Odah, Tarek

INTRODUCTION: The U.S. Food and Drug Administration (FDA) has recently approved the Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) for treatment of gastrointestinal bleeding. Hemospray can be used as a monotherapy in certain circumstances and as salvage therapy in others. In this analysis, we compare the immediate hemostasis effects of Hemospray in upper gastrointestinal bleeding when used as a monotherapy compared to when used as a salvage treatment after failure of conventional hemostatic measures. METHODS: An extensive search for available studies comparing hemostasis effects of Hemospray as monotherapy versus salvage therapy in the treatment of upper gastrointestinal bleeding was performed in MEDLINE and Google scholar engine. Twenty-two studies were included. Odds ratios were calculated. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed-effects or random-effects model. RESULTS: A total of 489 patients were included and divided into two groups, monotherapy group (N = 267 patients) and salvage group (N = 222 patients). A pooled odds ratio of 0.72 (95% confidence interval CI 0.27-1.92, P = 0.86) was obtained between two groups. Moreover, immediate hemostasis was achieved in 94% and 96.8% for monotherapy and salvage therapy, respectively. CONCLUSION: Both monotherapy and salvage therapies were highly effective in achieving immediate hemostasis in upper gastrointestinal bleeding.