Post written by Shou-jiang Tang, MD, from the Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.

The authors present 3 consecutive cases of diffusely ulcerated esophagus with clinically significant bleeding. The first 2 cases failed conventional hemostatic treatment including clipping and injection therapy. In the third case, hemospray was used as the first line monotherapy. Immediate hemostasis was achieved in all 3 patients, and they did not develop recurrent bleeding for more than 2 months.

The authors propose that hemospray application should be considered as the first line therapy in diffuse esophageal ulcerations with clinically significant bleeding, potentially reducing the need of repeating endoscopy. Once the hemospray achieves hemostasis, it provides a cyto-protective barrier on the diffusely ulcerated mucosa against ongoing acid reflux, allowing the new tissue to grow more efficiently during ulcer healing period.

Hemospray is a new hemostatic agent. Currently, hemospray is approved for non-variceal bleeding and can be used either as a primary hemostatic monotherapy or a salvage modality. There are clinical scenarios in which endoscopists should think of using hemospray first.

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