Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France.
Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France.
Clin Res Hepatol Gastroenterol. 2021 Sep;45(5):101558. doi: 10.1016/j.clinre.2020.10.003. Epub 2020 Nov 7.
In the recent years, topical hemostatic powders have been used for the management of upper gastrointestinal bleeding. The aim of this study was to report on the use of an hemostatic powder (Hemospray®), outside regular hours, by on-call endoscopists during urgent endoscopic procedures.
In this retrospective multicenter cohort study, consecutive patients having undergone an urgent endoscopy with the use of Hemospray® from November 2015 to December 2018 in the Paris and suburbs area were included. We collected clinical, biological and endoscopic variables. The outcomes such as the recurrence, repeat endoscopy and hemostatic treatment need, complications and survival were also collected.
A total of 152 patients (mean 65 years old, 70.4% male) were included. Amongst the 31 endoscopists, 11 were "more experienced", and performed 48% of the endoscopies. The most common causes of bleeding were peptic ulcer (47.7%), malignancy (22.2%) and esophagitis (12.4%). Most bleedings originated from the upper GI tract (95.0%). Hemospray® was used as a salvage therapy in 60.8% of cases. Other hemostatic techniques were used in 52.9% of cases. Immediate bleeding cessation was noted in 79.0% of cases, recurrence in 39.9% of cases, and 26.4% of patients benefited from a repeat endoscopic hemostasis. 34 (23.0%) patients required a non-endoscopic treatment. At day 30, the survival rate was 71.6%. One complication was reported (perforation).
Hemostatic powder application by on-call endoscopists outside regular hours is technically feasible, but comes with a high risk of rebleeding in severely ill patients.
近年来，局部止血粉已被用于上消化道出血的治疗。本研究旨在报告在紧急内镜检查中，值班内镜医师在非工作时间使用止血粉（Hemospray®）的情况。
这是一项回顾性多中心队列研究，纳入了 2015 年 11 月至 2018 年 12 月期间在巴黎及周边地区接受紧急内镜检查并使用 Hemospray®治疗的连续患者。我们收集了临床、生物学和内镜相关变量。同时还收集了再出血、重复内镜检查和止血治疗需求、并发症和生存率等结局。
共纳入 152 例患者（平均年龄 65 岁，70.4%为男性）。在 31 名内镜医师中，11 名经验更丰富，完成了 48%的内镜检查。最常见的出血原因是消化性溃疡（47.7%）、恶性肿瘤（22.2%）和食管炎（12.4%）。大多数出血源于上消化道（95.0%）。止血粉在 60.8%的情况下被用作挽救性治疗。在 52.9%的情况下还使用了其他止血技术。79.0%的病例即刻止血成功，39.9%的病例出现再出血，26.4%的患者需要重复内镜止血。34 例（23.0%）患者需要非内镜治疗。在第 30 天，生存率为 71.6%。报告了 1 例并发症（穿孔）。
值班内镜医师在非工作时间使用止血粉是可行的，但在病情严重的患者中再出血风险较高。
