamin K Antagonists	3 (17.6)	0	3 (43)
DOAC	3 (17.6)	0	2 (29)
Antiaggregation therapy	5 (29.4)	2 (22)	3 (43)
Short term success	12 (79.6)	6 (67)	5 (71)	ns
Primary therapy	7 (70)	3/5 (60)	3/4 (75)
Salvage therapy	5 (71.4)	3/4 (75)	2/3 (67)
Long term success	10 (76.9)	6/7 (86)	3/5 (75)	ns
Primary therapy	6 (75)	3/4(75)	2/3 (67)
Salvage therapy	4 (57.1)	3/3 (100)	1/2 (50)
Re-bleeding rate	7 (41.2)	3 (33)	4 (57)	ns
Primary therapy	3 (30)	2/5 (40)	1/4 (25)
Salvage therapy	4 (57.1)	1/4 (25)	3/3 (100)

DOAC: Direct acting oral anticoagulant; HS: Hemospray; EC: Endoclot; HP: Hemostatic powders; HS and EC: Including patients who received both Hemospray and Endoclot at different time points.

Citation: Vitali F, Naegel A, Atreya R, Zopf S, Neufert C, Siebler J, Neurath MF, Rath T. Comparison of Hemospray^® and Endoclot^™ for the treatment of gastrointestinal bleeding. World J Gastroenterol 2019; 25(13): 1592-1602
URL: https://www.wjgnet.com/1007-9327/full/v25/i13/1592.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i13.1592