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A 68-year-old man who was taking acetylsalicylic acid for a previous right occipital stroke was admitted to our hospital for an episode of syncope with subsequent facial trauma and mandibular fracture. The syncopal episode was due to hemorrhagic shock resulting from a massive hematemesis. His initial laboratory data showed the following: hemoglobin level 5.4g/dL, white blood cell count (WBC) 17620/mm3 with a normal differential, platelets 118000/mm3, blood urea nitrogen 82mg/dL, creatinine 1.3mg/dL, international normalized ratio (INR) 1.28, and he had an admission Rockall score of 6 and a Glasgow Blatchford Score (GBS) of 18. An urgent esophagogastroduodenoscopy (EGD) was performed using an Olympus GIF-1TH190 endoscope (Olympus, Japan), which revealed a submucosal lesion of 6cm in diameter on the gastric fundus with spurting bleeding from a central ulcerated area of the tumor (●" Fig.1a). Because of the location and shape of the lesion, clips could not be applied, thermal therapy worsened the hemorrhage instead of stopping it, and complete hemostasis was still not observed after injection of 10mL diluted epinephrine (1:10000) with the aim of slowing the active bleeding (●" Fig.1b). Therefore, a decision was made to apply Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) using a 10-Fr catheter, which did achieve definitive bleeding control (●" Fig.1c, ●" Fig.1d, ●" Fig.1e; ●" Video 1). No follow-up EGD was performed.No further bleedingoccurreduntil surgery on the 10th day after admission. The patient underwent openwedge resection of the gastric fundus including the tumor with 1.5-cm negative margins (R0 resection).

Successful use of Hemospray as a bridge to surgery in life-threatening bleeding from a gastrointestinal stromal tumor of the stomach