Use of Hemospray® in Upper Gastrointestinal Bleeding due to Gastric Ischemia

Abstract

We present a case of a patient with a history of unresectable pancreatic adenocarcinoma who required biliodigestive diversion surgery with Roux-en-Y reconstruction. Due to the presence of portal cavernomatosis, and recurrent episodes of upper gastrointestinal bleeding, gastric devascularization surgery was performed. The patient experienced an initial episode of gastrointestinal bleeding with cardiopulmonary arrest as a complication. After resuscitation, an upper gastrointestinal endoscopy was performed which showed a visible vessel at the gastroenteroanastomosis; a hemostatic clip was placed, and the bleeding stopped. After 72 hours, the patient presented a new episode of hematemesis which led to another upper gastrointestinal endoscopy revealing an area of congestive, friable mucosa with deposits of fibrin and profuse bleeding on the greater gastric curvature; the suspected diagnosis was ischemic gastropathy This area had been recently evaluated by endoscopy and had shown normal characteristics. Endoscopic treatment was performed using TC-325 hemostatic powder (Hemospray®, Cook), and the bleeding stopped. The patient responded well to the applied treatment and had a favorable outcome.