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Lai L, Liu X, Su J. Comparative efficacy of gelatin sponge, microcoils, and nbca in arterial gastrointestinal bleeding: a retrospective study. BMC Gastroenterol 2025; 25:412. [PMID: 40426059 PMCID: PMC12117964 DOI: 10.1186/s12876-025-04010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 05/20/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Arterial gastrointestinal bleeding poses a serious threat to life that requires timely and effective intervention. This study evaluated the effectiveness of three different embolization strategies: the use of gelatin sponge alone, in combination with microcoils, and in combination with n-butyl cyanoacrylate (NBCA). METHODS This retrospective study included 68 patients with acute arterial gastrointestinal bleeding (Forrest F1), categorized into three embolization groups: gelatin sponge alone (n = 23), gelatin sponge + microcoils (*n* = 23), and gelatin sponge + NBCA (n = 22). Clinical success was defined as complete hemostasis without rebleeding within 30 days. Multivariate analysis adjusted for age, NSAID use, and bleeding site. RESULTS The gelatin sponge + NBCA group achieved 100% clinical success, significantly higher than gelatin sponge + microcoils (91.30%) and gelatin sponge alone (65.22%) (P < 0.001). Rebleeding rates were lowest with NBCA (0% vs. 34.78% for gelatin sponge alone; P < 0.001), and complication rates favored NBCA (13.6% vs. 47.8%; P = 0.013). Multivariate analysis confirmed the superiority of combination strategies, with gelatin sponge + NBCA showing the highest odds of success (adjusted OR = 24.12, 95% CI: 2.98-195.21, P = 0.003). Subgroup analyses revealed no significant interaction between embolic strategy and bleeding site (P > 0.05), though upper GI cases trended toward higher success rates (92.3-100%) compared to lower GI (80-100%). CONCLUSION The study underscores the superiority of combination embolic strategies over the application of gelatin sponge alone for managing arterial gastrointestinal bleeding. The addition of microcoils and NBCA to gelatin sponge enhances both the efficacy and durability of embolic interventions, suggesting their preferential use in clinical practice to optimize patient outcomes.
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Affiliation(s)
- Longxiang Lai
- Department of Interventional Radiology, Jining No. 1 People's Hospital, Shandong Province, Jining City, 272000, China
| | - Xian Liu
- Department of Interventional Radiology, Jining No. 1 People's Hospital, Shandong Province, Jining City, 272000, China
| | - Juan Su
- Department of Neurology, Jining No. 1 People's Hospital, Shandong Province, Jining City, 272000, China.
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Mega PF, de Moura EGH, Bestetti AM, Ramai D, Kumar A, Hajjar LA, Thompson CC, de Moura DTH. Endoscopic vacuum therapy for the management of nonvariceal upper gastrointestinal bleeding: a valuable resource for the endoscopist's toolbox. Endoscopy 2025. [PMID: 39983768 DOI: 10.1055/a-2544-6448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2025]
Abstract
Endoscopic vacuum therapy (EVT) is a well-established method for managing gastrointestinal perforations. During the COVID pandemic, case reports demonstrated the effective use of EVT in controlling COVID-related diffuse duodenal bleeding. Owing to its unique mechanism of action, this approach may also be effective for other types of nonvariceal upper gastrointestinal bleeding (NVUGIB). This study aimed to assess EVT in the treatment of NVUGIB.This retrospective analysis of a prospectively collected database included patients who underwent EVT for the treatment of NVUGIB. The primary outcome was clinical success. Secondary outcomes included technical success and safety. Subgroup analysis comparing the outcomes for patients with and without COVID was conducted.19 patients underwent EVT for NVUGIB, with 57.9% having failed other therapies. Technical success occurred in all patients, and clinical success was achieved in 89.5%. There was no difference in the clinical success rates between patients with or without COVID (88% versus 91%, respectively). No procedure-related adverse events occurred. EVT appears to be safe and effective in the management of NVUGIB. This approach could be particularly useful in refractory or diffuse bleeding. Larger studies are warranted to validate these findings.
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Affiliation(s)
- Paulo Ferreira Mega
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
| | - Alexandre Moraes Bestetti
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
| | - Daryl Ramai
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | - Atul Kumar
- Piedmont Physicians Gastroenterology, Piedmont Healthcare Inc, Atlanta, United States
| | - Ludhmila Abrahão Hajjar
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
- Department of Clinical Emergencies and Intensive Care, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, United States
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Department of Gastroenterology, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Gastrointestinal Endoscopy Division, Instituto D'Or de Pesquisa e Ensino, Hospital Vila Nova Star, Sao Paulo, Brazil
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Wang W, Zhang K, Ming F, Chen B, Zhang H, Wang Z, Jiang X, Zhang H, Shang G, Bao Y, Peng H, Liu S, Ling X, Li W, Zhu H, Zhang Y, Cai S, Ding Z, Lin R. A novel scheme for non-invasive drug delivery with a magnetically controlled drug delivering capsule endoscope. J Control Release 2025; 381:113591. [PMID: 40024342 DOI: 10.1016/j.jconrel.2025.113591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 11/18/2024] [Accepted: 02/26/2025] [Indexed: 03/04/2025]
Abstract
There is a lack of effective means for precise drug delivery of gastrointestinal diseases. Herein we report a novel magnetically controlled drug delivering capsule endoscope (MDCE) to achieve precision drug delivery for gastrointestinal diseases. MDCE integrates a drug delivery system into conventional capsule endoscope. It can carry 0.5 ml of liquid medication, which can be sprayed onto the target area using an electric pump upon detecting lesions by convolutional neural network (CNN)-model. Additionally, with the aid of an external magnet, the operator can adjust the posture and drug delivery direction of the capsule endoscope to enhance the accuracy of drug release. This adjustment process is monitored in real-time through the camera at the front of the capsule endoscope. To validate the clinical efficacy of the MDCE, we established porcine intestinal epithelial injury and bleeding models, and we demonstrated that MDCE could accurately deliver drugs under magnetic control through direct visualization. MDCE could significantly reduce injury area by delivering organoids to porcine injury sites after 7 days compared to the control group (48 mm2vs. 21 mm2, p = 0.018). MDCE could significantly reduce bleeding time by spraying norepinephrine to porcine intestinal bleeding site compared to the control group (731 s vs. 418 s, p = 0.007). These demonstrate that MDCE could actively accurately release drugs under magnetic control through direct visualization in a non-invasive manner. This opens a new chapter for the precision treatment of gastrointestinal diseases and provides a novel approach for oral drug administration for systemic diseases.
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Affiliation(s)
- Weijun Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Kun Zhang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | | | - Biao Chen
- Department of Emergency General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hao Zhang
- ANKON Technologies Co., Ltd., Wuhan, China
| | - Zhe Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin Jiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hang Zhang
- ANKON Technologies Co., Ltd., Wuhan, China
| | - Guochen Shang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuhui Bao
- ANKON Technologies Co., Ltd., Wuhan, China
| | | | - Shanshan Liu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin Ling
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wenhao Li
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Huanpeng Zhu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yurui Zhang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sicheng Cai
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhen Ding
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
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Fujishiro M, Iguchi M, Ono S, Funasaka K, Sakata Y, Mikami T, Kataoka M, Shimaoka S, Michida T, Igarashi Y, Tanaka S. Guidelines for endoscopic management of nonvariceal upper gastrointestinal bleeding (second edition). Dig Endosc 2025; 37:447-469. [PMID: 40114631 DOI: 10.1111/den.15019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/19/2025] [Indexed: 03/22/2025]
Abstract
The Japan Gastroenterological Endoscopy Society has prepared Guidelines for Endoscopic Practice in Nonvariceal Upper Gastrointestinal Bleeding as part of the initiative to develop evidence-based endoscopic practice guidelines. Hemorrhagic gastroduodenal (peptic) ulcers are the primary cause of nonvariceal upper gastrointestinal bleeding. With the advent of a super-aged society, the cases caused by Helicobacter pylori are on the decline, whereas those caused by drugs (e.g. aspirin) have been increasing. Endoscopic hemostasis is currently the first-line treatment for nonvariceal upper gastrointestinal bleeding, and various methods have been devised for this purpose. It is recommended to stabilize the vital signs of the patient before and after endoscopic hemostasis with appropriate management based on an assessment of the severity of illness, in addition to the administration of acid secretion inhibitors. These guidelines describe the evaluation and initial treatment of nonvariceal upper gastrointestinal bleeding, as well as the selection of endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding and its management after endoscopic hemostasis. This is achieved by classifying nonvariceal upper gastrointestinal bleeding into two main categories, namely, peptic ulcer and other types of gastrointestinal bleeding. We prepared statements for any available literature with supporting evidence, including the levels of evidence and recommendations. New evidence has been pooled since the publication of the first edition in this area; however, the levels of evidence and recommendations mostly remain low.
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Affiliation(s)
| | | | - Satoshi Ono
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kohei Funasaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Tatsuya Mikami
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Tomoki Michida
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Ye Y, Liu L, Xu L. Preliminary exploration of the application of cyanoacrylate glue in Forrest IIa and IIb peptic ulcer hemorrhage. Surg Endosc 2025; 39:3155-3166. [PMID: 40199748 DOI: 10.1007/s00464-025-11702-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2025] [Accepted: 03/31/2025] [Indexed: 04/10/2025]
Abstract
OBJECTIVE This study aims to preliminarily investigate the therapeutic effect of cyanoacrylate glue (CG) on Forrest IIa and IIb peptic ulcer hemorrhage (PCH). METHODS From January 2020 to May 2024, we retrospectively collected data on patients with Forrest IIa and IIb PCH treated with CG using emergency endoscopic hemostasis at a single center and subsequently evaluated and compared the efficacy of CG with respect to ulcer location, Forrest staging, and ulcer size. RESULTS A total of 93 patients were enrolled, achieving 100% technical success without 24-h rebleeding. The rebleeding rate at 72 h was 1.1% (95% confidence interval [CI]: 0.2-5.9%), and the rebleeding rate at 7 days was 2.2% (95% CI: 0.6-7.6%). The median age of the patients was 43.0 years. There were 42 patients (45.2%) with Forrest IIa ulcers and 51 patients (54.8%) with Forrest IIb ulcers. Sixty patients (64.5%) had ulcers ranging in size from 1.0 to 2.0 cm, while 33 patients (35.5%) had ulcers larger than 2.0 cm. The ulcers were located in the antrum (19 cases), angulus (38 cases), gastric body (11 cases), and duodenal bulb (25 cases). Median procedure time was 12.0 min, with duodenal PCH requiring significantly less time than stomach PCH (P < 0.05). CG treatment efficacy was comparable between Forrest IIa/IIb ulcers as well as across ulcer sizes (P > 0.05). CONCLUSIONS CG is particularly effective and safe for PCH located in the duodenal bulb, as well as for both Forrest IIa and IIb PCH.
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Affiliation(s)
- Ye Ye
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
| | - Liansheng Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
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Tejedor-Tejada J, Hermida B, Camblor C, Emara M, Youssef Mohamed S, Perez-Pariente JM. Timing of endoscopy in high-risk patients with acute upper gastrointestinal bleeding: Results of a multicenter international cohort study. GASTROENTEROLOGIA Y HEPATOLOGIA 2025:502455. [PMID: 40288487 DOI: 10.1016/j.gastrohep.2025.502455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 04/11/2025] [Accepted: 04/22/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVE The optimal timing for high-risk patients with acute upper gastrointestinal bleeding (AUGIB) remains uncertain. The study aimed to evaluate whether the timing of endoscopy influences outcomes in high-risk patients with AUGIB. PATIENTS AND METHODS We conducted a retrospective, international, multicenter cohort study. High-risk patients (Glasgow-Blatchford score >7 points) with AUGIB, who underwent therapeutic endoscopy between September and December 2023 (n=511), were recruited. Patients were classified into three groups based on endoscopic timing: urgent (t≤6h), early (624h). Using descriptive statistics and logistic regression analyses, we identified the optimal timing for endoscopy and analyzed its association with 30-day outcomes, adjusting for confounding factors. RESULTS The results showed that urgent timing (n=130) was associated with worse outcomes compared to early (n=205) and elective (n=176) endoscopy, including higher 30-day all-cause mortality (p=0.047), increased rates of repeat endoscopy (p=0.034), higher 30-day transfusion rates (p=0.021), and longer lengths of stay (p=0.038). These findings were particularly consistent among patients admitted with non-variceal bleeding. In the multivariate analysis, urgent endoscopy (OR 2.47, 1.28-4.57), Charlson index (OR 1.39, 1.01-1.93), systolic blood pressure <90mmHg (OR 3.66, 1.44-9.31), tachycardia (OR 1.02, 1.01-1.05), and malignancy (OR 1.68, 1.37-7.73) were identified as worse prognostic factors. CONCLUSIONS High-risk patients with AUGIB who underwent urgent endoscopy exhibited worse outcomes, particularly those patients with non-variceal bleeding. Comorbidities, shock, urgent endoscopy and malignancy were identified as predictors of 30-day mortality. These findings highlight the importance of prior resuscitation, pharmacotherapy, and early endoscopy.
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Affiliation(s)
- Javier Tejedor-Tejada
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain.
| | - Benito Hermida
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Cristina Camblor
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Mohamed Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, Egypt; Alyousif Hospital, Alkhobar, Saudi Arabia
| | | | - Jose M Perez-Pariente
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
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Zhang R, Wang SB, He JF, Cai TH, Chen YM, Zhan TH. Transcatheter arterial embolization for acute nonvariceal upper Gastrointestinal bleeding in children: a single-center retrospective study. BMC Surg 2025; 25:168. [PMID: 40253344 PMCID: PMC12008960 DOI: 10.1186/s12893-025-02908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 04/09/2025] [Indexed: 04/21/2025] Open
Abstract
OBJECTIVE This study aims to provide a preliminary report on the outcomes of transcatheter arterial embolization (TAE) in pediatric patients with acute nonvariceal upper gastrointestinal bleeding (NVUGIB) to establish optimal practices for this intervention and explore its potential value in improving the management of pediatric patients. METHODS A retrospective analysis was conducted on children with NVUGIB who underwent TAE at a single institutional center between February 2022 and April 2024. Comprehensive data were collected, including patient demographics, clinical manifestations, diagnostic and therapeutic procedures, intraoperative findings, and follow-up outcomes. RESULTS A total of 266 cases with NVUGIB were admitted to the institutional center, with 14 cases (5.26%) undergoing TAE. There were 10 males and 4 females. The average age was 7.21 ± 4.77 years old, and the average hospital stay was 13.14 ± 8.69 days. Nine cases (64.29%) had hematochezia, 2 cases (14.29%) had hematemesis, 3 cases (21.42%) had both hematochezia and hematemesis. Six cases (42.86%) had no significant medical history, 3 cases (21.42%) had previous Helicobacter pylori infections, 2 cases (14.29%) had previous lymphomas, and 1 case (7.14%) each had immune disorders, gastroenteritis, and fever. The mean preoperative minimum hemoglobin level was 57.85 ± 21.25 g/L. All cases underwent gastroenteroscopy before TAE. Ten cases (71.43%) had duodenal bulb ulcers, 3 cases (21.43%) had duodenal ulcers, and 1 case (7.14%) had multiple ulcers in the gastric antrum. Bleeding was visible on endoscopy in 6 cases (Forrest Classification Ib,42.86%) (Table 2; Fig. 2), which were treated. All cases underwent TAE, and the timing of TAE averaged 4.29 ± 4.53 days. The responsible vessel was identified intraoperatively in all cases: gastroduodenal artery in 7 cases (50%) and pancreaticoduodenal artery in 7 cases (50%). A pseudoaneurysm was found in 2 cases (14.29%). Embolization of the responsible vessel was performed in all cases, using platinum coils alone in 8 cases (57.14%) and platinum coils combined with gelatin sponge in 6 cases (42.8%). All cases were followed up for an average of 13.69 ± 8.77 months, and no recurrence was detected. CONCLUSION TAE represents a promising intervention for pediatric patients with acute NVUGIB. Nevertheless, optimal timing, embolization techniques, and selection of embolizing agents necessitate further comprehensive investigation.
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Affiliation(s)
- Rong Zhang
- Vascular Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, China
- Vascular Surgery, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Gulou District, Fuzhou, Fujian Province, China
| | - Shi Biao Wang
- Pediatric Intensive Care Medicine, Fujian Children's Hospital, Fuzhou, China
| | - Jian Feng He
- Vascular Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, China
- Vascular Surgery, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Gulou District, Fuzhou, Fujian Province, China
| | - Tian Hong Cai
- Vascular Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, China
- Vascular Surgery, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Gulou District, Fuzhou, Fujian Province, China
| | - Yang Mei Chen
- Pediatric Intensive Care Medicine, Fujian Children's Hospital, Fuzhou, China
| | - Teng Hui Zhan
- Vascular Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, China.
- Vascular Surgery, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Road, Gulou District, Fuzhou, Fujian Province, China.
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Wang J, Yu L, Liu L, Luo Y, Lv N, Shu X, Zhu Z. Non-epinephrine monotherapy matches combination therapy in high-risk PUB patients. Sci Rep 2025; 15:12763. [PMID: 40229353 PMCID: PMC11997162 DOI: 10.1038/s41598-025-97705-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 04/07/2025] [Indexed: 04/16/2025] Open
Abstract
Currently, there is no clear indication in the guidelines whether non-epinephrine injection monotherapy requires the addition of epinephrine for hemostasis.The purpose of this study is to compare the hemostatic efficacy of non-epinephrine injection monotherapy with combination therapy including extra epinephrine injection for peptic ulcer bleeding (PUB) patients . We retrospectively analyzed PUB patients who underwent endoscopic non-epinephrine injection as a monotherapy or combined non-epinephrine injection with epinephrine injection treatment in our center from March 2014 to January 2023 and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis. A total of 548 eligible patients were included in this study. After PSM, for PUB patients with nonbleeding visible vessels(FIIa), the recurrent bleeding rates by Days 3, 7, 14, and 30 after PSM were 17.6%, 26.5%, 27.9%, and 27.9% in the MT group, respectively, and rates were 1.4%, 5.6%, 6.9%, and 6.9% in the CT group, respectively, with significant differences observed between the 2 groups (P = 0.001, P = 0.001, P = 0.001 and P = 0.001, respectively).However, for PUB patients with spurting bleeding, oozing bleeding, and adherent clots, there were no significant differences between the two groups. For PUB patients with spurting bleeding(FIa) and oozing bleeding (FIb) ulcers, non-epinephrine injection monotherapy and epinephrine injection combined therapy have similar hemostatic efficacy. However, for PUB patients with visible blood vessel (FIIa) ulcers, combined therapy has higher hemostatic efficacy than non-epinephrine injection monotherapy.
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Affiliation(s)
- Jingsong Wang
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, 518116, P. R. China
| | - Lintao Yu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Linlin Liu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Yixing Luo
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Nonghua Lv
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zhenhua Zhu
- Department of Gastroenterology, Jiangxi Provincial Key Laboratory of Digestive Diseases, Jiangxi Clinical Research Center for Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
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9
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Martyak M, Soult A, Britt LD. Diagnosis and management of gastrointestinal hemorrhage: What you need to know. J Trauma Acute Care Surg 2025:01586154-990000000-00961. [PMID: 40205645 DOI: 10.1097/ta.0000000000004599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2025]
Abstract
ABSTRACT Acute gastrointestinal (GI) hemorrhage is a common cause for hospital admission that requires prompt diagnosis and multidisciplinary management to optimize clinical outcomes. Acute gastrointestinal bleeding (GIB) includes both upper and lower GI tract sources with an extensive list of differential pathologies. This review provides a systematic approach to both upper and lower GIB management, emphasizing initial resuscitation, stabilization, diagnostic evaluation to identify the source, and treatment modalities. Endoscopy remains the cornerstone for diagnostic and interventional purposes, significantly reducing the need for surgical procedures. However, lower GIB and severe or refractory cases may necessitate additional imaging and interventions, including surgical management. Integrating clinical guidelines, evidence-based strategies, and individualized care, this review delineates what you need to know to diagnose and manage acute GI hemorrhage. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Michael Martyak
- From the Surgery Department, Eastern Virginia Medical School, Old Dominion University, Norfolk, Virginia
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Ni Y, Ali K, Tang P, Hayat K, Cheng Z, Xu B, Qin Z, Zhang W. Over-the-scope clips for Nonvariceal upper gastrointestinal bleeding: a systematic review and meta-analysis of randomized studies. Postgrad Med J 2025; 101:351-359. [PMID: 39500365 DOI: 10.1093/postmj/qgae155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Indexed: 03/18/2025]
Abstract
BACKGROUND & AIMS Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common and potentially life-threatening condition. Over-the-scope clips (OTSCs) have emerged as a promising endoscopic treatment option for NVUGIB. We aimed to analyze the efficacy and safety of OTSCs compared to standard endoscopic treatments (ST) in patients with NVUGIB. METHODS We conducted a comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases from inception to June 2024 for randomized controlled trials (RCTs) comparing OTSCs with ST for NVUGIB. The primary outcomes were initial hemostasis and persistent bleeding. Secondary outcomes included rebleeding rates, mortality, hospital stays and others. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random/fixed-effects models. RESULTS Six RCTs involving 621 patients were included in the meta-analysis. OTSCs demonstrated significantly higher initial hemostasis (OR 4.80, 95% CI 1.78-12.96; P = 0.002) and lower persistent bleeding rates (OR 0.17, 95% CI 0.05-0.56; P = 0.003) compared to ST group. The rebleeding rate was significantly lower in the OTSC group 7-days re-bleeding (OR 0.27, 95% CI 0.14-0.53; P = 0.001); 30-days rebleeding (OR 0.40, 95%CI 0.22, 0.70; P = 0.002). No significant differences were observed in mortality (OR 0.65, 95% CI 0.31-1.33; P = 0.38) and hospital stay (mean difference 0.79 days 95%CI -0.57, 2.15) between the two groups. CONCLUSIONS OTSCs are more effective than ST for achieving hemostasis and preventing rebleeding in patients with NVUGIB, without increasing mortality. Key message What is Already Known Previous studies have shown that nonvariceal upper gastrointestinal bleeding (NVUGIB) is a serious medical condition that needs effective endoscopic interventions. The success rates of standard treatments for achieving hemostasis and preventing rebleeding are not consistent. What This Study Adds According to this study, over-the-scope clips (OTSCs) have the same mortality rate as standard endoscopic treatments, but they significantly improve initial hemostasis and lower rebleeding rates. Impact on Research, Practice, or Policy The findings support the use of OTSCs as a preferred intervention for NVUGIB, which could affect clinical guidelines and encourage additional research focused on improving endoscopic techniques and patient outcomes in the management of gastrointestinal bleeding.
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Affiliation(s)
- Yuanzhi Ni
- Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Dongxin Road. No. 848, Gongshu District, 310000, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Yuhangtang Road. No. 866, Xihu District, 310000, Hangzhou, Zhejiang, China
| | - Kamran Ali
- Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, 322000, No. 1, Shangcheng Avenue, Yiwu, Zhejiang, China
| | - Penghao Tang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Chaowang Road, No. 318, Gongshu District, 310000, Hangzhou, Zhejiang, China
| | - Khizar Hayat
- Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, 322000, No. 1, Shangcheng Avenue, Yiwu, Zhejiang, China
| | - Zhiwen Cheng
- Zhejiang University School of Medicine, Hangzhou, Yuhangtang Road. No. 866, Xihu District, 310000, Hangzhou, Zhejiang, China
| | - Benfeng Xu
- Graduate School of Zhejiang Chinese Medical University, Bingwen Road, No. 548, Bingjiang District, 310000 Hangzhou, Zhejiang, China
| | - Zhiwen Qin
- Graduate School of Zhejiang Chinese Medical University, Bingwen Road, No. 548, Bingjiang District, 310000 Hangzhou, Zhejiang, China
| | - Wu Zhang
- Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Dongxin Road. No. 848, Gongshu District, 310000, Hangzhou, Zhejiang, China
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11
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Nagesh VK, Pulipaka SP, Bhuju R, Martinez E, Badam S, Nageswaran GA, Tran HHV, Elias D, Mansour C, Musalli J, Bhattarai S, Shobana LS, Sethi T, Sethi R, Nikum N, Trivedi C, Jarri A, Westman C, Ahmed N, Philip S, Weissman S, Weinberger J, Bangolo AI. Management of gastrointestinal bleed in the intensive care setting, an updated literature review. World J Crit Care Med 2025; 14:101639. [DOI: 10.5492/wjccm.v14.i1.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 11/08/2024] [Accepted: 12/02/2024] [Indexed: 12/11/2024] Open
Abstract
Gastrointestinal (GI) bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit (ICU). This literature review consolidates current insights on the epidemiology, etiology, management, and outcomes of GI bleeding in critically ill patients. GI bleeding remains a significant concern, especially among patients with underlying risk factors such as coagulopathy, mechanical ventilation, and renal failure. Managing GI bleeding in the ICU requires a multidisciplinary approach, including resuscitation, endoscopic intervention, pharmacologic therapy, and sometimes surgical procedures. Even with enhanced management strategies, GI bleeding in the ICU is associated with considerable morbidity and mortality, particularly when complicated by multi-organ failure. This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients, aiming to enhance survival rates and improve the quality of care within the ICU setting.
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Affiliation(s)
- Vignesh K Nagesh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sai Priyanka Pulipaka
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ruchi Bhuju
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Emelyn Martinez
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shruthi Badam
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gomathy Aarthy Nageswaran
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Hadrian Hoang-Vu Tran
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Daniel Elias
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Charlene Mansour
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jaber Musalli
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sanket Bhattarai
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Lokeash Subramani Shobana
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Tannishtha Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Ritvik Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Namrata Nikum
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Chinmay Trivedi
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Amer Jarri
- Department of Pulmonology and Critical Care, HCA Florida Bayonet Point Hospital, Hudson, FL 34667, United States
| | - Colin Westman
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Nazir Ahmed
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Shawn Philip
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jonathan Weinberger
- Department of Gastroenterology, Hackensack University Medical Center, Hackensack, NJ 07061, United States
| | - Ayrton I Bangolo
- Department of Hematology & Oncology, John Theurer Cancer Center at Hackensack University Medical Center, Hackensack, NJ 07601, United States
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12
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Liu K, Zhang W, Gao L, Bai J, Dong X, Wang Y, Chen H, Dong J, Fang N, Han Y, Liu Z. Efficacy of hemostatic powder monotherapy versus conventional endoscopic treatment for nonvariceal GI bleeding: a meta-analysis and trial sequential analysis. Gastrointest Endosc 2025; 101:539-550.e14. [PMID: 39265743 DOI: 10.1016/j.gie.2024.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND AND AIMS Hemostatic powder (HP) is a novel hemostasis modality for nonvariceal GI bleeding. This meta-analysis was performed to evaluate the efficacy of HP monotherapy versus conventional endoscopic treatment (CET) for nonvariceal GI bleeding. METHODS PubMed, EMBASE, and Cochrane Library databases were systematically searched from inception to October 16, 2023. The primary outcomes were the initial hemostatic rate and the 30-day recurrent bleeding rate. After the meta-analysis, a trial sequential analysis (TSA) was also conducted to decrease the risk of random errors and validate the result. RESULTS The meta-analysis included 8 studies, incorporating 653 patients in total. Given significant heterogeneity, all analyses were segregated into malignancy-related and nonmalignancy-related GI bleeding lesions. For the former, HP monotherapy significantly improved the initial hemostasis rate and 30-day recurrent bleeding rate compared with CET (relative risk [RR], 1.50; 95% confidence interval [CI], 1.28-1.75; P < .001; RR, .32; 95% CI, .12-.86; P = .02, respectively), and TSA supported the results. For nonmalignancy-related GI bleeding, HP monotherapy and CET have similar initial hemostasis and 30-day recurrent bleeding rates (RR, 1.08; 95% CI, .98-1.19; P = .11; RR, 1.15; 95% CI, .46-2.90; P = .76, respectively), but the TSA failed to confirm the results. CONCLUSIONS HP monotherapy surpassed CET in terms of the initial hemostasis rate and 30-day recurrent bleeding rate for patients with malignancy-related GI bleeding. However, their relative efficacy for nonmalignancy-related GI bleeding remains unresolved.
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Affiliation(s)
- Kai Liu
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, Ordos Central Hospital, Ordos School of Clinical Medicine, Inner Mongolia Medical University, Ordos, China
| | - Li Gao
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Jiawei Bai
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China; Department of Gastroenterology, School of Medicine, Yan'an University, Yan'an, China
| | - Xin Dong
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Yue Wang
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China; Department of Gastroenterology, Xi'an Medical University, Xi'an, China
| | - Hui Chen
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Jiaqiang Dong
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Nian Fang
- Department of Gastroenterology, Third Clinical Medical College, Nanchang University, Nanchang, China; Department of Gastroenterology, The First Hospital of Nanchang (The Third Affiliated Hospital of Nanchang University), Nanchang, China
| | - Ying Han
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
| | - Zhiguo Liu
- Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China.
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13
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He M, Desai S, Wang Y, Yang CW, Friedenberg F, Gillespie A. Inpatient Outcomes of Gastrointestinal Bleeding in Advanced CKD and Kidney Transplant Recipients: A National Analysis 2016-2019. KIDNEY360 2025; 6:379-390. [PMID: 40146553 PMCID: PMC11970864 DOI: 10.34067/kid.0000000662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/19/2024] [Indexed: 03/29/2025]
Abstract
Key Points Advanced CKD and ESKD are independent risk factors for gastrointestinal bleeding hospitalizations, angiodysplasia bleeding, and in-hospital mortality. Patients with ESKD with gastrointestinal bleeding exhibit significantly higher rates of adverse outcomes compared with those without CKD. Patients with advanced CKD and ESKD had lower rates of early endoscopy and higher rates of delayed endoscopy, with delayed endoscopy linked to increased mortality. Background Patients with kidney disease are at increased risk for gastrointestinal bleeding (GIB). This study aimed to investigate the incidence, causes, interventions, and inpatient outcomes of GIB in patients with advanced CKD (ACKD), ESKD, and kidney transplant (KT) recipients, compared with those without CKD (NCKD). Methods This retrospective study used the Nationwide Inpatient Sample database to identify adult patients admitted nonelectively with GIB from 2016 to 2019. Patients were stratified into five groups: ACKD (CKD stages 4 or 5), ESKD, KT, NCKD, and others (including CKD stages 1–3 and unspecified CKD). We compared outcomes across these groups and conducted subgroup analyses within the ACKD and ESKD groups to explore the association between mortality and the timing of endoscopic evaluation. Multivariate logistic regression (for binary outcomes) and linear regression (for continuous outcomes) models were used to analyze the dependent variables. Results A total of 2,163,929 patients were included. The incidence of GIB hospitalizations was higher in the ACKD (3.2%) and ESKD (3.4%) groups and lower in the KT group (2.1%) compared with the NCKD group (2.2%). All-cause in-hospital mortality was increased in ACKD, ESKD, and KT (3.0%, 3.1%, and 2.0%, respectively) compared with NCKD (1.7%). ESKD patients had higher rates of mechanical ventilation, vasopressor support, and blood transfusion, along with prolonged and costly hospitalizations (P < 0.001). ACKD and ESKD groups had lower rates of early endoscopy (<24 hours) and higher rates of delayed endoscopy (>48 hours), with delayed endoscopy linked to increased mortality. ACKD and ESKD were independent risk factors for angiodysplasia bleeding, while KT was a risk factor for diverticular and esophageal bleeding. Conclusions ACKD and ESKD are independent risk factors for GIB hospitalizations and in-hospital mortality, with delayed endoscopy further worsening outcomes. Tailored treatment plans are essential to improve outcomes in this complex population.
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Affiliation(s)
- Mingyue He
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Shaan Desai
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Yichen Wang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chien-Wen Yang
- Department of Nephrology, Ochsner Medical Center, New Orleans, Los Angeles
- Department of Nephrology, Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Frank Friedenberg
- Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Avrum Gillespie
- Section of Nephrology, Hypertension and Kidney Transplantation, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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14
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Alali AA, Pittayanon R, Martel M, Martins BC, Almadi MA, Chen YI, Barkun AN. TC-325 Superiority in Malignant Gastrointestinal Bleeding: An Individual Patient Data Meta-Analysis of Randomized Trials. Am J Gastroenterol 2025; 120:332-339. [PMID: 39248610 DOI: 10.14309/ajg.0000000000003078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/14/2024] [Indexed: 09/10/2024]
Abstract
INTRODUCTION The efficacy of topical hemostatic agents, recommended for peptic ulcer bleeding, remains poorly characterized in malignant gastrointestinal bleeding (GIB). METHODS We performed an individual patient data meta-analysis assessing the efficacy of topical hemostatic agents in malignant GIB. The literature was searched using OVID MEDLINE, EMBASE, and ISI Web of Science databases (database inception to November 2023). Only randomized controlled trials (RCTs) comparing topical hemostatic agents with conventional endoscopic modalities in malignant GIB were included. Original RCT patient-level data were obtained. Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. Quality of the evidence was evaluated using the revised Cochrane risk-of-bias tool and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcome was immediate hemostasis; secondary outcomes were 30-day rebleeding and the composite measure of further bleeding (persistent bleeding or 30-day rebleeding). Other outcomes were all-cause mortality, adverse events, and need for additional nonendoscopic treatment. Odds ratios (ORs) from endpoint comparisons were pooled using logistic regression models. RESULTS Overall, 985 citations were identified; 3 RCTs (n = 160 patients) were included with all assessing TC-325 (Hemospray). TC-325 achieved immediate hemostasis more often than conventional endoscopic modalities (OR 46.6, 95% confidence interval [CI] 5.89-369.1) (low-level certainty). Thirty-day rebleeding (OR 0.28, 95% CI 0.11-0.70) and further bleeding (OR 0.11, 95% CI 0.05-0.26) were both significantly lower with TC-325 (very-low-level certainty). All-cause mortality and need for additional nonendoscopic treatment did not differ between groups. No adverse events were reported. Subgroup analysis confirmed TC-325 superiority in patients with upper GIB. DISCUSSION TC-325 seems superior to conventional endoscopic therapy in managing patients with malignant GIB. TC-325 results in improvements in immediate hemostasis, 30-day rebleeding, and further bleeding, based on very low-to-low certainties of evidence.
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Affiliation(s)
- Ali A Alali
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Thunayan Alghanim Gastroenterology center, Amiri Hospital, Sharq, Kuwait
| | - Rapat Pittayanon
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Myriam Martel
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Bruno Costa Martins
- Endoscopy Unit, Instituto do Cancer do Estado de Sao Paulo ICESP, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Majid A Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Yen-I Chen
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Alan N Barkun
- Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
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15
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Kuroda H, Abe T, Kamiyama N, Oguri T, Ito A, Nakaya I, Watanabe T, Abe H, Yusa K, Fujiwara Y, Sato H, Suzuki A, Endo K, Yoshida Y, Oikawa T, Kakisaka K, Sawara K, Miyasaka A, Matsumoto T. Novel subharmonic-aided pressure estimation for identifying high-risk esophagogastric varices. J Gastroenterol 2025; 60:187-196. [PMID: 39470783 PMCID: PMC11794364 DOI: 10.1007/s00535-024-02161-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 10/10/2024] [Indexed: 11/01/2024]
Abstract
BACKGROUND Subharmonic-aided pressure estimation (SHAPE) is a technique for determining changes in ambient pressure. We aimed to analyze a novel SHAPE integrated into ultrasound diagnostic equipment to predict patients with liver cirrhosis at high risk of esophagogastric varices (EV). METHODS This prospective study included 111 patients with liver cirrhosis diagnosed between 2020 and 2023. We obtained liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) using shear wave elastography and hepatic vein-portal vein (HV-PV) gradient using the SHAPE method. The EV risk was determined either as null, low, or high by esophagoscopy and Child-Pugh stage. RESULTS HV-PV gradient increased concordantly with the increase in EV risk (- 7.0 dB in null-risk, - 4.4 dB in low-risk, and - 2.0 dB in high-risk) with statistically significant difference among any two groups. The most appropriate cut-off value of the HV-PV gradient was - 3.5 dB, and sensitivity, specificity, and positive and negative predictive values were 80.0%, 89.0%, 80.0%, and 88.0%, respectively. The areas under the curve values for predicting the high-risk EV were 0.920, 0.843, and 0.824 for the HV-PV gradient, LSM, and SSM, respectively. CONCLUSIONS The novel SHAPE system demonstrated high accuracy in identifying patients with liver cirrhosis at a high risk of EV.
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Affiliation(s)
- Hidekatsu Kuroda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan.
| | - Tamami Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Naohisa Kamiyama
- Ultrasound General Imaging, GE HealthCare Japan, Hino-Shi, Japan
| | - Takuma Oguri
- Ultrasound General Imaging, GE HealthCare Japan, Hino-Shi, Japan
| | - Asami Ito
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Ippeki Nakaya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Takuya Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Hiroaki Abe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Kenji Yusa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Yudai Fujiwara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Hiroki Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Akiko Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Kei Endo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Yuichi Yoshida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Takayoshi Oikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Keisuke Kakisaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Kei Sawara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Akio Miyasaka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Iwate Medical University School of Medicine, Nishitokuta 2-1-1, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3694, Japan
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16
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Liu ZJ, Hong JY, Zhang C, She J, Zhai HH. Gastrointestinal bleeding after pancreatoduodenectomy: Report of four cases. World J Gastrointest Surg 2025; 17:100119. [PMID: 39872762 PMCID: PMC11757177 DOI: 10.4240/wjgs.v17.i1.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/16/2024] [Accepted: 10/18/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy. We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention. CASE SUMMARY The main symptoms included black stool, hematochezia, haematemesis, blood in the nasogastric tube, and hemorrhagic shock. The mean age was 66.25 years old and the median onset time was 340 d after the surgery. The bleeding location comprised gastrointestinal anastomosis, bile duct-jejunum anastomosis, and extraluminal bleeding. The possible causes included marginal ulcer, jejunal varix, and abdominal infection. Endoscopic hemostatic clips, as well as a covered stent using angiography, were utilized to stop the bleeding and three patients survived. Only one patient died of gastrointestinal bleeding, abdominal bleeding, abdominal infection, hypovolemic shock, and disseminated intravascular coagulation. CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
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Affiliation(s)
- Zi-Jin Liu
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jia-Yi Hong
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chao Zhang
- Department of Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jing She
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Hui-Hong Zhai
- Department of Gastroenterology and Hepatology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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17
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Almasri H, Rabeeah S, Sidhu G, Qurashi A, Bassett J, Sawaf B, Abbarh S. Gastroduodenal Artery (GDA) Pseudoaneurysm as a Cause of Massive Upper Gastrointestinal (GI) Bleeding Years After Partial Gastrectomy. J Investig Med High Impact Case Rep 2025; 13:23247096251323076. [PMID: 40119668 PMCID: PMC11938441 DOI: 10.1177/23247096251323076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 02/01/2025] [Accepted: 02/06/2025] [Indexed: 03/24/2025] Open
Abstract
Gastroduodenal artery (GDA) pseudoaneurysm is a rare complication of gastric and pancreatic surgery. The presentation is often severe gastrointestinal (GI) bleeding with up to a 90% mortality rate. Proper identification of past gastrectomy based on history or endoscopic appearance is essential for timely embolization or surgery, given that endoscopic management often fails. Here, we present a 65-year-old man who has a history of gastric ulcer-related surgery without clear documentation and hypertension presented with hematemesis, black stools, and syncope. Upper endoscopy showed signs of gastroenterostomy with stenosis and duodenal ulcer with spurting hemorrhage. Two days after endoscopic therapy, a recurrence of massive GI bleeding was noted. A celiac arteriogram was done by interventional radiology, demonstrating a pseudoaneurysm off the GDA. Successful embolization was performed with helical coils. The GI bleeding stopped, and the patient became stable after that. The GDA pseudoaneurysm-related bleeding should always be suspected in patients who underwent gastrectomy, bypass surgery, or pancreatectomy. Endoscopic interventions are usually temporary and sometimes can only give anatomical correlation before angiogram and embolization offer a definite treatment. Patients with GDA pseudoaneurysm can be entirely asymptomatic for a long time. The most common site of bleeding is the duodenum. Surgical interventions can also be offered if an angiogram is not successful in stopping the bleeding.
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18
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Tau JA. Topical hemostatic preventative and therapeutic agents: clinical impact and utility. Gastrointest Endosc 2025; 101:36-44. [PMID: 39111391 DOI: 10.1016/j.gie.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 06/23/2024] [Accepted: 07/28/2024] [Indexed: 10/05/2024]
Affiliation(s)
- J Andy Tau
- Austin Gastroenterology, Austin, Texas, USA
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19
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Lei Y, Tau JA, Copland AP. Topical Hemostatic Agents. Am J Gastroenterol 2024:00000434-990000000-01514. [PMID: 39787339 DOI: 10.14309/ajg.0000000000003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 12/23/2024] [Indexed: 01/12/2025]
Affiliation(s)
- Yang Lei
- Division of Gastroenterology & Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - J Andy Tau
- Austin Gastroenterology, Austin, Texas, USA
| | - Andrew P Copland
- Division of Gastroenterology & Hepatology, University of Virginia, Charlottesville, Virginia, USA
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20
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Liu R, Yuan X, Liu J, Liu S, Xie J, Hu B. A novel endoscopic electrocoagulation hemostasis technique for uncontrolled intraprocedural bleeding: series connection of foreign body forceps and hemostatic forceps. Endoscopy 2024; 56:E338-E340. [PMID: 38594009 PMCID: PMC11003816 DOI: 10.1055/a-2291-9766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Ruide Liu
- Department of Gastroenterology and Hepatology & Digestive Endoscopy Medical Engineering Research Laboratory West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xianglei Yuan
- Department of Gastroenterology and Hepatology & Digestive Endoscopy Medical Engineering Research Laboratory West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia Liu
- Department of Gastroenterology and Hepatology & Digestive Endoscopy Medical Engineering Research Laboratory West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuang Liu
- Department of Gastroenterology and Hepatology & Digestive Endoscopy Medical Engineering Research Laboratory West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia Xie
- Department of Gastroenterology and Hepatology & Digestive Endoscopy Medical Engineering Research Laboratory West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology & Digestive Endoscopy Medical Engineering Research Laboratory West China Hospital, Sichuan University, Chengdu, Sichuan, China
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21
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Bering J, Batheja MJ, Abraham NS. Endoscopic Hemostasis and Antithrombotic Management. Gastroenterol Clin North Am 2024; 53:573-586. [PMID: 39489576 DOI: 10.1016/j.gtc.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Abstract
This review highlights the available literature for antithrombotic management and hemostasis techniques that can be leveraged when caring for patients on antithrombotic medications who may develop gastrointestinal bleeding (GIB). Risks of both index GIB as well as risk of recurrent GIB are reviewed with emphasis on the balance between therapeutic benefits and bleeding hazards that are inherent with these medications. For management of these complications, an in-depth review of the various endoscopic hemostasis techniques that can be utilized is also provided.
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Affiliation(s)
- Jamie Bering
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
| | - Mashal J Batheja
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Neena S Abraham
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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22
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Acehan F, Karsavuranoğlu B, Aslan M, Kalkan C, Sahiner ES, Inan O, Comoglu M, Yilmaz Y, Ates I. Improved outcomes in patients with non-variceal upper gastrointestinal bleeding while undergoing antithrombotic therapy: A propensity score matching analysis. Dig Liver Dis 2024; 56:1854-1862. [PMID: 38755023 DOI: 10.1016/j.dld.2024.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/22/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND This study sought to examine the effect of antithrombotic use on clinical outcomes in non-variceal upper gastrointestinal bleeding (UGIB). METHODS Patients consecutively diagnosed with non-variceal UGIB between February 2019 and September 2020 were divided into two groups based on their antithrombotic use: users and non-users. Using propensity score matching (PSM) and multivariable regression analyses, the impact of antithrombotic use prior to UGIB presentation on clinical outcomes was examined. RESULTS In the entire cohort, there were 210 and 260 patients in the antithrombotic user and non-user groups, respectively. Using PSM analysis with seven covariates, two matched groups of 157 patients were created at a 1:1 ratio. In the matched cohort, despite their longer hospital stays and a higher rate of intensive care unit admissions, the patients in the user group had lower 30- and 90-day mortality rates (4.5% vs. 14.0 %; p = 0.003 and 8.9% vs. 18.5 %; p = 0.014, respectively). In the entire cohort, multivariable analyses adjusted for confounding factors revealed that antithrombotic use was associated with lower risks of in-hospital (adjusted OR: 0.437; 95 % CI: 0.191-0.999), 30-day (adjusted OR: 0.261; 95 % CI: 0.099-0.689), and 90-day (adjusted OR: 0.386; 95 % CI: 0.182-0.821) mortality. CONCLUSION Antithrombotic use prior to UGIB presentation was found to be an independent protective factor for all-cause mortality.
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Affiliation(s)
- Fatih Acehan
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey.
| | | | - Meryem Aslan
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Cagdas Kalkan
- Department of Gastroenterology, Ankara City Hospital, Ankara, 06800, Turkey
| | - Enes Seyda Sahiner
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Osman Inan
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Mustafa Comoglu
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Yusufcan Yilmaz
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, 06800, Turkey
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23
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Nagpal P, Dane B, Aghayev A, Fowler KJ, Hedgire SS, Bartel TB, Cash BD, Collins JD, Kirsch DS, Lo HS, Pietryga JA, Ripley B, Santillan CS, Kim DH, Steigner ML. ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding: 2024 Update. J Am Coll Radiol 2024; 21:S433-S447. [PMID: 39488353 DOI: 10.1016/j.jacr.2024.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 08/31/2024] [Indexed: 11/04/2024]
Abstract
This document summarizes the relevant literature for the selection of the initial imaging in five clinical scenarios in patients with suspected or known nonvariceal upper gastrointestinal bleeding (UGIB). These clinical scenarios include suspected nonvariceal UGIB without endoscopy performed; endoscopically confirmed nonvariceal UGIB with clear source but treatment not possible or continued bleeding after endoscopic treatment; endoscopically confirmed nonvariceal UGIB without a confirmed source; suspected nonvariceal UGIB with negative endoscopy; and postsurgical or post-traumatic nonvariceal UGIB when endoscopy is contraindicated. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of nonvariceal UGIB. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Prashant Nagpal
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Bari Dane
- NYU Grossman School of Medicine, New York, New York
| | - Ayaz Aghayev
- Panel Chair, Brigham & Women's Hospital, Boston, Massachusetts
| | - Kathryn J Fowler
- Panel Chair, University of California San Diego, San Diego, California
| | - Sandeep S Hedgire
- Panel Vice-Chair, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Twyla B Bartel
- Global Advanced Imaging, PLLC, Little Rock, Arkansas; Commission on Nuclear Medicine and Molecular Imaging
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Jeremy D Collins
- Mayo Clinic, Rochester, Minnesota; Society for Cardiovascular Magnetic Resonance
| | | | - Hao S Lo
- UMass Memorial Health and UMass Chan Medical School, Worcester, Massachusetts; Committee on Emergency Radiology-GSER
| | - Jason A Pietryga
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Beth Ripley
- VA Puget Sound Health Care System and University of Washington, Seattle, Washington
| | | | - David H Kim
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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24
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Luo Q, Luo J, Luan Z, Xu K, Tian L, Zhang K, Peng X, Yuan M, Zheng C, Shu Z, Zhang Y, Tan S, Dan R, Mequanint K, Fan C, Xing M, Yang S. Blue Laser Triggered Hemostatic Peptide Hydrogel for Gastrointestinal Bleeding Treatment. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2405290. [PMID: 39011814 DOI: 10.1002/adma.202405290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/16/2024] [Indexed: 07/17/2024]
Abstract
In an emergency, nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic hemostasis is considered the gold standard intervention. However, current endoscopic hemostasis is very challenging to manage bleeding in large-diameter or deep lesions highly prone to rebleeding risk. Herein, a novel hemostatic peptide hydrogel (HPH) is reported, consisting of a self-assembly peptide sequence CFLIVIGSIIVPGDGVPGDG (PFV) and gelatin methacryloyl (GelMA), which can be triggered by blue laser endoscopy (BLE) for nonvariceal upper gastrointestinal bleeding treatment without recurring bleeding concerns. Upon contact with GelMA solution, PFV immediately fibrillates into β-sheet nanofiber and solvent-induced self-assembly to form HPH gel. HPH nanofiber networks induced ultrafast coagulation by enveloping blood cells and activating platelets and coagulation factors even to the blood with coagulopathy. Besides its remarkable hemostatic performance in artery and liver injury models, HPH achieves instant bleeding management in porcine NVUGIB models within 60 s by preventing the rebleeding risk. This work demonstrates an extraordinary hemostatic agent for NVUGIB intervention by BLE for the first time, broadening potential application scenarios, including patients with coagulopathy and promising clinical prospects.
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Affiliation(s)
- Qiang Luo
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Jie Luo
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Zhaohui Luan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Kaige Xu
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, R3T 2N2, Manitoba, Canada
| | - Lixing Tian
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Kebin Zhang
- Clinical Medical Research Center, Xinqiao Hospital, No.183, Xinqiao Street, Chongqing, 400037, China
| | - Xue Peng
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Mengxue Yuan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Chuanhao Zheng
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Zhenzhen Shu
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Yuchen Zhang
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Shali Tan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Ruijue Dan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Kibret Mequanint
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, London, N6A 5B9, Canada
| | - Chaoqiang Fan
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
| | - Malcolm Xing
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, R3T 2N2, Manitoba, Canada
| | - Shiming Yang
- Department of Gastroenterology, Xinqiao Hospital, No. 183, Xinqiao Street, Chongqing, 400037, China
- Chongqing Municipality Clinical Research Center for Gastroenterology, Chongqing, 400037, China
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25
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Yamaguchi A, Kamada H, Semba S, Kato N, Okuda Y, Teraoka Y, Mizumoto T, Tamaru Y, Hatakeyama T, Kouno H, Yoshida S. Effectiveness and safety of a new clip for delivery using a duodenoscope for bleeding after endoscopic sphincterotomy. Endosc Int Open 2024; 12:E1190-E1195. [PMID: 39411363 PMCID: PMC11479791 DOI: 10.1055/a-2420-2419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/06/2024] [Indexed: 10/19/2024] Open
Abstract
Background and study aims Hemostasis for post-endoscopic sphincterotomy (post-EST) bleeding involves no standard strategy. New clips designed for delivery using the duodenoscope (SureClip, Micro-Tech, Nanjing, China) have been utilized for gastrointestinal bleeding hemostasis and bleeding prevention after polypectomy and papillectomy. We retrospectively analyzed the effectiveness and safety of SureClip for post-EST bleeding. Patients and methods Of 608 patients with endoscopic sphincterotomy (EST), 41 cases (6.7%) experienced post-EST bleeding from 2019 to 2023. Of these patients, 24 underwent hemostasis by SureClip, and the success rate of complete hemostasis and complication by hemostasis by SureClip was analyzed. Results In 12 and 12 patients with urgent and delayed bleeding, 11 (91.7%) and 11 (91.7%) had successful hemostasis, respectively. In addition, missed patients achieved complete hemostasis with additional transcatheter arterial embolization and balloon compression, respectively. No complications were observed, including perforation, pancreatitis, and clipping bile duct and pancreatic duct by mistake. Conclusions Hemostasis with SureClip is safe, effective, and not expensive for post-EST bleeding. It could be the first choice for hemostasis in patients with post-EST bleeding refractory to balloon compression.
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Affiliation(s)
- Atsushi Yamaguchi
- Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Hiroki Kamada
- Endoscopy, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Shigeaki Semba
- Endoscopy, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Naohiro Kato
- Endoscopy, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Yasuhiro Okuda
- Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
- Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuji Teraoka
- Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Takeshi Mizumoto
- Endoscopy, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Yuzuru Tamaru
- Endoscopy, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | | | - Hirotaka Kouno
- Gastroenterology, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Shigeto Yoshida
- Endoscopy, Kure Medical Center and Chugoku Cancer Center, Kure, Japan
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Wang H, Tan YQ, Han P, Xu AH, Mu HL, Zhu Z, Ma L, Liu M, Xie HP. Left inferior phrenic arterial malformation mimicking gastric varices: A case report and review of literature. World J Gastrointest Surg 2024; 16:3057-3064. [PMID: 39351559 PMCID: PMC11438799 DOI: 10.4240/wjgs.v16.i9.3057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/08/2024] [Accepted: 08/16/2024] [Indexed: 09/18/2024] Open
Abstract
BACKGROUND Gastric submucosal arterial dilation resulting from splenic artery occlusion represents an exceedingly rare etiology of acute upper gastrointestinal bleeding (UGIB). Although endoscopy is a widely utilized diagnostic and therapeutic modality for gastrointestinal bleeding, it has limitations in detecting arterial abnormalities. CASE SUMMARY This report presents a rare case of massive UGIB in a 57-year-old male with a tortuous left inferior phrenic artery accompanied by splenic artery occlusion. "Gastric varices" was identified during the patient's endoscopy one year before hemorrhage. Despite initial hemostasis by endoscopic clipping, the patient experienced massive rebleeding after one month, requiring intervention with transcatheter arterial embolization (TAE) to achieve hemostasis. CONCLUSION This is the first case to report UGIB due to a tortuous left inferior phrenic artery. This case highlights the limitations of endoscopy in identifying arterial abnormalities and emphasizes the potential of TAE as a viable alternative for the management of arterial bleeding in the gastrointestinal tract.
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Affiliation(s)
- Han Wang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yi-Qing Tan
- Department of Radiology, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan University, Wuhan 430063, Hubei Province, China
| | - Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - An-Hui Xu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Han-Lin Mu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zhe Zhu
- Department of Pathology and Cell Biology, Columbia University Irving medical center, New York-Presbyterian Hospital, New York, NY 10065, United States
| | - Li Ma
- Department of Gastroenterology, Jianli People's Hospital, Jianli 433300, Hubei Province, China
| | - Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Hua-Ping Xie
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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27
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Lai Y, Jiang M, Zhang X, Zhang L, Chen Z, Du Y, Wang S, Zhao J, Li Z. Novel endoscopic tattooing dye based on polyvinylpyrrolidone-modified polydopamine nanoparticles for labeling gastrointestinal lesions. J Mater Chem B 2024; 12:9345-9356. [PMID: 39171740 DOI: 10.1039/d4tb01298d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Endoscopic tattooing is a localization technique that is particularly important for identifying gastrointestinal lesions for follow-up and subsequent treatment. However, the dyes currently used for endoscopic tattooing have a short tattooing time, high cost, and many side effects. Herein, we designed and prepared polydopamine (PDA) nanoparticles modified with polyvinylpyrrolidone (PVP) for endoscopic tattooing using a physical encapsulation method. PDA has good stability and high adhesion properties, and its stability was further enhanced after PVP modification. In vitro and in vivo tests demonstrated that PDA/PVP has good biosafety. Endoscopic tattooing with PDA/PVP in a porcine model showed that the dye could be stabilized in the digestive tract for at least 60 days. Furthermore, our research results demonstrated that PDA/PVP has excellent reactive oxygen species (ROS) and reactive nitrogen species (RNS) scavenging ability and can promote wound healing. Overall, the strategy proposed herein will lead to the use of an innovative dye for endoscopic tattooing of gastrointestinal lesions.
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Affiliation(s)
- Yongkang Lai
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
- Department of Gastroenterology, Ganzhou People's Hospital, Jiangxi Medical College, Nanchang University, Ganzhou 341000, China
| | - Mengni Jiang
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Xinyuan Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Liang Zhang
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Zheng Chen
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Yiqi Du
- Department of Gastroenterology, Shanghai Institute of Pancreatic Diseases, Changhai Hospital; National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai, China.
| | - Shige Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Jiulong Zhao
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
| | - Zhaoshen Li
- Department of Gastroenterology, Shanghai Changhai Hospital, Naval Medical University, Shanghai 200433, China.
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Maity R, Dhali A, Biswas J. Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding. World J Clin Cases 2024; 12:5462-5467. [PMID: 39188600 PMCID: PMC11269988 DOI: 10.12998/wjcc.v12.i24.5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/20/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common medical emergency in clinical practice. While the incidence has significantly reduced, the mortality rates have not undergone a similar reduction in the last few decades, thus presenting a significant challenge. This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis. Since ANUVGIB predominantly affects the elderly population, the impact of comorbidities may be responsible for the poor outcomes. A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly. Early risk stratification plays a crucial role in deciding the line of management and predicting mortality. Emerging scoring systems such as the ABC (age, blood tests, co-morbidities) score show promise in predicting mortality and guiding clinical decisions. While conventional endoscopic therapies remain cornerstone approaches, novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives, particularly in cases refractory to traditional modalities. By integrating validated scoring systems and leveraging novel therapeutic modalities, clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.
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Affiliation(s)
- Rick Maity
- General Medicine, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
| | - Arkadeep Dhali
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, United Kingdom
- School of Medicine and Population Health, University of Sheffield, Sheffield S102HQ, United Kingdom
| | - Jyotirmoy Biswas
- General Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India
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Jiang Y, Li Y, Xiong Z, Morelli JN, Shen Y, Hu X, Hu D, Li Z. Localization and etiological stratification of non-neoplastic small bowel bleeding via CT imaging: a 10-year study. Insights Imaging 2024; 15:189. [PMID: 39090483 PMCID: PMC11294299 DOI: 10.1186/s13244-024-01778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/10/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES The purpose of this study is to assess the diagnostic efficacy of contrast-enhanced CT scans for small bowel bleeding. METHODS This retrospective study evaluated patients diagnosed with non-neoplastic small intestinal bleeding (including duodenum) who underwent abdominal CT at our institution from December 2013 to March 2023. Patients were categorized into diverticulum and non-diverticulum groups based on the cause of bleeding. Active bleeding was defined on the CT images as extravasation of contrast material in the intestinal lumen during the arterial phase and/or progressive accumulation of contrast material during the venous phase. We have documented the original report (extracted from the medical record system and additional consultation opinions from senior radiologists), including the presence of active bleeding and its potential bleeding location. Furthermore, two radiologists reassessed the CT images, seeking consensus on the diagnosis between them. RESULTS The study included 165 patients, predominantly male, with a median age of 30 years. Active bleeding was identified in 48.3% of patients. Notably, all identified bleeding diverticula in the diverticulum group exhibited cul-de-sac termination. Among the identified causes of bleeding, Crohn's disease was most prevalent (46.7%, N of causes = 64). Significant differences were observed in the diagnostic methods between the diverticulum and non-diverticulum groups, with surgery predominantly applied in the diverticulum group, and endoscopy in the non-diverticulum group (n = 49 vs n = 15, p = 0.001). Contrast agent extravasation was significantly higher in the diverticulum group (n = 54 vs n = 16, p = 0.001), and Meckel's diverticulum cases appearing tubular were significantly higher than in other diverticulum cases (n = 25 vs n = 3, p < 0.001). CONCLUSION CT allows for a higher detection rate of diverticular bleeding, even if asymptomatic, guiding classification into multiple potentially clinically relevant categories. CRITICAL RELEVANCE STATEMENT Contrast-enhanced CT imaging is effective in determining the location and cause of non-neoplastic small bowel bleeding, especially diverticular bleeding. Therefore, the use of enhanced CT should be prioritized in the diagnosis and management of small bowel bleeding. KEY POINTS CT has potential value in the diagnosis of small bowel bleeding. CT imaging suggests possible surgical intervention for active bleeding detection. CT diagnoses and localizes small bowel bleeding, aiding in treatment and prioritizing in guidelines.
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Affiliation(s)
- Yuchen Jiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanqiu Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziman Xiong
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - John N Morelli
- Department of Radiology, St. John's Medical Center, Tulsa, OK, USA
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Karna R, Hans B, Nasereddin T, Chaudhary D, Dhawan M. Comparison of mechanical and thermal therapy in upper gastrointestinal bleeding: an analysis of efficacy outcomes. Proc AMIA Symp 2024; 37:734-741. [PMID: 39165805 PMCID: PMC11332638 DOI: 10.1080/08998280.2024.2381180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 08/22/2024] Open
Abstract
Background Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a complication of dual antiplatelet therapy (DAPT) and direct oral anticoagulant therapy (DOAC). There is a lack of data comparing mechanical therapy (clips) with thermal therapy in this population. Methods We conducted a retrospective chart review of patients undergoing urgent/emergent endoscopy for NVUGIB while being on DAPT or DOAC. Patients who had DAPT/DOAC held as per American Society of Gastrointestinal Endoscopy guidelines were excluded from the study. Results A total of 122 patients were included in the study. There was no difference in primary hemostasis, rebleeding rate, rescue hemostatic procedure, and 30-day mortality between the mechanical and thermal therapy groups. The mechanical therapy group had a significantly higher rate of prolonged length of stay (61.2% vs 38.9%, P = 0.02), serious clinical outcomes (56% vs 37.5%, P = 0.04), and intensive care unit admissions (50% vs 20.8%, P = 0.001) than the thermal therapy group. Conclusion Patients on DAPT/DOAC presenting with NVUGIB can undergo mechanical or thermal endoscopic intervention without a significant difference in achieving primary hemostasis, rebleeding, requiring a secondary procedure, or mortality outcomes.
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Affiliation(s)
- Rahul Karna
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Bandhul Hans
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Thayer Nasereddin
- Indianapolis Gastroenterology and Hepatology, Indianapolis, Indiana, USA
| | - Dhruv Chaudhary
- Division of Gastroenterology and Hepatology, Columbus, Georgia, USA
| | - Manish Dhawan
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Li XJ, Fung BM. Advancements in endoscopic hemostasis for non-variceal upper gastrointestinal bleeding. World J Gastrointest Endosc 2024; 16:376-384. [PMID: 39072248 PMCID: PMC11271718 DOI: 10.4253/wjge.v16.i7.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/06/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024] Open
Abstract
Non-variceal upper gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality. Traditionally, through-the-scope (TTS) clips, thermal therapy, and injection therapies are used to treat GI bleeding. In this review, we provide an overview of novel endoscopic treatments that can be used to achieve hemostasis. Specifically, we discuss the efficacy and applicability of over-the-scope clips, hemostatic agents, TTS doppler ultrasound, and endoscopic ultrasound, each of which offer an effective method of reducing rates of GI rebleeding.
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Affiliation(s)
- Xue Jing Li
- Department of Gastroenterology and Hepatology, Banner-University Medical Center Phoenix, Phoenix, AZ 85006, United States
| | - Brian M Fung
- Department of Gastroenterology, Arizona Digestive Health, Mesa, AZ 85210, United States
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Cui H, Gao Q, Zhao Z, Ma X. Upper gastrointestinal bleeding as a warning sign of gastrointestinal cancer. Prev Med Rep 2024; 43:102773. [PMID: 38883926 PMCID: PMC11176783 DOI: 10.1016/j.pmedr.2024.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
Background Upper gastrointestinal bleeding (UGIB) is a prevalent etiology for hospital admissions on a global scale. However, the significance of UGIB as a warning sign of gastrointestinal (GI) cancer is frequently disregarded due to its uncommon and atypical symptoms. Methods In the Kailuan study, participants diagnosed with UGIB were assigned as the case group and were randomly matched in a 1:4 ratio with a control group of comparable age and sex from 2006 to 2018 in Tangshan. The statistical analysis included a total of 1250 UGIB patients and 5000 individuals without UGIB. The impact of UGIB on cancer incidence was evaluated using a Cox proportional hazards model, enabling the investigation of both site-specific and time-dependent effects of UGIB on cancer incidence. Results The mean age of the patients was 60.91 ± 13.08 years. Over an average follow-up period of 8.92 years, there were 102 cases of cancer in the UGIB group and 210 cases in the non-UGIB group. The results of the Cox model analysis indicated that the strength of association between UGIB and cancer depends on specific cancer site. Excluding patients with follow-up periods of less than 1, 3, and 5 years weakened the associations between UGIB and GI cancer in sensitivity analysis. Conclusion UGIB may serve as a sign of occult cancer, necessitating thorough evaluation of middle-aged and elderly patients presenting with this warning symptom to detect the possibility of missing a cancer diagnosis.
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Affiliation(s)
- Haozhe Cui
- School of Medicine, Nankai University, Tianjin, China
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, China
| | - Qinglun Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhiming Zhao
- The Faculty of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiangming Ma
- Department of Hepatobiliary Surgery, Kailuan General Hospital, Tangshan, China
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Saha B, Danielson AP, Mundell WC. 49-Year-Old Man With Melena and Abdominal Pain. Mayo Clin Proc 2024; 99:992-996. [PMID: 38520448 DOI: 10.1016/j.mayocp.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 03/25/2024]
Affiliation(s)
- Bibek Saha
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Alex P Danielson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - William C Mundell
- Advisor to residents and Consultant in Hospital Internal Medicine, Mayo Clinic, Rochester, MN.
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Baş B, Küçükdemirci Ö, Ustaoglu M. Ankaferd blood stopper: A novel additional strategy for less experienced gastroenterologists in gastrointestinal bleeding treatment. Medicine (Baltimore) 2024; 103:e38319. [PMID: 39259086 PMCID: PMC11142764 DOI: 10.1097/md.0000000000038319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/04/2024] [Accepted: 05/01/2024] [Indexed: 09/12/2024] Open
Abstract
The Ankaferd Blood Stopper (ABS) proves effective in managing various bleedings, particularly in surgical and dental procedures. This study assesses ABS efficacy endoscopically by less-experienced endoscopists for non-variceal upper gastrointestinal bleeding (NVUGB). Between 2016 and 2021, our hospital's Gastroenterology Department Endoscopy Unit conducted a retrospective data analysis of 653 patients who underwent endoscopy for NVUGB. The study included 202 patients who underwent endoscopic interventions performed by endoscopists with less than 3 years of experience. Based on the method used for endoscopic hemostasis, we classified those treated with ABS (either alone or as a second method) as group 1. In contrast, we classified patients treated with non-ABS hemostatic methods into Group 2. The study included 202 patients, with 96 (47.52%) in Group 1 and 106 (52.48%) in Group 2. All patients in Group 1 achieved bleeding control, while 4 patients in Group 2 initially did not achieve bleeding control; however, bleeding control was subsequently established following ABS administration. After 1 month of follow-up, mortality occurred in 3 out of 202 patients (1.48%), and all these cases were in Group 2. There is a significant difference in the need for blood transfusion between the groups (P < .001). Regarding the bleeding source, bulbus ulcer and gastric cancer were more prevalent in Group 2. On the other hand, although statistical significance was not reached in the comparison of rebleeding rates between groups, numerically, a higher incidence of recurrent bleeding was observed in Group 2 (Group 1: 3 [3.1%], Group 2: 8 [7.5%]; P = .167). Additionally, a similar relationship was noted among intensive care admissions (Group 1: 5 [5.2%]; Group 2: 7 [6.6%]; P = .675). In the group that used ABS, there were significantly higher rates of hypotension, tachycardia, syncope, and the need for transfusion than in the other group. In medical practice, this distinction often stems from the shared preference of clinicians to use ABS as a salvage method in cases of more severe bleeding. Considering all the findings, it is evident that using ABS through endoscopy in cases of NVUGIB significantly improves procedural success, irrespective of the endoscopist's experience level.
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Affiliation(s)
- Berk Baş
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Ömer Küçükdemirci
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Müge Ustaoglu
- Department of Gastroenterology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
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Vimonsuntirungsri T, Thungsuk R, Nopjaroonsri P, Faknak N, Pittayanon R. The Efficacy of Metoclopramide for Gastric Visualization by Endoscopy in Patients With Active Upper Gastrointestinal Bleeding: Double-Blind Randomized Controlled Trial. Am J Gastroenterol 2024; 119:846-855. [PMID: 38059896 DOI: 10.14309/ajg.0000000000002620] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION The 2021 American College of Gastroenterology Guidelines suggested using of intravenous erythromycin before endoscopy in patients with upper gastrointestinal bleeding (UGIB) to enhance endoscopic view and reduce the need for repeat endoscopy. Evidence on intravenous metoclopramide, which is more accessible, is scant, especially in patients with active UGIB. This study aimed to evaluate the efficacy of metoclopramide for gastric visualization in patients with active UGIB. METHODS Between April 10, 2021, and October 8, 2022, this double-blind, double-center randomized controlled trial enrolled patients with active UGIB (hematemesis or presence of fresh blood in the nasogastric tube). The eligible patients were randomly assigned in a concealed 1:1 allocation to metoclopramide or placebo. The primary outcome was adequate visualization by objective endoscopic visualized gastroduodenal scores (EVS). Secondary outcomes included mean difference in EVS, duration of esophagogastroduodenoscopy (EGD), immediate hemostasis, need for a second look EGD, units of blood transfusion, length of hospital stay, and 30-day rebleeding rate. RESULTS Of the 68 eligible patients, 3 of each group were excluded by protocol violation. Finally, 62 patients (31 metoclopramide and 31 placebo) were analyzed. The percentage of patients with adequate visualization in metoclopramide and placebo group was 77.4% and 61.6% (odds ratio [OR] 2.16 [0.71-6.58], P = 0.16). The need for a second look EGD in the 72 hours was lower in the metoclopramide group (3.2% vs 22.6%, OR 0.11 [0.01-0.99], P = 0.02), whereas the other secondary outcomes were not different. However, in gastric lesions subgroup analysis, metoclopramide improved the adequate visualization rate (92.9% vs 50%, OR 13 [1.32-128.10], P = 0.03) and mean EVS at fundus (1.79 ± 0.42 vs 1.29 ± 0.72; P = 0.03). DISCUSSION Metoclopramide did not improve endoscopic visualization but decreased the need for second look EGD in patients with overall active UGIB. It improved gastric visualization in those with UGIB due to gastric lesions, primarily by improving visualization in the fundus ( ClinicalTrials.gov number NCT04771481).
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Affiliation(s)
- Thanrada Vimonsuntirungsri
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Natee Faknak
- Department of Medicine, Sawanpracharak Hospital, Nakhon Sawan, Thailand
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Kukeev I, Quint E, Sebbag G, Dukhno O. Left gastric artery embolization for recurrent massive intraluminal postoperative bleeding after revisional laparoscopic one anastomosis gastric bypass surgery. J Surg Case Rep 2024; 2024:rjae070. [PMID: 38706484 PMCID: PMC11068415 DOI: 10.1093/jscr/rjae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 05/07/2024] Open
Abstract
Laparoscopic one-anastomosis gastric bypass (LOAGB) has gained popularity as safe weight-reduction procedure. Bleeding is the common postoperative complication. We present a successful treatment of recurrent bleeding after LOAGB by embolization of the left gastric artery (LGA) and later development of necrotizing pancreatitis. A 41-year-old patient with previous bariatric surgeries undergone LOAGB surgery with development of massive intraluminal bleeding in the postoperative period. Attempts of unsuccessful endoscopic treatment were done and the bleeding was stopped by LGA embolization. In the post-embolization period, the patients developed necrotizing pancreatitis. Postoperative bleeding is the serious complications of the bariatric LOAGB procedure. Transcatheter Arterial Embolization (TAE) is the possible treatments after unsuccessful endoscopic attempts to stop the bleeding. The technical and clinical success rates of TAE in post-gastrectomy bleeding are 100 and 79%, respectively. TAE can be successfully used to stop obstinate recurrent postoperative bleeding after a LOAGB procedure.
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Affiliation(s)
- Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
| | - Oleg Dukhno
- Bariatric Surgery Unit, Department of General Surgery B, Soroka University Medical Center, Ben-Gurion University of the Negev, Yitzhack I. Rager Blvd 151, PO Box 151, Beer Sheva 84101, Israel
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Barannikov SV, Cherednikov EF, Polubkova GV, Vorontsov AK, Maleev YV, Bolkhovitinov AE, Prokhorov GV. First experience of using alginate polymer polysaccharide hemostatic hydrogel in complex endoscopic treatment of unstable gastroduodenal ulcer bleeding: Clinical cases. KUBAN SCIENTIFIC MEDICAL BULLETIN 2024; 31:73-92. [DOI: 10.25207/1608-6228-2024-31-3-73-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
Background. Gastroduodenal ulcer bleeding continues to be a serious problem in modern emergency surgery. Early intensive therapy combined with endoscopic hemostasis remains crucial for successful treatment of patients with ulcerative hemorrhages. The problem of recurrent bleeding, which is recorded in 12–33% of cases, even when using combined methods of endoscopic hemostasis, is still the most difficult challenge in the treatment of patients with ulcerative bleeding. The search for new approaches in the endoscopic treatment of bleeding gastroduodenal ulcers is considered to be highly relevant.Description of clinical cases. The present paper describes the experience of using an alginate polymer polysaccharide hemostatic hydrogel in the complex treatment of two patients with unstable bleeding from duodenal ulcers. Patient B., 70 years old, with severe somatic pathology and a history of ulcers for 20 years, was admitted to the Voronezh City Clinical Emergency Hospital No. 1 with gastroduodenal ulcer bleeding. According to urgent esophagogastroduodenoscopy, the patient was diagnosed with a bleeding ulcer of the anterior wall of the duodenum with unstable bleeding (Forrest IIA). A large thrombosed vessel 2 mm in diameter was detected in the ulcer base. Patient K., 50 years old, suffering from type II diabetes mellitus for 4 years, was admitted to an emergency hospital with Forrest IIB bleeding from an extensive ulcerative defect of the duodenum. The complex treatment of patients involved a personalized approach using an alginate polymer polysaccharide hemostatic hydrogel during therapeutic endoscopy. After applying a powdered alginate hemostatic agent, a transparent hydrogel tightly fixed to the ulcer was formed on the surface of the ulcerative defect, which remained on the surface of the defect for up to 3–4 days and provided a prolonged hemostatic effect without any damaging effect on the ulcer and the surrounding mucous membrane of the duodenum. Transendoscopic application of an alginate polymer polysaccharide hemostatic hydrogel on the surface of a bleeding ulcer in the complex treatment of unstable ulcer bleeding prevented recurrent bleeding and ensured proper healing of the ulcer defect, thereby improving treatment results for patients with complicated peptic ulcer disease.Conclusion. Clinical observations have shown that the use of alginate polymer polysaccharide hemostatic hydrogels in combined endoscopic treatment of unstable gastroduodenal ulcer bleeding reliably prevents recurrence of hemorrhage, stabilizes the condition of patients in the early stages, improves the quality of healing of a bleeding ulcerative defect, thereby suggesting the prospects of use of this hemostatic in the treatment of gastroduodenal ulcer bleeding. However, the present paper describes only the first experience of the clinical use of hemostatic alginate polymer polysaccharide hemostatic hydrogel, which is to be analyzed in more details on a larger sample of patients.
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Abe H, Tarasawa K, Hatta W, Koike T, Sato I, Ono Y, Ogata Y, Saito M, Jin X, Kanno T, Uno K, Asano N, Imatani A, Fujimori K, Fushimi K, Masamune A. Similar Effect of Vonoprazan and Oral Proton Pump Inhibitors for Preventing Rebleeding in Cases of Upper Gastrointestinal Bleeding. Intern Med 2024; 63:911-918. [PMID: 37558479 PMCID: PMC11045377 DOI: 10.2169/internalmedicine.2211-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
Objective The use of a proton pump inhibitor (PPI) reduces rebleeding and mortality in patients with upper gastrointestinal bleeding (UGIB). Vonoprazan is a novel oral agent with strong and sustained acid-inhibitory activity. We clarified the effect of vonoprazan compared with oral PPIs in such patients. Methods We analyzed the Diagnosis Procedure Combination database. The primary outcome was rebleeding, and secondary outcomes were in-hospital mortality and in-hospital mortality after rebleeding. Propensity score matching was performed to balance the comparison groups, and logistic regression analyses were used to compare the outcomes between vonoprazan and oral PPIs. Patients Patients on vonoprazan or oral PPIs who underwent endoscopic hemostasis for UGIB between 2014 and 2019 were included. Results We enrolled 78,964 patients, of whom 27,101 and 51,863 were prescribed vonoprazan and a PPI, respectively. After propensity score matching, the rebleeding rate of vonoprazan did not significantly differ from that of oral PPIs [6.4% vs. 6.1%; odds ratio (OR), 1.05; 95% confidence interval (CI), 0.98-1.13]; similarly, the in-hospital mortality rate (1.4% vs. 1.5%; OR, 0.91; 95% CI, 0.79-1.05) and in-hospital mortality after rebleeding (0.3% vs. 0.2%; OR, 1.09; 95% CI, 0.78-1.54) also did not significantly differ between the groups. The acquired findings were robust across dose-restricted analyses and several sensitivity analyses. Conclusion Rebleeding and in-hospital mortality risks in patients on vonoprazan were similar to those in patients on oral PPIs. Considering the higher cost of vonoprazan, oral PPIs might be an optimal oral agent as an acid-suppressive therapy in such patients.
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Affiliation(s)
- Hiroko Abe
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Isao Sato
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Yoshitaka Ono
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
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Wang J, Peng X, Ye Z, He S, Liu L, Luo Y, Lv N, Shu X, Zhu Z. Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers). Surg Endosc 2024; 38:1791-1806. [PMID: 38291159 DOI: 10.1007/s00464-024-10679-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Currently, there is no clear consensus on whether medical treatment or endoscopic treatment should be used for peptic ulcer bleeding patients with adherent clot. The aim of this study is to investigate the hemostatic effects of medical treatment, single endoscopic treatment, and combination endoscopic treatment for peptic ulcer bleeding (PUB) patients with adherent clot. METHODS We retrospectively analyzed PUB patients with adherent clot who underwent endoscopic examination or treatment in our center from March 2014 to January 2023 and received intravenous administration of proton pump inhibitors. Patients were divided into medical treatment (MT) group, single endoscopic treatment (ST) group, and combined endoscopic treatment (CT) group. Subsequently, inverse probability of treatment weighting (IPTW) was performed to calculate the rebleeding rate. RESULTS A total of 605 eligible patients were included in this study. After IPTW, the rebleeding rate in the MT group on days 3, 7, 14, and 30 were 13.3 (7.3), 14.2 (7.8), 14.5 (7.9), and 14.5 (7.9), respectively; the rebleeding rates in the ST group were 17.4 (5.1), 20.8 (6.1), 20.8 (6.1), and 20.8 (6.1), respectively; the rebleeding rates in the CT group were 0.4 (0.9), 1.7 (3.3), 2.3 (4.5), and 2.3 (4.5), respectively. Although the rebleeding rate in the medical treatment group was higher, there was no significant difference among the three groups on days 3, 7, 14, and 30 (P = 0.132, 0.442, 0.552, and 0.552). CONCLUSIONS Medical therapy has similar hemostatic efficacy with endoscopic treatment for PUB patients with adherent clot (FIIb ulcers). However, for patients with more risk factors and access to well-equipped endoscopy centers, endoscopic treatment may be considered. The choice of treatment approach should be based on the individual conditions of the patient, as well as other factors such as medical resources available.
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Affiliation(s)
- Jingsong Wang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Xiang Peng
- Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhen Ye
- Department of Postgraduate, Jiangxi University of Traditional Chinese Medicine, Nanchang, 330004, Jiangxi, China
| | - Shan He
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Linlin Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Yixing Luo
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Nonghua Lv
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Zhenhua Zhu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Gaoxin Branch, Nanchang, 330096, Jiangxi, China.
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Vakil N. Endoscopic Diagnosis, Grading, and Treatment of Bleeding Peptic Ulcer Disease. Gastrointest Endosc Clin N Am 2024; 34:217-229. [PMID: 38395480 DOI: 10.1016/j.giec.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Peptic ulcer bleeding is a major cause for hospital admissions and has a significant mortality. Endoscopic interventions reduce the risk of rebleeding in high-risk patients and several options are available including injection therapies, thermal therapies, mechanical clips, hemostatic sprays, and endoscopic suturing. Proton-pump inhibitors and Helicobacter pylori treatment are important adjuncts to endoscopic therapy. Endoscopic therapy is indicated in Forrest 1a, 1b, and 2a lesions. Patients with Forrest 2b lesions may do well with proton-pump inhibitor therapy alone but can also be managed by removal of the clot and targeting endoscopic therapy to the underlying lesion.
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Affiliation(s)
- Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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41
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Manupeeraphant P, Wanichagool D, Songlin T, Thanathanee P, Chalermsuksant N, Techathuvanan K, Sethasine S. Intravenous metoclopramide for increasing endoscopic mucosal visualization in patients with acute upper gastrointestinal bleeding: a multicenter, randomized, double-blind, controlled trial. Sci Rep 2024; 14:7598. [PMID: 38556533 PMCID: PMC10982284 DOI: 10.1038/s41598-024-57913-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/22/2024] [Indexed: 04/02/2024] Open
Abstract
Acute upper gastrointestinal hemorrhage (UGIH) is the most common emergency condition that requires rapid endoscopic treatment. This study aimed to evaluate the effects of pre-endoscopic intravenous metoclopramide on endoscopic mucosal visualization (EMV) in patients with acute UGIH. This was a multicenter, randomized, double-blind controlled trial of participants diagnosed with acute UGIH. All participants underwent esophagogastroduodenoscopy within 24 h. Participants were assigned to either the metoclopramide or placebo group. Modified Avgerinos scores were evaluated during endoscopy. In total, 284 out of 300 patients completed the per-protocol procedure. The mean age was 62.8 ± 14.3 years, and 67.6% were men. Metoclopramide group achieved a higher total EMV and gastric body EMV score than the other group (7.34 ± 1.1 vs 6.94 ± 1.6; P = 0.017 and 1.80 ± 0.4 vs 1.64 ± 0.6; P = 0.006, respectively). Success in identifying lesions was not different between the groups (96.5% in metoclopramide and 93.6% in placebo group; P = 0.26). In the metoclopramide group, those with active variceal bleeding compared with the control group demonstrated substantial improvements in gastric EMV (1.83 ± 0.4 vs 1.28 ± 0.8, P = 0.004), antral EMV (1.96 ± 0.2 vs 1.56 ± 0.6, P = 0.003), and total EMV score (7.48 ± 1.1 vs 6.2 ± 2.3, P = 0.02). Pre-endoscopic intravenous metoclopramide improved the quality of EMV in variceal etiologies of UGIH, which was especially prominent in those who had signs of active bleeding based on nasogastric tube assessment.Trial Registration: Trial was registered in Clinical Trials: TCTR 20210708004 (08/07/2021).
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Affiliation(s)
- Paveeyada Manupeeraphant
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Dhanusorn Wanichagool
- Division of Gastroenterology, Phra Nakhon Si Ayutthaya Hospital, Ayutthaya, Thailand
| | - Thaphat Songlin
- Division of Gastroenterology, Panyananthaphikkhu Chonprathan Medical Center, Nonthaburi, Thailand
| | - Piyarat Thanathanee
- Division of Gastroenterology, Banphaeo General Hospital, Samut Sakhon, Thailand
| | - Nalerdon Chalermsuksant
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Karjpong Techathuvanan
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand
| | - Supatsri Sethasine
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, 681 Samsen Road, Dusit District, Bangkok, 10300, Thailand.
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42
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Toro Tole D, Maurel A, Hedger J, Kwan S, Weber D. A systematic review of failed endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding. J Gastrointest Surg 2024; 28:309-315. [PMID: 38446116 DOI: 10.1016/j.gassur.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a surgical emergency, usually managed via endoscopy. Approximately 2% of patients will have another significant bleed after therapeutic endoscopy and may require either transarterial embolization (TAE) or surgery. In 2011, the National Institute for Health and Care Excellence guidelines recommended that TAE should be the preferred option offered in this setting. METHODS This study aimed to conduct an appraisal of guidelines on NVUGIB using the Appraisal of Guidelines for Research and Evaluation II tool. A specific review of their recommendations on the management of adult patients with failed endoscopic hemostasis that required TAE or surgery was conducted. RESULTS The quality of the guidelines was moderate; most could be recommended with changes. However, their recommendations regarding TAE vs surgery were widely heterogeneous. A closer review of the underpinning evidence showed that most studies were retrospective, with a small sample size and missing data. CONCLUSION Because of the heterogeneity in evidence, the decision regarding TAE vs surgery requires further research. Deciding between these modalities is primarily based on TAE availability and patient comorbidities. However, surgery should not be dismissed as a key option after failed endoscopic hemostasis.
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Affiliation(s)
- David Toro Tole
- Department of Surgery, Royal Darwin Hospital, Darwin, Australia.
| | - Amelie Maurel
- Department of Surgery, Royal Darwin Hospital, Darwin, Australia
| | - Joe Hedger
- School of Medicine, Flinders University, Darwin, Australia.
| | - Sherman Kwan
- Department of Surgery, Royal Perth Hospital, Perth, Australia
| | - Dieter Weber
- Department of Surgery, Royal Perth Hospital, Perth, Australia
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43
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Ito N, Funasaka K, Fujiyoshi T, Nishida K, Satta Y, Furukawa K, Kakushima N, Furune S, Ishikawa E, Mizutani Y, Sawada T, Maeda K, Ishikawa T, Yamamura T, Ohno E, Nakamura M, Miyahara R, Sasaki Y, Haruta JI, Fujishiro M, Kawashima H. Risk factors for rebleeding in gastroduodenal ulcers. Ir J Med Sci 2024; 193:173-179. [PMID: 37432526 DOI: 10.1007/s11845-023-03450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers. AIMS The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding. METHODS We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods. RESULTS Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2 mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786-0.870). CONCLUSIONS Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2 mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.
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Affiliation(s)
- Nobuhito Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Toshihisa Fujiyoshi
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Kazuki Nishida
- Department of Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Aichi, Japan
| | | | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Naomi Kakushima
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Furune
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, 1-98 Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | | | - Jun-Ichi Haruta
- Department of Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Acehan F, Karsavuranoğlu B, Kalkan C, Aslan M, Altiparmak E, Ates I. Three Simple Parameters on Admission to the Emergency Department are Predictors for Endoscopic Intervention in Patients with Suspected Nonvariceal Upper Gastrointestinal Bleeding. J Emerg Med 2024; 66:64-73. [PMID: 38267298 DOI: 10.1016/j.jemermed.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/31/2023] [Accepted: 08/31/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND A considerable number of patients with nonvariceal upper gastrointestinal bleeding (UGIB) need endoscopic intervention. OBJECTIVE The aim of this study was to determine factors that predict the need for endoscopic intervention at the time of admission to the emergency department. METHODS Consecutive patients with International Classification of Diseases, Tenth Revision diagnosis code K92.2 (gastrointestinal hemorrhage) who underwent upper endoscopy between February 2019 and February 2022, including patients diagnosed with nonvariceal UGIB in the emergency department in the study were reviewed retrospectively. The patients were divided into two groups: those treated endoscopically and those not treated endoscopically. These two groups were compared according to clinical and laboratory findings at admission and independent predictors for endoscopic intervention were determined using multivariate regression analysis. RESULTS Although 123 patients (30.3%) were treated endoscopically, endoscopic treatment was not required in 283 (69.7%) patients. Syncope, mean arterial pressure (MAP), and blood urea nitrogen (BUN) at admission were independent predictors for endoscopic intervention in the multivariate analysis, after adjusting for endoscopy time. The area under the curve of the syncope+MAP+BUN combination for endoscopic intervention was 0.648 (95% CI 0.588-0.708). Although the syncope+MAP+BUN combination predicted the need for intervention significantly better than pre-endoscopy Rockall and AIMS65 scores (p = 0.010 and p < 0.001, respectively), there was no significant difference in its comparison with the Glasgow-Blatchford score (p = 0.103). CONCLUSIONS Syncope, MAP, and BUN at admission were independent predictors for endoscopic therapy in patients with nonvariceal UGIB. Rather than using complicated scores, it would be more practical and easier to predict the need for endoscopic intervention with these three simple parameters, which are included in the Glasgow-Blatchford score.
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Affiliation(s)
- Fatih Acehan
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey.
| | | | - Cagdas Kalkan
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Meryem Aslan
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Emin Altiparmak
- Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Ihsan Ates
- Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
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Pittayanon R, Barkun A. Reply. Gastroenterology 2024; 166:226-227. [PMID: 37866764 DOI: 10.1053/j.gastro.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Alan Barkun
- Division of Gastroenterology, McGill University and McGill University Health Center, Montreal, Quebec, Canada
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Gupta S, Anirvan P, Panigrahi MK. Use of Hemospray for Management of Malignant Gastrointestinal Bleeding: Game-Changing Strategy or Just Another Red Herring? Gastroenterology 2024; 166:225-226. [PMID: 37734422 DOI: 10.1053/j.gastro.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Shubham Gupta
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prajna Anirvan
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Ramai D, Deliwala SS, Mozell D, Facciorusso A, Chandan S, Persaud A, Singh K, Anderloni A, Barakat MT. Adverse Events of Endoscopic Clip Placement: A MAUDE Database Analysis. J Clin Gastroenterol 2024; 58:76-79. [PMID: 36728443 DOI: 10.1097/mcg.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/22/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Clips are endoscopic mechanical devices with tensile and closure strength that can approximate tissue and provide hemostasis through a tamponade effect. Clips are ubiquitously used in endoscopic practice, and numerous studies have validated the clinical efficacy of clips, with recent guidelines recommending them as a first-line intervention for recurrent and persistent nonvariceal gastrointestinal bleeding. However, the safety profile for these devices has yet to be delineated, thus, we aim to investigate this feature by examining the adverse events reported to the Food and Drug Administration. METHODS Postmarketing surveillance data from the Food and Drug Administration Manufacturer And User Facility Device Experience database were analyzed from January 2012 to January 2021. The Manufacturer And User Facility Device Experience database is a reporting software and does not independently verify the details of complications. RESULTS Two thousand five hundred forty reports were issued, of which 287 were patient adverse events and 2766 were device problems. Activation, separation, and positioning issues were most common. No consequences or clinically significant impact on patients were seen in 1968 reports. Foreign bodies were seen in 97 cases, hemorrhage in 57 cases, tissue damage in 42 cases, embedded clips in tissues/plaques in 16 cases, perforation in 15 cases, lacerations in 6 cases, and infection in 3 cases. CONCLUSIONS While the most commonly reported device problems involved activation, separation, and positioning, most patients were clinically unaffected. Moreover, perforation and infection were exceedingly rare, further highlighting the safety profile of endoscopic clips.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology, Hepatology, and Nutrition, University of Utah Health, Salt Lake City, UT
| | - Smit S Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI
| | - Daniel Mozell
- Department of Internal Medicine, Elmhurst Hospital, Elmhurst
| | - Antonio Facciorusso
- Department of Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, NE
| | - Alana Persaud
- Division of Gastroenterology and Hepatology, SUNY Downstate, NY
| | - Kelita Singh
- Division of Gastroenterology, Stanford University, CA
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Humanitas Clinical, and Research Center - IRCCS, Milano, Italy
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Huang J, Liao F, Tang J, Shu X. Development of a model for predicting acute cerebral infarction induced by non-variceal upper gastrointestinal bleeding. Clin Neurol Neurosurg 2023; 235:107992. [PMID: 37944305 DOI: 10.1016/j.clineuro.2023.107992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/04/2023] [Accepted: 09/26/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the risk factors for acute cerebral infarction(ACI) in patients with non-variceal upper gastrointestinal bleeding(NVUGIB), and construct a model for predicting ACI in NVUGIB patients. METHODS A model for predicting ACI induced by NVUGIB was established on the basis of a retrospective study that involved 1282 patients who were diagnosed with NVUGIB in the emergency department and Gastroenterology Department of Nanchang University Affiliated Ganzhou Hospital from January 2019 to December 2021. Receiver operating characteristic (ROC) curves were drawn to evaluate the sensitivity and specificity of the model and CHA2DS2-VASc score to predict ACI. Delong's test was used to compare AUCs of the present score and the CHA2DS2-VASc score. RESULTS There were 1282 patients enrolled in the study, including 69 in the ACI group and 1213 in the non-ACI group. Multivariate analysis revealed that hypertension, diabetes, red blood cell (RBC) transfusion, mechanical ventilation, D-dimer, rate pressure product (RPP), somatostatin and mean platelet volume (MPV) were factors associated with ACI induced by NVUGIB. A model based on the eight factors was established, Logit(P)= 0.265 + 1.382 × 1 + 1.120 × 2 + 1.769 × 3 + 0.839 × 4-1.549 × 5-0.361 × 6 + 0.045 × 7 + 1.158 × 8(or 1.069 ×9) (X1, hypertension=1; X2, diabetes=1; X3, RBC transfusion=1; X4, mechanical ventilation=1; X5, somatostatin=1; X6, MPV(fL); X7, D-dimer(ng/l); X8, low RPP= 1; X9, high RPP = 2). The area under ROC curve of the model was 0.873, the sensitivity and specificity were 0.768 and 0.887, respectively. The area under ROC curve of CHA2DS2-VASc score was 0.792, the sensitivity and specificity were 0.728 and 0.716, respectively. Delong's test showed the area under ROC curve of the present study was significantly larger than that of CHA2DS2-VASc score. CONCLUSIONS Hypertension, diabetes, RBC transfusion, mechanical ventilation, D-dimer, RPP, somatostatin and MPV were factors associated with ACI induced by NVUGIB. A model constructed based on these factors showed excellent prediction of ACI, and was superior to CHA2DS2-VASc score. However, this needs to be further validated by multi-center study with a larger sample size.
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Affiliation(s)
- Jiaming Huang
- Department of Gastroenterology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou, Jiangxi 341000, China
| | - Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Jianhua Tang
- Department of Gastroenterology, Nanchang University Affiliated Ganzhou Hospital, Ganzhou, Jiangxi 341000, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
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Kozarek RA. DDS Perspective: If Gastroenterology Were a Dog, Would Endoscopy Be Its Tail? Has Therapeutic GI Endoscopy Learned to Wag the Dog? Dig Dis Sci 2023; 68:4297-4300. [PMID: 37798571 DOI: 10.1007/s10620-023-08115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Richard A Kozarek
- Emeritus Executive Director, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave, Seattle, WA, 98101, USA.
- Clinical Investigator, Center for Interventional Immunology, Benaroya Research Institute, 1201 Ninth Ave, Seattle, WA, 98101, USA.
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50
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Guo H, Stach J, Belletrutti PJ. A Rare Cause of Life-Threatening Upper Gastrointestinal Bleeding. Gastroenterology 2023; 165:1118-1121. [PMID: 37245591 DOI: 10.1053/j.gastro.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Howard Guo
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jesse Stach
- Department of Medicine, Section of Gastroenterology and General Internal Medicine, Medicine Hat Regional Hospital, Medicine Hat, Alberta, Canada
| | - Paul J Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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