scholarly journals Effectiveness of hemostatic powders in lower gastrointestinal bleeding: a systematic review and meta-analysis

2021 ◽  
Vol 09 (08) ◽  
pp. E1283-E1290
Author(s):  
Antonio Facciorusso ◽  
Marco Bertini ◽  
Michele Bertoni ◽  
Nicola Tartaglia ◽  
Mario Pacilli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Meta Analysis ◽  
Lower Gastrointestinal Bleeding ◽  
Random Effects Model ◽  
Limited Evidence ◽  
Mild Abdominal Pain ◽  
Bibliographic Search ◽  
Rebleeding Rate ◽  
User Friendly

Abstract Background and study aims There is limited evidence on the effectiveness of hemostatic powders in the management of lower gastrointestinal bleeding (LGIB). We aimed to provide a pooled estimate of their effectiveness and safety based on the current literature. Patients and methods Literature review was based on computerized bibliographic search of the main databases through to December 2020. Immediate hemostasis, rebleeding rate, adverse events, and mortality were the outcomes of the analysis. Pooled effects were calculated using a random-effects model. Results A total of 9 studies with 194 patients were included in the meta-analysis. Immediate hemostasis was achieved in 95 % of patients (95 % confidence interval [CI] 91.6 %–98.5 %), with no difference based on treatment strategy or bleeding etiology. Pooled 7- and 30-day rebleeding rates were 10.9 % (95 %CI 4.2 %–17.6 %) and 14.3 % (95 %CI 7.3 %–21.2 %), respectively. Need for embolization and surgery were 1.7 % (95 %CI 0 %–3.5 %) and 2.4 % (95 %CI 0.3 %–4.6 %), respectively. Overall, two patients (1.9 %, 95 %CI 0 %–3.8 %) experienced mild abdominal pain after powder application, and three bleeding-related deaths (2.3 %, 95 %CI 0.2 %–4.3 %) were registered in the included studies. Conclusion Novel hemostatic powders represent a user-friendly and effective tool in the management of lower gastrointestinal bleeding.

scholarly journals A180 SENSITIVITY AND SPECIFICITY OF LOWER GASTROINTESTINAL BLEEDING SCORES TO PREDICT ADVERSE OUTCOMES: SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 47-48
Author(s):  
M M Almaghrabi ◽  
M Gandhi ◽  
A Iansavitchene ◽  
V Jairath ◽  
M Sey
Keyword(s):  
Systematic Review ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Risk Prediction ◽  
Full Text ◽  
Endoscopic Therapy ◽  
Meta Analysis ◽  
Lower Gastrointestinal Bleeding ◽  
Risk Scores ◽  
Full Text Review

Abstract Background Acute lower gastrointestinal bleeding (LGIB) is a common reason for emergency hospitalization. In most patients bleeding resolves spontaneously, although some presentations result in adverse outcome such as transfusion, therapeutic intervention, rebleeding and mortality. Risk prediction scores are important to stratify patients at presentation with LGIB. Aims To perform a systematic review and meta-analysis comparing LGIB risk prediction scores. We provide a summary effect measure of their predictive values for 30-day mortality, safe discharge, rebleeding, need for blood transfusion, and need for endoscopic therapy/IR/surgery. Methods Electronic search for relevant publications after 1990 was conducted in PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, NIH ClinicalTrials.gov, and Cochrane Database of Systematic Reviews. We also searched relevant published conference abstracts over the past 5 years. Studies with a primary goal of deriving or validating a LGIB risk score were included. Title and abstracts were reviewed by two independent reviewers and then full text review was done by both reviewers. Results Our search identified 1,832 citations for review. After title and abstract review, 68 publications were selected for full text review. So far, a total of 16 citations were excluded since we started full text review including: insufficient information (n=14), review article (n=2). Thus far, we identified 14 risk scores and algorithms from 9 studies. Two of the risk scores are UGIB risk scores that were assessed for LGIB. Of these studies, 3 were validation studies, one derivation study and five for both validation and derivation. The scores assessed safety of discharge (n=3), mortality (n=4), need for therapy (n=8), severe bleeding (n=8) and requirement for blood transfusion (n=1). A meta-analysis will follow. Conclusions We conducted a systematic review of LGIB risk scores, with a meta-analysis to follow if appropriate, for use to predict 30-day mortality, safe discharge, rebleeding, required blood transfusion, endoscopic therapy/IR/surgery. Funding Agencies None

Systematic review with meta-analysis: limited benefits from early colonoscopy in acute lower gastrointestinal bleeding

2020 ◽  
Vol 52 (5) ◽  
pp. 774-788 ◽  
Author(s):  
Omar Kherad ◽  
Sophie Restellini ◽  
Majid Almadi ◽  
Lisa L. Strate ◽  
Charles Ménard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Meta Analysis ◽  
Lower Gastrointestinal Bleeding

Sa108 A SYSTEMATIC REVIEW AND META-ANALYSIS OF LOWER GASTROINTESTINAL BLEEDING RISK SCORES TO PREDICT ADVERSE OUTCOMES

2021 ◽  
Vol 160 (6) ◽  
pp. S-424
Author(s):  
Majed M. Almaghrabi ◽  
Mandark Gandhi ◽  
Leonardo Guizzetti ◽  
Alla Iansavichene ◽  
Kathryn Oakland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Lower Gastrointestinal Bleeding ◽  
Adverse Outcomes ◽  
Risk Scores

scholarly journals A115 A SYSTEMATIC REVIEW AND META-ANALYSIS OF LOWER GASTROINTESTINAL BLEEDING RISK SCORES TO PREDICT ADVERSE OUTCOMES

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 94-96
Author(s):  
M M Almaghrabi ◽  
M Gandhi ◽  
L Guizzetti ◽  
A Iansavitchene ◽  
K Oakland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Risk Prediction ◽  
Risk Score ◽  
Major Bleeding ◽  
Full Text ◽  
Meta Analysis ◽  
Lower Gastrointestinal Bleeding ◽  
Full Text Review ◽  
Discharge From Hospital

Abstract Background Acute lower gastrointestinal bleeding (LGIB) is a common reason for emergency hospitalization. In most patients, bleeding resolves spontaneously but some cases can be fatal. Risk prediction scores can be useful in risk stratifying patients with LGIB at the time of presentation although the most discriminative LGIB risk score is unknown. Aims To perform a systematic review and meta-analysis comparing LGIB risk prediction scores. Methods Following the PRISMA statement, a systematic search for relevant publications after 1990 was conducted in Ovid Medline, EMBASE, Web of Science and CENTRAL electronic databases. We also searched published conference abstracts over the past 5 years. Studies with a primary aim of deriving or validating a LGIB risk score were included. Title and abstracts were reviewed by two independent reviewers followed by full text review and data extraction by both reviewers. Diagnostic classification data for combinations of risk score and clinical outcome were meta-analyzed using a hierarchical summary receiver operator characteristic curve (ROC) model, allowing for random-effects by study, and fixed-effect of the risk score thresholds to influence both sensitivity and specificity. Area under the summary ROC were estimated from model parameters for the pre-specified LGIB risk score thresholds-of-interest. Results Our search identified 2,331 citations for review, of which 100 remained after the title and abstract screen, and 18 ultimately met criteria for inclusion in the meta-analysis after full text review. From these, we identified 21 risk prediction scores for LGIB, although only four had sufficient number of papers to meta-analyze (Oakland, Strate, NOBLADS, and BLEED score). For the outcome safe discharge from hospital, the Oakland score had an area under the receiver operating characteristics curve (AUROC) of 85.5% (95% CI: 82.1%, 88.3%). For the outcome major bleeding, the Oakland score had an AUROC of 78.9% (95% CI: 75.1%, 82.2%); the Strate score had an AUROC of 74.4% (95% CI: 70.4%, 78.0%); the NOBLADS score had an AUROC of 60.3% (95% CI: 55.9%, 64.5%); and the BLEED score had an AUROC of 65.6% (95% CI: 61.4%, 69.7%). For the outcome, need for hemostasis, the Oakland had an AUROC of 99.0% (95% CI: 97.7%, 99.6%); the Strate score had an AUROC of 82.1% (95% CI: 78.5%, 85.2%); the NOBLADS score had an AUROC of 23.9% (95% CI: 20.3%, 27.8%). For the outcome, need for transfusion, the Oakland score had an AUROC of 99.0% (95% CI: 97.7%, 99.6%); the NOBLADS score had an AUROC of 87.7% (95% CI: 84.5%, 90.3%). Conclusions The Oakland score was the most discriminative risk prediction model for safe discharge from hospital, major bleeding, need for hemostasis, and need for transfusion. Funding Agencies None

scholarly journals Efficacy of Hemospray in Upper Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 29 (1) ◽  
pp. 69-76
Author(s):  
Hemant Mutneja ◽  
Abhishek Bhurwal ◽  
Andrew Go ◽  
Gurpartap Singh Sidhu ◽  
Shilpa Arora ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Prospective Studies ◽  
Primary Outcome ◽  
Upper Gastrointestinal Bleeding ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Randomized Controlled ◽  
Bibliographic Search ◽  
Rebleeding Rate ◽  
Upper Gastrointestinal

Background and Aims: Hemospray is a non-contact modality of endoscopic hemostasis that has been used in the management of upper gastrointestinal bleeding (UGIB) with varying success. Our aim was to evaluate the efficacy of Hemospray in the management of UGIB. Methods: An electronic bibliographic search of digital dissertation databases was performed from inception till October 2019. All prospective studies, including randomized controlled trials evaluating the efficacy of Hemospray in the management of UGIB were analysed. The primary outcome was immediate haemostasis and the secondary outcome was rebleeding rate. Subgroup analyses based on etiology of UGIB (tumour-related, variceal, etc) were also performed. Results: A total of 11 prospective studies, including 4 randomized trials were included for the analysis. The pooled immediate haemostasis rate with Hemospray was 93% (95% CI 90.3-95%, p<0.001). Rebleeding occurred in 14.4% (95% CI 8.8-22.8%, p<0.001) of patients. For the subgroup of tumour-related bleeding, the immediate haemostasis rate was 95.3% (95% CI 89.6-97.3%; p <0.001) and rebleeding rate was 21.9% (95% CI 13.9-32.7%, p <0.001). In patients with variceal bleeding, immediate haemostasis was achieved in 92.7% (95% CI 83.6-96.9%; p<0.001) of patients, with a rebleeding rate of 3.1% (95% CI 0.9-10.2%, p <0.001). Conclusion: Hemospray shows high immediate haemostasis and low bleeding percentages. The odds were in its favour compared to conventional endoscopic modalities, but not statistically significant. The results are undermined by the risk of bias in the studies. Nevertheless, it is an easy technique that should be further investigated with better studies.

Tranexamic Acid in Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Joanna C. Dionne ◽  
Simon JW Oczkowski ◽  
Beverley J. Hunt ◽  
Massimo Antonelli ◽  
Marije Wijnberge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Tranexamic Acid ◽  
Meta Analysis

scholarly journals Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies

Foods ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 296
Author(s):  
Sun Jo Kim ◽  
Nguyen Hoang Anh ◽  
Nguyen Co Diem ◽  
Seongoh Park ◽  
Young Hyun Cho ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Bone Health ◽  
Observational Studies ◽  
Meta Analysis ◽  
Random Effects Model ◽  
High Intake ◽  
Quantitative Evidence ◽  
Osteoporosis Risk ◽  
Reduced Risk

Many studies have analyzed the effects of β-cryptoxanthin (BCX) on osteoporosis and bone health. This systematic review and meta-analysis aimed at providing quantitative evidence for the effects of BCX on osteoporosis. Publications were selected and retrieved from three databases and carefully screened to evaluate their eligibility. Data from the final 15 eligible studies were extracted and uniformly summarized. Among the 15 studies, seven including 100,496 individuals provided information for the meta-analysis. A random effects model was applied to integrate the odds ratio (OR) to compare the risk of osteoporosis and osteoporosis-related complications between the groups with high and low intake of BCX. A high intake of BCX was significantly correlated with a reduced risk of osteoporosis (OR = 0.79, 95% confidence interval (CI) 0.70–0.90, p = 0.0002). The results remained significant when patients were stratified into male and female subgroups as well as Western and Asian cohorts. A high intake of BCX was also negatively associated with the incidence of hip fracture (OR = 0.71, 95% CI 0.54–0.94, p = 0.02). The results indicate that BCX intake potentially reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.

scholarly journals Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110308
Author(s):  
Andrew Platt ◽  
Mostafa H. El Dafrawy ◽  
Michael J. Lee ◽  
Martin H. Herman ◽  
Edwin Ramos
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Operative Intervention ◽  
Lumbosacral Spine ◽  
Random Effects Model ◽  
Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

scholarly journals Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review

2017 ◽  
Vol 05 (10) ◽  
pp. E959-E973 ◽  
Author(s):  
Kathryn Oakland ◽  
Jennifer Isherwood ◽  
Conor Lahiff ◽  
Petra Goldsmith ◽  
Michael Desborough ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Flexible Sigmoidoscopy ◽  
Meta Analysis ◽  
Computed Tomographic Angiography ◽  
Lower Gastrointestinal Bleeding ◽  
Treatment Modalities ◽  
Computed Tomographic ◽  
Meta Analyses ◽  
Tomographic Angiography ◽  
Risk Ratios

Abstract Background and study aims Investigations for lower gastrointestinal bleeding (LGIB) include flexible sigmoidoscopy, colonoscopy, computed tomographic angiography (CTA), and angiography. All may be used to direct endoscopic, radiological or surgical treatment, although their optimal use is unknown. The aims of this study were to determine the diagnostic and therapeutic yields of endoscopy, CTA, and angiography for managing LGIB, and their influence on rebleeding, transfusion, and hospital stay. Patients and methods A systematic search of MEDLINE, PubMed, EMBASE, and CENTRAL was undertaken to identify randomized controlled trials (RCTs) and nonrandomized studies of intervention (NRSIs) published between 2000 and 12 November 2015 in patients hospitalized with LGIB. Separate meta-analyses were conducted, presented as pooled odds (ORs) or risk ratios (RR) with 95 % confidence intervals (CIs). Results Two RCTs and 13 NRSIs were included, none of which examined flexible sigmoidoscopy, or compared endotherapy with embolization, or investigated the timing of CTA or angiography. Two NRSIs (57 – 223 participants) comparing colonoscopy and CTA were of insufficient quality for synthesis but showed no difference in diagnostic yields between the two interventions. One RCT and 4 NRSIs (779 participants) compared early colonoscopy (< 24 hours) with colonoscopy performed later; meta-analysis of the NRSIs demonstrated higher diagnostic and therapeutic yields with early colonoscopy (OR 1.86, 95 %CI 1.12 to 2.86, P = 0.004 and OR 3.08, 95 %CI 1.93 to 4.90, P < 0.001, respectively) and reduced length of stay (mean difference 2.64 days, 95 %CI 1.54 to 3.73), but no difference in transfusion or rebleeding. Conclusions In LGIB there is a paucity of high-quality evidence, although the limited studies on the timing of colonoscopy suggest increased rates of diagnosis and therapy with early colonoscopy.

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