title: Management of acute variceal bleeding using hemostatic powder.
abstract: OBJECTIVE
  This study aimed to test the safety and efficacy of Hemospray® for emergency control of acute variceal bleeding (AVB) due to portal hypertension in cirrhotic patients.
  
  
  METHODS
  This single-arm, prospective trial, conducted at two hospitals in Belgium and Egypt, included patients admitted to the emergency room with hematemesis and/or melena and known or suspected liver cirrhosis. All patients received urgent hemodynamic stabilization, octreotide (50 mcg bolus then 25 mcg/hour for 24 hours) and intravenous ceftriaxone (1 g/hour). Endoscopy to confirm AVB and Hemospray® application (if indicated) was performed within six hours of admission. Patients were kept under observation for 24 hours and underwent second endoscopy and definitive therapy (band ligation and/or cyanoacrylate injection in cases of gastric varices) the next day.
  
  
  RESULTS
  Thirty-eight patients were admitted for suspected AVB, and 30 of these had confirmed AVB (70% male; mean age 59.5 years (range, 32.0-73 years)). Child-Pugh class C liver disease was present in 53.4%. Esophageal varices were observed in 83.4% of patients, gastric varices in 10%, and duodenal varices in 6.6%. Spurting bleeding at the time of endoscopy was observed in 43.4%. One patient developed hematemesis six hours after Hemospray® application and underwent emergency endoscopic band ligation. No major adverse events or mortalities were observed during 15-day follow-up.
  
  
  CONCLUSIONS
  Hemospray® application was safe and effective at short-term follow-up for emergency treatment of AVB in cirrhotic patients.
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium ; Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Mikkawy
authors.affiliation: Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Haitham
authors.initials: H
authors.lastname: Abdalla
authors.affiliation: Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute, Cairo, Egypt.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mostafa
authors.affiliation: Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Devière
keywords: Variceal bleeding; hemostatic powder; portal hypertension