Hemospray, an approved hemostatic powder indicated for endoscopic hemostasis in gastrointestinal (GI) bleeding, has been shown in several studies to be highly effective as a monotherapy and in combination with conventional hemostatic techniques for the immediate management of GI bleeding, according to a meta-analysis published in the Journal of Clinical Gastroenterology.
The meta-analysis was based on a systematic review of research databases, spanning from their inception to March of 2019. Investigators included 19 studies that reported clinical outcomes associated with Hemospray use in GI bleeding.
The primary outcome of the meta-analysis was the pooled rates of clinical success, defined as initial hemostasis following Hemospray application monotherapy or in combination therapy in patients with GI bleeding. Secondary outcomes included pooled rebleeding rates and adverse events.
In the overall pooled study population, 212 patients received Hemospray monotherapy, while 602 patients received Hemospray combined with conventional hemostatic techniques. The pooled rate of clinical success following Hemospray application was 92% (95% CI, 87%-96%).
Additionally, the overall pooled early post-intervention rebleeding rate was 20% (95% CI, 16%-26%). The overall pooled rate of delayed rebleeding following Hemospray application was 23% (95% CI, 16%-31%). No statistical difference was found between studies comparing Hemospray monotherapy vs Hemospray combined with conventional therapy in terms of clinical success (risk ratio [RR], 1.02; 95% CI, 0.96-1.08; P =.34) and early rebleeding (RR, 0.89; 95% CI, 0.75-1.07; P =.214).
Limitations of this meta-analysis were the inclusion of non-US-based studies as well as the inconsistent availability of data on 30-day rebleeding and mortality rates from some studies.
The investigators wrote that, “Controlled studies and cost-effectiveness analyses are needed to further validate this endoscopic hemostatic modality and better define optimal target patient populations.”
Ofosu A, Ramai D, John F, et al. The efficacy and safety of hemospray for the management of gastrointestinal bleeding: a systematic review and meta-analysis. J Clin Gastroenterol. 2021;55(5):e37-e45. doi: 10.1097/MCG.0000000000001379