title: Upper gastrointestinal active bleeding ulcers: review of literature on the results of endoscopic techniques and our experience with Hemospray.
abstract: OBJECTIVE
  Acute gastrointestinal (GI) bleeding can lead from mild to immediately life-threatening clinical conditions. Upper GI bleeding (UGIB) is associated with a mortality of 6-10%. Spurting and oozing bleeding are associated with major risk of failure. Hemospray™ (TC-325), a new hemostatic powder, may be useful in these cases. Aim of this study is to review the efficacy of traditional endoscopic treatment in Forrest 1a-1b ulcers and to investigate the usefulness of Hemospray in these patients.
  
  
  METHODS
  A MEDLINE search was performed and articles that evaluated hemostatic efficacy and rebleeding rate with traditional endoscopic techniques related to Forrest classification were reviewed. Patients with Forrest 1a-1b ulcers were treated with Hemospray, either as monotherapy or in association with other endoscopic techniques. Primary outcome was immediate hemostasis, secondary outcomes were recurrent bleeding and adverse events related to Hemospray use.
  
  
  RESULTS
  Analysis of literature showed that mean initial hemostasis success rate in Forrest 1a-1b ulcers was of 92.8%, and mean rebleeding rate was of 13.3%. We enrolled 13 patients treated with Hemospray. Initial hemostasis was achieved in 100% and we reported three cases of rebleeding. No adverse events occurred.
  
  
  CONCLUSIONS
  Forrest 1a-1b bleeding ulcer is very difficult to treat. Hemospray appears to be an effective hemostatic therapy for these ulcers. However, additional prospective studies are needed to validate these findings.
authors.affiliation: Department of Gastrointestinal Endoscopy, University San Paolo Hospital , Milano , Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Masci
authors.forename: Monica
authors.initials: M
authors.lastname: Arena
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Morandi
authors.forename: Paolo
authors.initials: P
authors.lastname: Viaggi
authors.forename: Benedetto
authors.initials: B
authors.lastname: Mangiavillano
mesh_terms: D016558:Hemostasis, Endoscopic / Q000379:methods*; D006490:Hemostatics; D006801:Humans; D008903:Minerals / Q000627:therapeutic use*; D010438:Peptic Ulcer Hemorrhage / Q000628:therapy*; D013276:Stomach Ulcer
chemical_list: D006490:Hemostatics; D008903:Minerals; C581750:hemospray
keywords: hemospray; peptic ulcers; upper bleeding.