scholarly journals Novel hemostatic adhesive powder for nonvariceal upper gastrointestinal bleeding

2019 ◽  
Vol 07 (12) ◽  
pp. E1763-E1767
Author(s):  
Jin-Seok Park ◽  
Hyung Kil Kim ◽  
Yong Woon Shin ◽  
Kye Sook Kwon ◽  
Don Haeng Lee
Keyword(s):  
Gastrointestinal Bleeding ◽  
Success Rate ◽  
Medical Records ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Bleeding Site ◽  
Success Rates ◽  
Main Study ◽  
Rebleeding Rate ◽  
Upper Gastrointestinal

Abstract Background and study aims A new hemostatic adhesive powder (UI-EWD) was developed to reduce high rebleeding rates and technical challenges associated with application of currently available hemostatic powders. The aim of the current study was to assess performance of UI-EWD for nonvariceal upper gastrointestinal bleeding (NVUGIB). Patients and methods A total of 56 consecutive patients that received UI-EWD monotherapy for endoscopic hemostasis due to NVUGIB were retrospectively reviewed. Main study outcomes were success rates with immediate hemostasis and rebleeding within 30 days. Outcomes were analyzed by reviewing patient medical records. Results Etiologies of bleeding were: post-endoscopic therapy bleeding in 46 (82.1 %), peptic ulcer in 8 (14.3 %), tumor in 1 (1.8 %), and other in 1 (1.8 %). UI-EWD was successfully applied at bleeding site in all cases. The success rate of immediate hemostasis was 96.4 % (54/56), and the 30-day rebleeding rate among patients that achieved immediate hemostasis was 3.7 % (2/54). No adverse event related to use of UI-EWD occurred. Conclusion UI-EWD was found to have a high immediate hemostasis success rate in NVUGIB when used as monotherapy and showed promising results in terms of preventing rebleeding.

Efficacy of a novel hemostatic adhesive powder in patients with refractory upper gastrointestinal bleeding: a pilot study

Endoscopy ◽  
2019 ◽  
Vol 51 (05) ◽  
pp. 458-462 ◽  
Author(s):  
Jin-Seok Park ◽  
Byung Wook Bang ◽  
Su Jin Hong ◽  
Eunhye Lee ◽  
Kye Sook Kwon ◽  
...  
Keyword(s):  
Pilot Study ◽  
Gastrointestinal Bleeding ◽  
Success Rate ◽  
Salvage Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
High Success Rate ◽  
Bleeding Site ◽  
Endoscopic Procedures ◽  
Upper Gastrointestinal

Abstract Background A new hemostatic adhesive powder (UI-EWD) has been developed to reduce the high re-bleeding rates associated with the currently available hemostatic powders. The current study aimed to assess the efficacy of UI-EWD as a salvage therapy for the treatment of refractory upper gastrointestinal bleeding (UGIB). Methods A total of 17 consecutive patients who had failed to achieve hemostasis with conventional endoscopic procedures and had undergone treatment with UI-EWD for endoscopic hemostasis in refractory UGIB were prospectively enrolled in the study. We evaluated the success rate of initial hemostasis and rate of re-bleeding within 30 days. Results All patients underwent successful UI-EWD application at the bleeding site. Initial hemostasis occurred in 16/17 patients (94 %). Re-bleeding within 30 days occurred in 3/16 patients (19 %) who had achieved initial hemostasis. In the second-look endoscopy after 24 hours, hydrogel from UI-EWD was found attached at the bleeding site in 11/16 patients (69 %). Conclusion UI-EWD has a high success rate for initial hemostasis in refractory UGIB and shows promising results in the prevention of re-bleeding.

scholarly journals Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jongbeom Shin ◽  
Boram Cha ◽  
Jin-Seok Park ◽  
Weonjin Ko ◽  
Kye Sook Kwon ◽  
...  
Keyword(s):  
Success Rate ◽  
Salvage Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Effective Control ◽  
Success Rates ◽  
Gastrointestinal Tumor ◽  
Bleeding Rate ◽  
Tumor Bleeding ◽  
Hemostatic Powder ◽  
Upper Gastrointestinal

Abstract Background Gastrointestinal tumor bleeding remains a clinical challenge because it is difficult to treat with conventional endoscopic hemostatic options. Recently, an endoscopic hemostatic powder (UI-EWD) was developed and reported to provide effective control of upper gastrointestinal bleeding. The aim of current study was to evaluate the feasibility and efficacy of this novel hemostatic powder in tumor bleeding. Methods A total of 41 consecutive patients with upper gastrointestinal tumor bleeding were included. UI-EWD was applied in all patients as an auxiliary hemostatic method as a salvage therapy or monotherapy during endoscopic treatment. Hemostasis success rates, adverse event related to UI-EWD, and rates of re-bleeding were evaluated. Results In all cases, UI-EWD application was successful at tumor bleeding sites. Immediate hemostasis occurred in 40/41 (97.5%) patients, and re-bleeding within 28 days occurred in 10 of 40 (22.5%) patients that achieved initial hemostasis. The success rate of immediate hemostasis for UI-EWD monotherapy was 100% (23/23). The re-bleeding rate at 28 days after UI-EWD monotherapy was 26.1% (6/23). No adverse events associated with UI-EWD application were encountered. Conclusions The success rate of UI-EWD for immediate hemostasis in cases of GI tumor bleeding was excellent and UI-EWD produced promising results with respect to the prevention of re-bleeding. Based on these results, we suggest that UI-EWD be considered an effective salvage therapy or even monotherapy for GI tumor bleeding.

scholarly journals Management of acute upper gastrointestinal bleeding

BMJ ◽  
2019 ◽  
pp. l536 ◽  
Author(s):  
Adrian J Stanley ◽  
Loren Laine
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Variceal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Ulcer Bleeding ◽  
Vasoactive Drugs ◽  
Upper Gastrointestinal

Abstract Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with a reported mortality of 2-10%. Patients identified as being at very low risk of either needing an intervention or death can be managed as outpatients. For all other patients, intravenous fluids as needed for resuscitation and red cell transfusion at a hemoglobin threshold of 70-80 g/L are recommended. After resuscitation is initiated, proton pump inhibitors (PPIs) and the prokinetic agent erythromycin may be administered, with antibiotics and vasoactive drugs recommended in patients who have cirrhosis. Endoscopy should be undertaken within 24 hours, with earlier endoscopy considered after resuscitation in patients at high risk, such as those with hemodynamic instability. Endoscopic treatment is used for variceal bleeding (for example, ligation for esophageal varices and tissue glue for gastric varices) and for high risk non-variceal bleeding (for example, injection, thermal probes, or clips for lesions with active bleeding or non-bleeding visible vessel). Patients who require endoscopic therapy for ulcer bleeding should receive high dose proton pump inhibitors after endoscopy, whereas those who have variceal bleeding should continue taking antibiotics and vasoactive drugs. Recurrent ulcer bleeding is treated with repeat endoscopic therapy, with subsequent bleeding managed by interventional radiology or surgery. Recurrent variceal bleeding is generally treated with transjugular intrahepatic portosystemic shunt. In patients who require antithrombotic agents, outcomes appear to be better when these drugs are reintroduced early.

scholarly journals Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Gut ◽  
2018 ◽  
Vol 67 (10) ◽  
pp. 1757-1768 ◽  
Author(s):  
Joseph JY Sung ◽  
Philip WY Chiu ◽  
Francis K L Chan ◽  
James YW Lau ◽  
Khean-lee Goh ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Working Group ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Asia Pacific ◽  
Endoscopic Management ◽  
Three Stages ◽  
Upper Gastrointestinal

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the ’gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.

scholarly journals Comparing the performance of the ABC, AIMS65, GBS, and pRS scores in predicting 90-day mortality or rebleeding among emergency department patients with acute upper gastrointestinal bleeding: A prospective multicenter study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shuang Liu ◽  
Xiaoming Zhang ◽  
Joseph Harold Walline ◽  
Xuezhong Yu ◽  
Huadong Zhu
Keyword(s):  
Gastrointestinal Bleeding ◽  
Multicenter Study ◽  
Upper Gastrointestinal Bleeding ◽  
Characteristic Curve ◽  
Prospective Multicenter Study ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Tertiary Hospitals ◽  
Rebleeding Rate ◽  
Emergency Department Patients ◽  
Upper Gastrointestinal

Abstract Background and Objectives Acute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB. Methods This was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding. Results Among the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675–0.768; P<0.001) and 0.711 (95% CI 0.663–0.757; P<0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624–0.721; P<0.001) and GBS (AUC, 0.624; 95% CI, 0.569–0.679; P<0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70. Conclusion In patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.

scholarly journals Increasing the low-risk threshold for patients with upper gastrointestinal bleeding during the COVID-19 pandemic: a prospective, multicentre feasibility study

2021 ◽  
pp. flgastro-2021-101851
Author(s):  
Philip Dunne ◽  
Victoria Livie ◽  
Aaron McGowan ◽  
Wilson Siu ◽  
Sardar Chaudhary ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Low Risk ◽  
Descriptive Data ◽  
Risk Threshold ◽  
All Cause Mortality ◽  
Risk Patients ◽  
Rebleeding Rate ◽  
Upper Gastrointestinal ◽  
Related Mortality

ObjectiveDuring the COVID-19 pandemic, we extended the low-risk threshold for patients not requiring inpatient endoscopy for upper gastrointestinal bleeding (UGIB) from Glasgow Blatchford Score (GBS) 0–1 to GBS 0–3. We studied the safety and efficacy of this change.MethodsBetween 1 April 2020 and 30 June 2020 we prospectively collected data on consecutive unselected patients with UGIB at five large Scottish hospitals. Primary outcomes were length of stay, 30-day mortality and rebleeding. We compared the results with prospective prepandemic descriptive data.Results397 patients were included, and 284 index endoscopies were performed. 26.4% of patients had endoscopic intervention at index endoscopy. 30-day all-cause mortality was 13.1% (53/397), and 33.3% (23/69) for pre-existing inpatients. Bleeding-related mortality was 5% (20/397). 30-day rebleeding rate was 6.3% (25/397). 84 patients had GBS 0–3, of whom 19 underwent inpatient endoscopy, 0 had rebleeding and 2 died. Compared with prepandemic data in three centres, there was a fall in mean number of UGIB presentations per week (19 vs 27.8; p=0.004), higher mean GBS (8.3 vs 6.5; p<0.001) with fewer GBS 0–3 presentations (21.5% vs 33.3%; p=0.003) and higher all-cause mortality (12.2% vs 6.8%; p=0.02). Predictors of mortality were cirrhosis, pre-existing inpatient status, age >70 and confirmed COVID-19. 14 patients were COVID-19 positive, 5 died but none from UGIB.ConclusionDuring the pandemic when services were under severe pressure, extending the low-risk threshold for UGIB inpatient endoscopy to GBS 0–3 appears safe. The higher mortality of patients with UGIB during the pandemic is likely due to presentation of a fewer low-risk patients.

scholarly journals Gambaran Esofagogastroduodenoskopi Pasien Hematemesis dan atau Melena di RSUP M Djamil Padang Periode Januari 2010 - Desember 2013

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Fadhil Alfino Azmi ◽  
Saptino Miro ◽  
Detty Iryani
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Medical Records ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Manifestations ◽  
Erosive Gastritis ◽  
Descriptive Data ◽  
Common Etiology ◽  
Integrated Diagnostics ◽  
Upper Gastrointestinal

AbstrakPerdarahan saluran cerna bagian atas adalah kehilangan darah dalam lumen saluran cerna yang bermula dari esofagus sampai duodenum. Manifestasi kinis berupa hematemesis (muntah darah) dan atau melena (tinja hitam). Kasus ini masih banyak dilaporkan dari berbagai rumah sakit. Etiologi yang sering dilaporkan adalah varises esofagus, ulkus peptikum, gastritis erosif dan lain-lain. Tujuan penelitian ini adalah mengetahui frekuensi diagnosis esofagogastroduodenoskopi (EGD) pasien hematemesis dan atau melena di RSUP M Djamil Padang. Jenis penelitian yang digunakan adalah deskriptif retrospektif. Data diambil secara total sampling dari rekam medik pasien hematemesis dan atau melena yang dilakukan pemeriksaan EGD di Instalasi Diagnostik Terpadu (IDT) RSUP M Djamil Padang periode.Januari.2010.–.Desember.2013. Hasil penelitian menunjukkan 162 pasien kasus terbanyak adalah ulkus gaster (27,8%). Menurut jenis kelamin, pria lebih banyak dibanding wanita yaitu pria (64,8%) dan wanita (35,2%) rasio 1,8 : 1. Kelompok umur terbanyak adalah 51-60 tahun yaitu (20,0%). Lokasi lesi yang paling banyak ditemukan adalah gaster (48,8%).Kata kunci: esofagogastroduodenoskopi, perdarahan saluran cerna bagian atas, hematemesis, melena AbstractUpper gastrointestinal bleeding is a loss of blood in lumen of the gastrointestinal tract from esophagus to duodenum. Clinical manifestations are hematemesis (vomiting of blood) and/or melena (black stools). Many cases were widely reported from various hospitals. The most common etiology that often being reported are esophageal varices, peptic ulcer, erosive gastritis, etc. The objective of this study was to determine the frequency of esophagogastroduodenoscopy(EGD) findings in patients with hematemesis and/or melena in M Djamil Hospital Padang. The design of this research was retrospective descriptive. Data was taken from the result of patient's EGD examination(medical records) that having hematemesis and/or melena in Integrated Diagnostics Installation of M Djamil Hospital Padang from January 2010 to December 2013. The results showed that the highest cases of 162 patients were gastric ulcer (27.8%). According to gender, more men cases than women cases.  Men (64.8%) and women (35.2%) with ratio 1.8 : 1. Most cases occurred on 51-60 years old (20.0%). Location of lesions were most commonly found in gaster (48.8%).Keywords: esophagogastroduodenoscopy, upper gastrointestinal bleeding, hematemesis, melena

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