Bestari Muhammad Begawan, Joewono Ignatius Ronaldi, Girawan Dolvy, Argatio Jefry Tahari, Abdurachman Siti Aminah
Division of Gastroenterohepatology, Department of Internal Medicine, Hasan Sadikin General Hospital-Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
Santo Borromeus Hospital Bandung, Bandung, Indonesia.
Case Rep Gastroenterol. 2020 Feb 6;14(1):70-79. doi: 10.1159/000505775. eCollection 2020 Jan-Apr.
Gastrointestinal bleeding (GIB) is one of the main indications for performing endoscopy; this condition can be life threatening. In some cases, emergency endoscopy (EE) is necessary to identify the source and stop the bleeding. Recently, hemostatic powder was introduced, one of which was Hemospray® (Cook Medical, Winston-Salem, NC, USA), which showed promising results for rapid hemostasis in primary treatment and salvage when conventional methods fails. Samples were taken retrospectively for a duration of 3 years since Hemospray was first introduced in Indonesia, from January 2016 to January 2019. The total number of EEs that used Hemospray were 37 procedures for 37 patients; 21 (56.8%) were males and 16 (43.2%) were females, while the average age was 67.8 years. Hemospray was used for upper GIB in 30 cases (81.1%) and for lower GIB in 7 (18.9%). Hemospray was used as monotherapy for 24 patients (64.9%) and as secondary modality for 13 (35.1%). The primary treatment was argon plasma coagulation in 8 cases (21.6%), adrenaline in 4 (10.8%), and Histoacryl® in 1 (2.7%). The mortality rate was 37.8% ( = 14); most deaths occurred within 30 days after the EE was performed, and none of the deaths was related to endoscopy or GIB. Hemospray was able to achieve hemostasis in all cases. Furthermore, there was no event of rebleeding. When conventional modalities alone were inadequate, the combination with Hemospray appeared to be able to control the bleeding. One of the main advantages of Hemospray is the ease in reaching difficult areas, and it require less skill compared to conventional modalities.
消化道出血（GIB）是进行内镜检查的主要指征之一；这种情况可能危及生命。在某些情况下，需要进行急诊内镜检查（EE）以确定出血源并止血。最近，引入了止血粉，其中一种是Hemospray®（美国北卡罗来纳州温斯顿 - 塞勒姆市库克医疗公司），在传统方法失败时，它在初次治疗和挽救治疗中实现快速止血方面显示出有前景的结果。自2016年1月Hemospray首次在印度尼西亚引入以来，进行了为期3年的回顾性样本采集，时间跨度从2016年1月至2019年1月。使用Hemospray的急诊内镜检查总数为37例，涉及37名患者；其中男性21例（56.8%），女性16例（43.2%），平均年龄为67.8岁。Hemospray用于上消化道出血30例（81.1%），下消化道出血7例（18.9%）。Hemospray作为单一疗法用于24例患者（64.9%），作为二线治疗用于13例（35.1%）。初次治疗采用氩离子凝固术8例（21.6%），肾上腺素4例（10.8%），组织黏合剂1例（2.7%）。死亡率为37.8%（n = 14）；大多数死亡发生在急诊内镜检查后30天内，且无一例死亡与内镜检查或消化道出血相关。Hemospray在所有病例中均能实现止血。此外，没有再出血事件。当单独使用传统方法不足时，与Hemospray联合使用似乎能够控制出血。Hemospray的主要优点之一是易于到达困难部位，与传统方法相比所需技能更少。
