The Use and Safety of A Novel Haemostatic Spray in the Endoscopic Management of Acute Non-Variceal Upper Gastrointestinal Bleeding in Children

Aims and background: Advanced endo-haemostatic technique performance and experience is extremely variable in distribution amongst pediatric endoscopists. Haemostatic spray (Hemospray®), a novel endo-haemostatic topically applied powder has the advantage of extreme ease of use and; hence may lower the threshold of competency required by the endoscopist thereby potentially reducing mortality. The aim of the study is to prospectively evaluate the efficacy and the safety of haemostatic spray in paediatric patients with AUGIB. Methods: Prospective enrolment of children with acute upper gastrointestinal bleeding (AUGIB) (group one) occurred, either as primary therapy or as an adjunct to standard endo-haemostatic therapeutic techniques. Patients were assessed for likely need for endo-haemostatic intervention of >8/24 of the paediatric Sheffield AUGIB score. A follow up endoscopy occurred in those deemed to have clinical need pre-discharge. For comparison, anoher group (group two) of patients,who received conventional endo-haemostatic treatment in the preceding 36 months, were reviewed. Results: A total of 20 applications of hemospray occurred in 17 patients (8 male, median (range) age: 6.5years (2 days-17.75years) and a total of 29 patients were enrolled in group two ((16 male, median (range) age: 5.1 (0.25–17.0)). All patients tolerated haemostatic spray applications with no adverse events. The haemostatic spray group achieved 100% Initial hemostasis with 18% rebleeding rate, although only a 6% failure rate after re-application. In the conventional group, similar 100% initial hemostasis was achieved with 24% re-bleeding rate and 7% failure rate necessitating surgical interventions. Conclusions: This paediatric series suggests that monotherapy with haemostatic spray is as effective as conventional approaches in the management of AUGIB. Address correspondence and reprint requests to Professor Mike Thomson, Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Weston Bank, Sheffield, S10 2TH, UK (e-mail: mike.thomson@sch.nhs.uk). Received 1 October, 2017 Accepted 17 February, 2018 Author contributions: Study conception and design: Thomson. Application of hemospray: Narula, Rao, Urs, Belsha, Thomson. Acquisition of data: Belsha. Analysis and interpretation of data: Belsha, Thomson. Drafting of manuscript: Thomson. Critical revision: Narula, Rao, Urs, Belsha. Conflict of interest statement: All contributing authors confirm no real or potential conflict of interest to declare. The hospital bought the hemostatic sprays at the correct commercial price. No subsidies were provided at all. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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