PWE-007 When to use hemospray? a single centre experience
Bibliographic record
Abstract
Introduction Hemospray is an inorganic nanopowder produced by Cook Medical and is licensed in Europe and Canada for the management of nonvariceal upper gastrointestinal bleed (NVUGIB). The powder adheres to liquid and forms a coagulum which concentrates clotting factors and stimulates the internal clotting cascade. There are numerous reports of successful haemostasis with hemospray, some reporting success rates of 85%.1However, the knowledge of which lesion is most suitable for hemospray use remains unclear. We report our experience at Guys and St Thomas’ NHS trust to establish the lesions most likely to benefit from hemospray either as a primary intervention or an add-on strategy. Method A retrospective review of endoscopic procedures that required hemospray was performed and the data was extracted from our endoscopy reporting system between December 2013 and February 2015 (14 months). We identified 32 patients who received hemospray, and excluded 2 where hemospray was applied blindly and the bleeding lesion was missed. The primary outcome was achieving primary haemostasis. Cases where primary haemostasis was not achieved or bleeding recurred requiring further endoscopic or radiological intervention were considered unsuccessful. Results The 30 procedures were divided according to the procedure performed. Procedure induced bleeding: 9/30 (7 post Barrett’s endoscopic mucosal resection (EMR), 1 post gastric polypectomy and 1 iatrogenic bleed post nasojejunal tube insertion). NVUGIB: 17/30. Enteroscopy small bowel bleed: 2/30. Colonoscopy: 2/30. Primary haemostasis was achieved in 80%, of which 10% required further endoscopic procedure or interventional radiological intervention (Table 1). The coagulum was not seen on second endoscopy. Conclusion Hemospray provides good hemostasis for post procedure, in particular post EMR bleed, as a single agent or where coagulation alone failed. Bleeding from Forrest 1b, 2a and 2b responded well to hemospray as a second modality, or single modality when the lesion was inaccessible. Forrest 1a had a poor response to hemospray and all cases required further endotherapy or interventional radiology. Further evidence is required to establish the value of hemospray in colonic and variceal bleed. Disclosure of interest None Declared. Reference Smith et al. Hemospray application in nonvariceal upper gastrointestinal bleeding: results of the survey to Evaluate the application of hemospray in the luminal tract. J Clin Gastroenterol. 2014 Nov-Dec;48(10):e89-92
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".