The clinical utility and outcomes of Hemospray as primary versus salvage therapeutic modality for endoscopic hemostasis: A retrospective cohort study

Hemospray, an inorganic hemostatic powder, has emerged as a promising tool for managing gastrointestinal bleeding (GIB), offering advantages in ease of use and effectiveness across various bleeding etiologies. In this retrospective cohort study of 55 patients at a tertiary care center, we evaluated Hemospray as either a primary or salvage endoscopic hemostatic therapy. Immediate hemostasis was achieved in 100% of primary cases and 97% of salvage cases. Although not statistically significant, rebleeding occurred less frequently in the primary group (14%) than in the salvage group (30%). Patients in the primary therapy group required fewer post-procedure transfusions and had shorter hospital stays, though this may be related to the differing bleeding etiologies rather than treatment modality. Mortality did not differ significantly between groups. These findings align with previous literature highlighting high rates of immediate hemostasis but variable rebleeding outcomes. While concerns persist about long-term hemostatic durability, particularly in monotherapy use, Hemospray's efficacy in treating bleeding from tumors and friable lesions-especially when used as a primary modality-underscores its clinical value. Despite limitations related to sample size and study design, our results support Hemospray's role as an effective primary or adjuvant intervention for both upper and lower GIB.