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Active bleeding caused by portal hypertensive gastropathy
VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Active bleeding caused by portal hypertensive gastropathy
Figure 1. Hemostatic powder diffusely covering the bleeding site.
Portal hypertensive gastropathy (PHG) hemorrhage is a serious adverse event of portal hypertension. It is difficult to treat because of the diffuse nature of bleeding. Management includes medical therapy to decrease the portal pressure, endoscopic thermal therapy requiring multiple sessions, and a transjugular intrahepatic portosystemic shunt in refractory cases. Hemospray (TC-325) is a novel hemostatic powder licensed for nonvariceal bleeding, and it has shown effectiveness in achieving hemostasis in bleeding peptic ulcers and bleeding secondary to gastric and colonic malignancies as well as preliminary encouraging results in the off-label management of acute variceal bleeding. There were no reported technique-related adverse events except rebleeding. Systemic embolization and mucosal injury have never been observed. In this video (Video 1; available online at www.giejournal.org), we present acute hemorrhage secondary to diffuse PHG bleeding treated off-label with Hemospray. A 41-year-old woman with alcohol-related cirrhosis (CHILD B) presented to the hospital with hematemesis. She was hemodynamically stable, and her hemoglobin level was 8.8 g/dL. Intravenous somatostatin and proton pump inhibitors were started immediately. An urgent gastroscopy was performed within 2 hours of
www.giejournal.org
admission that revealed active bleeding from severe PHG localized at the fundus. Hemospray monotherapy was applied, leading to hemostasis. The patient was kept under surveillance for 24 hours with a hemodynamically stable profile and no decrease in hemoglobin level. A follow-up control endoscopy was performed 24 hours later that showed moderate PHG with no active bleeding. Hemospray could play a role in management of acute PHG bleeding, whereas long-term medical therapy must be considered for all endoscopically treated patients. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Mostafa Ibrahim, MD, Delphine Degré, MD, Jacques Devière, MD, PhD, Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium http://dx.doi.org/10.1016/j.gie.2014.01.020
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1
Active bleeding caused by portal hypertensive gastropathy
Figure 1. Hemostatic powder diffusely covering the bleeding site.
Portal hypertensive gastropathy (PHG) hemorrhage is a serious adverse event of portal hypertension. It is difficult to treat because of the diffuse nature of bleeding. Management includes medical therapy to decrease the portal pressure, endoscopic thermal therapy requiring multiple sessions, and a transjugular intrahepatic portosystemic shunt in refractory cases. Hemospray (TC-325) is a novel hemostatic powder licensed for nonvariceal bleeding, and it has shown effectiveness in achieving hemostasis in bleeding peptic ulcers and bleeding secondary to gastric and colonic malignancies as well as preliminary encouraging results in the off-label management of acute variceal bleeding. There were no reported technique-related adverse events except rebleeding. Systemic embolization and mucosal injury have never been observed. In this video (Video 1; available online at www.giejournal.org), we present acute hemorrhage secondary to diffuse PHG bleeding treated off-label with Hemospray. A 41-year-old woman with alcohol-related cirrhosis (CHILD B) presented to the hospital with hematemesis. She was hemodynamically stable, and her hemoglobin level was 8.8 g/dL. Intravenous somatostatin and proton pump inhibitors were started immediately. An urgent gastroscopy was performed within 2 hours of
www.giejournal.org
admission that revealed active bleeding from severe PHG localized at the fundus. Hemospray monotherapy was applied, leading to hemostasis. The patient was kept under surveillance for 24 hours with a hemodynamically stable profile and no decrease in hemoglobin level. A follow-up control endoscopy was performed 24 hours later that showed moderate PHG with no active bleeding. Hemospray could play a role in management of acute PHG bleeding, whereas long-term medical therapy must be considered for all endoscopically treated patients. DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Mostafa Ibrahim, MD, Delphine Degré, MD, Jacques Devière, MD, PhD, Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium http://dx.doi.org/10.1016/j.gie.2014.01.020
Volume
-,
No.
-
: 2014 GASTROINTESTINAL ENDOSCOPY 1