Hemostatic Role of TC-325 in Tumor-Related Upper Gastrointestinal Bleeding: Experience in a Tertiary Care Centre

Abstract

Introduction. Conventional endoscopic methods have shown poor hemostatic efficacy in the treatment of bleeding esophagogastroduodenal tumors. Recent studies have suggested, on the contrary, a high therapeutic success with the use of TC-325 (Hemospray®, Cook Medical, Winston-Salem, NC) in this subgroup of patients. Its easy application and its ability to cover a large surface area appear to position it as a promising treatment for this indication, given the diffuse nature of bleeding in this type of lesions.

Objectives. Our primary aim was to evaluate the immediate and 72-hour hemostatic role of TC-325 in patients with upper gastrointestinal bleeding of tumor origin admitted to our institution. Our secondary objective was to analyze their rebleeding rate at one month and complications.

Materials and Methods. Retrospective, observational and longitudinal analysis, conducted between March 2018 and May 2022, based on the electronic records of the Digestive Endoscopy Unit of the Hospital de Gastroenterología Dr. Carlos Bonorino Udaondo, inpatient medical records and outpatient follow-up records of the Oncology service. We included all patients with upper gastrointestinal tumors with active bleeding verified during upper digestive video endoscopy (UDVE), with data available at least to analyze our primary objective. Clinical, demographic and endoscopic variables were collected, as well as laboratory data, tumor location and bleeding severity.

Results. A total of 21 patients, 81% men, with a mean age of 65 years were included. The most frequent presenting symptom was melena (81%), with gastric location being the most frequent (71.4%), and intestinal adenocarcinoma being the most common histological type. Immediate hemostasis was achieved in 19/21 patients (91%) treated with TC-325. Of the 18 patients who survived to 72 hours, 100% remained free of rebleeding at the end of this period. Furthermore, of the 16 patients alive at 30 days, only 4 (25%) rebleed, which allowed the application of definitive hemostatic treatments in better clinical conditions in 10 of them (3 patients underwent surgery and 7 others received radio and/or chemotherapy). Hemospray treatment was very safe, with no immediate or delayed complications. However, as these patients had locally advanced tumors or disseminated neoplasms, their prognosis was unfavorable, with mortality at 1 and 6 months of 24% and 66% respectively.

Conclusion. Treatment of tumoral upper gastrointestinal bleeding with TC-325 is very effective and safe. Its high rate of immediate and early hemostasis suggests a promising role as a bridging therapy, allowing the subsequent application of more definitive hemostatic treatments. Medium-term mortality remains equally high, given the generally advanced tumor stage.