Hemospray® during Emergency Endoscopy: Indonesia's First Experience from 37 Patients

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% (n = 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.