Pittayanon Rapat, Prueksapanich Piyapan, Rerknimitr Rungsun
Division of Gastroenterology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital The Thai Red Cross, Bangkok, Thailand.
Endosc Int Open. 2016 Sep;4(9):E933-6. doi: 10.1055/s-0042-109863. Epub 2016 Aug 31.
Currently, conventional endoscopic treatments provide an unsatisfactory hemostatic outcome in upper gastrointestinal bleeding from tumor. Hemospray has been shown to be useful in many active gastrointestinal bleeding conditions. This study aimed to compare the efficacy of Hemospray and conventional endoscopic hemostasis.
Fourteen patients with active upper gastrointestinal bleeding from tumor were recruited. Hemospray was applied at the bleeding site until hemostasis was achieved. Four patients were excluded because they prematurely received definitive therapy to prevent further bleeding within 48 hours. Another 10 patients from historical control were matched based on the type of gastrointestinal tumors. The 14-day rebleeding rates, length of hospital stay (LOS) and mortality rate at 30-day follow up were assessed.
Baseline characteristics including age, stage of tumor, and Blatchford score did not differ between the two groups. The 14-day rebleeding rate in the Hemospray group was 3 times lower than the control group but not statistically significant (10 % vs. 30 %; P = 0.60). LOS was no different between the 2 groups (28.2 ± 21.2 vs. 23.8 ± 12.5 days; P = 0.26). The 30-day mortality rate in the Hemospray group was 3 times lower than that of in the conventional therapy group but not significant (10 % vs. 30 %, P = 0.7).
Hemospray is a promising therapy for initial hemostasis in upper gastrointestinal bleeding from tumor because it can achieve hemostasis during the first 14 days, thus potentially allowing sufficient time before appropriate definitive intervention is considered.
目前，传统内镜治疗在上消化道肿瘤出血的止血效果并不理想。已证明Hemospry在许多活动性胃肠道出血情况中有用。本研究旨在比较Hemospry与传统内镜止血的疗效。
招募了14例患有活动性上消化道肿瘤出血的患者。在出血部位应用Hemospry直至止血。4例患者因在48小时内过早接受确定性治疗以防止进一步出血而被排除。根据胃肠道肿瘤类型匹配另外10例历史对照患者。评估14天再出血率、住院时间（LOS）和30天随访时的死亡率。
两组之间的基线特征，包括年龄、肿瘤分期和布拉奇福德评分无差异。Hemospry组的14天再出血率比对照组低3倍，但无统计学意义（10%对30%；P = 0.60）。两组之间的住院时间无差异（28.2±21.2对23.8±12.5天；P = 0.26）。Hemospry组的30天死亡率比传统治疗组低3倍，但无显著差异（10%对30%，P = 0.7）。
Hemospry是一种有前景的治疗上消化道肿瘤出血初始止血的方法，因为它可以在头14天内实现止血，从而有可能在考虑适当的确定性干预之前留出足够的时间。
