Hemostatic spray powder TC-325 in the primary endoscopic treatment of peptic ulcer related bleeding: multicentre international registry.

Introduction Upper gastrointestinal bleeding (UGIB) is a leading cause of morbidity and associated with a 2-17% mortality in the United Kingdom (UK) and USA [1]. Peptic ulcers account for 50% of UGIB’s. Endoscopic intervention in a timely manner can improve outcomes. Hemospray (Cook Medical, North Carolina, USA) is an endoscopic haemostatic powder for GI bleeding. This multicentre registry was created to collect data prospectively on the immediate Endoscopic haemostasis of GI bleeding in patients with peptic ulcer disease when Hemospray is applied as endoscopic monotherapy, dual therapy or rescue therapy. Methods Data were collected prospectively (January 2016 – March 2019) from 14 centres in the (UK, France, Germany and the USA). The application of Hemospray was decided upon at the endoscopist’s discretion. Results 202 patients with UGIB secondary to peptic ulcers were recruited. Immediate haemostasis was achieved in 178/202 (88%) of patients, 26/154 (17%) had a re-bleed, 21/175 (12%) died within 7 days, 38/175 (22%) died within 30 days (all-cause mortality). Hemospray combination therapy with other endoscopic modalities had an associated lower 30-day mortality (16%, P <0.05) relative to Hemospray monotherapy or rescue therapy. There were high immediate haemostasis rates across all PUD Forrest classifications. Conclusions This is the largest case series of outcomes of peptic ulcer bleeds treated with Hemospray. There were high immediate haemostasis rates with Hemospray in oesophageal and peptic ulcer bleeds.