619 Efficacy of Hemospray in Non-Variceal Upper Gastrointestinal Bleeds: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: 

Despite various accepted modalities of treatment, gastrointestinal bleeding (GIB) is a major cause of death in the United States. Recently, amongst other hemostatic powders, Hemospray (TC-325) emerged as an effective method in managing patients with non-variceal upper GIB. We conducted this systematic review with meta-analysis to assess the efficacy of Hemospray in patients with non-variceal upper GIB.

METHODS: 

A comprehensive literature search of PubMed, Cochrane, and Google Scholar was performed. Our search strategy was restricted to cohort studies and randomized controlled trials (RCTs). Our primary outcomes were clinical and technical success, while our secondary outcomes were aggregate rebleeding, early rebleeding, delayed rebleeding, refractory bleeding, mortality rate, and treatment failure. We used the R package “metafor” (version 2.1-0) and R Studio (version 3.6.0, Boston, Massachusetts) for statistical assessment.

RESULTS: 

A total of 19 studies with 747 patients were included for final analysis. Technical success of Hemospray was seen in 96.8% of applications (95% confidence interval (CI) 93%-98%, P < 0.0001, I² = 44.62%). Clinical success of Hemospray was seen in 92% of applications (95% CI 87%-95%, P < 0.0001, I² = 44.62%).

CONCLUSION: 

To our knowledge, this is the first systematic review and meta-analysis evaluating the efficacy of Hemospray in the management of non-variceal UGIB. The results herein indicate that Hemospray is non-inferior to conventional hemostatic modalities in terms of efficacious cessation of GIB. Hence, Hemospray can be used as an alternative option for the management of upper GIB. Given its ease of use in tandem with its reduced technical expertise for deployment relative to other modalities, Hemospray has the potential to become the new standard therapy for the management of upper GIB. Future research, including RCTs and large cohort studies are needed, to specifically compare Hemospray to other hemostatic powders as well as to other individual, mechanical modalities. Additionally, for the future, larger studies are needed to more accurately comment on the efficacy of Hemospray in upper variceal hemorrhage and lower bleeds, in an attempt to widen its scope of application to all GIB.