Control of upper gastrointestinal hemorrhage by endoscopic spraying of clotting factors.

A new technique for the endoscopic control of upper gastrointestinal hemorrhage has been developed. It consists of a spraying device which delivers atomized clotting factors (thrombin and fibrinogen) directly to a focal bleeding site. In vivo studies in a standardized dog model of acute gastric ulcer bleeding, demonstrated a significant reduction in bleeding time by spraying thrombin and cryoprecipitate (mean +/- SE bleeding time = 223 +/- 14 sec) as compared to a saline spray (mean 705 +/- 60 sec) or to the untreated controls (mean 498 +/- 43 sec), P less than 0.001. Similar results were obtained in the heparinized dog model. The mean bleeding time was 226 +/- 11 sec in the sprayed animals, while the control ulcers bled continuously. The four lumen spray tube fits the biopsy lumen of commercial gastroscopes. The feasibility of the technique for treatment of oozing venous bleeding sites in the upper gastrointestinal tract has been successfully tried in a clinical setting. The authors feel that the technique in its present form is ready for clinical testing in a controlled manner.