Médecine

Paramédical

Autres domaines


S'abonner

Experience with the use of a hemostatic powder in 152 patients undergoing urgent endoscopy for gastrointestinal bleeding - 07/11/20

Doi : 10.1016/j.clinre.2020.10.003 
Aymeric Becq a, , Charles Houdeville a, My-Linh Tran Minh b, Nils Steuer c, David Danan d, Marie Anne Guillaumot e, Einas Abou Ali e, Maximilien Barret e, Aurélien Amiot f, Nicolas Carbonell a, Philippe Marteau a, Ulriikka Chaput a, Xavier Dray a, Marine Camus a

the Parisian On-call Endoscopy Team (POET)1

  Other Parisian On-call Endoscopy Team (POET) members: Cyriaque Bon, Benoît Bordacahar, Bertrand Brieau, Charlotte Delattre, Johann Dreanic Julien Kirchgesner, Cécilia Landman, Anne Laurain, Guillaume Le Gall, Romain Leenhardt, Sara Lemoinne, Marie Lequoy, Nelson Lourenco, Chloé Martineau, Frédérick Moryoussef, Jean-Charles Nault, Jeanne Netter, Violaine Ozenne, Anna Pellat, Olivia Pietri, Pierrre Rompteaux, Adrien Sportes, Aziz Zaanan.

a Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, F-75012 Paris, France 
b Paris VII University, Saint Louis Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France 
c Paris XIII University, Avicennes Hospital, Assistance Publique Hôpitaux de Paris (APHP), Bobigny, France 
d Paris V Descartes University, HEGP, Assistance Publique Hôpitaux de Paris (APHP), Paris, France 
e Paris V Descartes University, Cochin Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris, France 
f Paris XII University, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris (APHP), Créteil, France 

Corresponding author at: Endoscopy department, Saint Antoine Hospital, Paris, France 184 Rue du Faubourg Saint Antoine, Paris, 75012 Tel: 01.71.97.08.43; Fax: 01.49.28.29.70.Endoscopy department, Saint Antoine HospitalParis, France 184 Rue du Faubourg Saint AntoineParis75012
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 07 November 2020

Highlights

Real life use of Hemospray®, during urgent endoscopies outside working hours, by mobile on-call endoscopists, has yet to be described.
The use of Hemospray® by our group was stable after becoming available and did not increase with the endoscopists experience.
Hemospray® was mostly used for upper GIB (95.0%), nearly half of which were due to PUD (47.7%).
Hemospray® was used as salvage therapy in 60.8% of cases. During follow up, 39.9% had recurrence. At 30 days of follow-up, mortality rate was 28.4%.
40.5% of our patients did not require a further intervention and were alive at day 30 of follow-up, despite being severely ill.

Le texte complet de cet article est disponible en PDF.

Abstract

Background and study aims

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.

Material and methods

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.

Results

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).

Conclusions

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.

Le texte complet de cet article est disponible en PDF.

Abbreviations : GIB, UGIB, PUD, POET

Keywords : Hemospray®, Hemostatic powder, Digestive bleeding, Gastrointestinal hemorrhage


Plan


© 2020  Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.