Tang Shou-Jiang, Hosseini-Carroll Pegah, Vesa Telciane S
Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
VideoGIE. 2019 Feb 7;4(3):142-144. doi: 10.1016/j.vgie.2018.12.010. eCollection 2019 Mar.
Bleeding from diffuse esophageal ulcerations can be difficult to treat. Hemospray is a hemostatic powder, and its mechanism of hemostasis is thought to be through concentrating clotting factors and forming mechanical plugs on bleeding vessels.
The authors present 3 consecutive cases of diffusely ulcerated esophagus with clinically significant bleeding. The first 2 cases failed conventional hemostatic treatment including clipping and injection therapy. In the third case, Hemospray was used as the first-line monotherapy.
Immediate hemostasis was achieved in all 3 patients, and they did not develop recurrent bleeding for more than 2 months.
The authors propose that Hemospray application should be considered as the first-line therapy in diffuse esophageal ulcerations with clinically significant bleeding, potentially reducing the need to repeat endoscopy. Once the Hemospray achieves hemostasis, it provides a cyto-protective barrier on the diffusely ulcerated mucosa against ongoing acid reflux, allowing the new tissue to grow more efficiently during the ulcer healing period.
弥漫性食管溃疡出血难以治疗。血喷粉是一种止血粉，其止血机制被认为是通过浓缩凝血因子并在出血血管上形成机械性栓塞。
作者报告了3例连续性弥漫性食管溃疡伴具有临床意义出血的病例。前2例常规止血治疗（包括钳夹和注射治疗）失败。第3例中，血喷粉被用作一线单一疗法。
所有3例患者均立即实现止血，且2个多月内未发生再出血。
作者提出，对于伴有具有临床意义出血的弥漫性食管溃疡，应考虑将应用血喷粉作为一线治疗方法，这可能减少重复内镜检查的必要性。一旦血喷粉实现止血，它会在弥漫性溃疡黏膜上形成细胞保护屏障，防止持续的胃酸反流，使新组织在溃疡愈合期能更有效地生长。
