Treatment proves easy to stomach
Marcus Fung (name changed to preserve patient confidentiality) knew something was badly wrong even though he felt no pain and wasn't in great discomfort. Not only did he pass black stools, he had just vomited blood. Fung, 55, was rushed to Prince of Wales Hospital.
In the emergency room, the doctors knew there was bleeding somewhere along his gastrointestinal tract, because Fung's stools indicated blood had passed through his digestive system. Fung's haemoglobin levels were measured to assess how much blood he had lost. Haemoglobin is the protein in red blood cells that carries oxygen and gives these cells their shape. It is measured in grams per 100ml of blood. Fung had lost three grams, indicating substantial blood loss.
An endoscope was put down Fung's mouth and into his stomach, washing and sucking away the blood so that the doctors could see the condition of the stomach lining.
They found a 1cm-wide ulcer where his gastric acids had eaten into the stomach walls and hit a blood vessel. Blood poured from the ulcer into the stomach cavity, causing Fung to throw up blood.
The uncontrolled internal bleeding meant he could potentially lose blood pressure and go into shock within an hour or two. About 10 per cent of patients with a bleeding peptic ulcer die.
In light of this medical emergency, Dr Joseph Sung, the vicechancellor of Chinese University, was called in. Sung, together with Dr Samuel Giday of Johns Hopkins University, was leading a study that used a new procedure called Hemospray to treat bleeding peptic ulcers.
With Hemospray, an endoscope was inserted into Fung's stomach and a proprietary powder with special clotting qualities was sprayed into the stomach, stopping the bleeding almost instantly. Sung says the powder is similar to that used by the US army in field conditions to stop bleeding from open wounds.
'The beauty of this method is how easy and effective it is,' says Sung. 'The entire procedure, from investigating the bleeding to using Hemospray to stop it, takes just 30 minutes.'
Hemospray does not require as much skill as conventional treatments. Conventional methods involve injecting epinephrine or other drugs to constrict the blood vessel; inserting a special heat-generating device into the endoscope to 'cook' the ulcer; or placing a clip on the punctured blood vessel. All these require an endoscopy expert with precision skills who might not be readily available.
Twenty years ago, doctors would have given patients blood transfusions and operated on them to suture the bleeding vessel. In some cases, the part of the stomach with the ulcer and injured blood vessel would have been removed. That would have left the patient with a lifetime of digestive problems.
Three days after the Hemospray, Fung had a repeat endoscopy. Sung found that the bleeding did not recur and that the rest of the Hemospray powder had been washed away by the stomach's natural acids.
Fung is now on anti-ulcer medication. When the ulcer has fully healed, Sung will decide whether to give him antibiotics. Hemospray has so far been used on about 20 patients with very good results, Sung says.