scholarly journals Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

2017 ◽  
Vol 05 (05) ◽  
pp. E324-E330 ◽  
Author(s):  
Regina Lamberts ◽  
Anna Koch ◽  
Christian Binner ◽  
Marcus Zachäus ◽  
Ingrid Knigge ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Anticoagulant Therapy ◽  
Endoscopic Therapy ◽  
High Risk Patient ◽  
Antiplatelet Agents ◽  
High Rate ◽  
Endoscopic Management ◽  
Success Rates ◽  
Primary Hemostasis

Abstract Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

scholarly journals First-line endoscopic treatment with over-the-scope clips in patients with either upper or lower gastrointestinal bleeding: a multicenter study

2018 ◽  
Vol 06 (11) ◽  
pp. E1317-E1321 ◽  
Author(s):  
Raffaele Manta ◽  
Santi Mangiafico ◽  
Angelo Zullo ◽  
Helga Bertani ◽  
Angelo Caruso ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Multicenter Study ◽  
Endoscopic Treatment ◽  
Antithrombotic Therapy ◽  
Line Treatment ◽  
Technical Success ◽  
First Line ◽  
Primary Hemostasis ◽  
First Line Treatment

Abstract Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients. Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated. Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 – 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group.  Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.

scholarly journals 1100. Facility Factors Are a Stronger Driver of Peri-Operative Vancomycin Use Than Patient Risk Factors

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S391-S391
Author(s):  
Westyn Branch-Elliman ◽  
William O’Brien ◽  
Judith Strymish ◽  
Kamal Itani ◽  
Kalpana Gupta
Keyword(s):  
High Risk ◽  
Total Joint Replacement ◽  
High Risk Patient ◽  
High Rate ◽  
Common Reason ◽  
Surgical Prophylaxis ◽  
Medical Centers ◽  
Facility Level ◽  
Manual Review ◽  
Colorectal Procedures

Abstract Background Prior reports suggest that the use of vancomycin for surgical prophylaxis is common and increasing. However, rates of administration and reasons for choosing vancomycin are unknown. Thus, we sought to quantify the frequency of vancomycin as a surgical prophylaxis agent and to determine drivers of use. Methods All Veteran patients undergoing major cardiac, orthopedic total joint, vascular, or colorectal procedures and entered into the VA External Peer Review Program (EPRP) database during the period from October 1, 2008 to September 30, 2013 were included. EPRP includes a manual review of surgical cases to measure type of prophylaxis, and, in the case of vancomycin, clinician-documented reasons for vancomycin use (β-lactam allergy, patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA), facility high rate of MRSA). Descriptive statistics were used to evaluate findings. Results Among 79, 058 surgical procedures at 109 different medical centers, 20,349 (25.7%) received vancomycin either alone or in combination with another agent for prophylaxis. Rates of vancomycin use were the highest for cardiac surgeries (10,455/21,396, 48.9%), followed by orthopedic total joint replacement surgeries (8,044/38,675, 20.8%), vascular surgeries (1,504/8,177, 18.4%) and colorectal surgeries (346/10,810, 3.2%). The most common reason for vancomycin use was a perceived high facility rate of MRSA (7,367, 36.2%) followed by β-lactam allergy (4,855, 23.9%) and high-risk patient (1,420/20,349, 7.0%). There was no reason documented in 5,194 (25.5%). The most common reason for vancomycin use differed by surgical type. Among cardiac and orthopedic cases, high facility rate was the most commonly reported reason, but β-lactam allergy was the most common driver among vascular and colorectal procedures. Conclusion Facility factors are a major driver of peri-operative vancomycin use, more so than β-lactam allergy or patient-level factors, particularly in cardiac and orthopedic surgery. These data suggest that facility-level interventions, such as implementation of specific guidelines, may be helpful for limiting vancomycin use in this population. Disclosures All authors: No reported disclosures.

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 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.

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.

Gastrointestinal Bleeding

2012 ◽  
Author(s):  
Deepak Agrawal ◽  
Don C Rockey
Keyword(s):  
Small Intestine ◽  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Ischemic Colitis ◽  
The United States ◽  
Endoscopic Management ◽  
Ulcer Formation ◽  
Minor Bleeding ◽  
Portal Hypertensive Gastropathy ◽  
Vascular Ectasia

Gastrointestinal bleeding (GIB) is commonly encountered in clinical practice, in both outpatient and inpatient settings. Minor bleeding, such as from hemorrhoids, is exceedingly common. Major bleeding requiring a high level of care results in approximately 1 million hospital admissions in the United States every year. Approximately 50% of these admissions are for upper gastrointestinal bleeding (UGIB), 40% for lower gastrointestinal bleeding (LGIB), and 10% for obscure GIB. This chapter discusses acute gastrointestinal bleeding covering history, physical examination, and laboratory studies, as well as endoscopic management and radiologic imaging. A section on UGIB covers endoscopic management, medical management, and radiologic and surgical management, variceal bleeding, Mallory-Weiss tear, Dieulafoy’s lesions, Cameron’s lesions, gastric antral vascular ectasia (GAVE), and portal hypertensive gastropathy. A section on LGIB covers diverticulosis, hemorrhoids, angiodysplasia, rectal ulcers, radiation proctitis, ischemic colitis, rectal varices, postpolypectomy bleeding, anal fissures, cancer, and polyps. Obscure GIB includes Meckel’s diverticulum, small intestinal diverticula, small intestine neoplasms, small intestine Dieulafoy’s lesion, non-steroidal antiinflammatory drug–induced small intestine erosions, and blue rubber bleb nevus syndrome. Figures include various bleeding ulcers, the wireless capsule, the bleeding vessel, a duodenal bulbar ulcer, treatment of a high-risk gastric ulcer, formation of varices, varices with a spurting lesion, various treatments for esophageal varices, a Mallory-Weiss tear, a Dieulafoy lesion in the rectum, severe portal hypertensive gastropathy, vascular ectasia, and ischemic colitis, plus an algorithm for obscure GIB. Tables cover major causes, terms and their definitions, clinical high-risk criteria for rebleeding and mortality, endoscopic high-risk stigmata for rebleeding and indications for endoscopic therapy, differentiation of portal hypertensive gastropathy and GAVE, and uncommon causes of obscure GIB. This chapter contains 21 highly rendered figures, 6 tables, 110 references, 5 MCQs.

UPDATE ON ENDOSCOPIC MANAGEMENT OF PEPTIC ULCER BLEEDING

2012 ◽  
pp. 5-11
Author(s):  
Ngoc Quy Hue Dang ◽  
Van Huy Tran
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Endoscopic Therapy ◽  
Active Bleeding ◽  
Ulcer Bleeding ◽  
Endoscopic Management ◽  
High Dose ◽  
Peptic Ulcer Bleeding

Peptic ulcer bleeding is a common medical emergency and still a potentially fatal condition. It is the best managed using a multidisciplinary approach by a team with medical, endoscopic and surgical expertise. Appropriate resuscitation followed by early endoscopy for diagnosis and treatment are of major importance in these patients. Endoscopy is recommended within 24 h of presentation. Endoscopic therapy is indicated for patients with high-risk stigmata, in particular those with active bleeding and visible vessels. A combination of proton pump inhibitors and endoscopic therapy (using a combination of injection and mechanical hemostasis) offers the best chance of hemostasis for those with active bleeding ulcers. The application of an ulcer-covering hemospray is a new promising tool. High dose proton pump inhibitors should be administered intravenously for 72 h in high-risk patients. Helicobacter pylori should be tested for in all patients with peptic ulcer bleeding and eradicated if positive

scholarly journals Comparison of Oral versus Intravenous Proton Pump Inhibitors in Preventing Re-bleeding from Peptic Ulcer after Successful Endoscopic Therapy

2018 ◽  
Vol 10 (4) ◽  
pp. 236-241
Author(s):  
Seyed Mohammad Valizadeh Toosi ◽  
Ahmad Reza Elahi Vahed ◽  
Iradj Maleki ◽  
Zohreh Bari
Keyword(s):  
Peptic Ulcer ◽  
High Risk ◽  
Blood Transfusion ◽  
Gastrointestinal Bleeding ◽  
Proton Pump ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Therapy ◽  
High Dose ◽  
Dose Oral ◽  
Upper Gastrointestinal

BACKGROUND Proton pump inhibitors (PPIs) are now widely prescribed for the management of patients with acute upper gastrointestinal bleeding; although its optimal dose and route of administration has remained a controversial issue. The aim of this study was to assess the clinical effectiveness of high dose oral versus intravenous (IV) PPI after successful endoscopic therapy in patients with bleeding peptic ulcer disease. METHODS 178 patients with active upper gastrointestinal bleeding due to a peptic ulcer with stigmata of high risk for re-bleeding entered the study. After successful endoscopic hemostasis, they were randomized to receive either high dose oral pantoprazole (80 mg stat and 80 mg twice daily for 3 days) or high dose intravenous pantoprazole (80 mg IV infusion within 30 minutes and 8 mg per hour for 3 days). After the 3rd day, the patients in both groups received oral pantoprazole 40 mg twice daily for one month. The end points were comparing the rate of re-bleeding or mortality, and the need for blood transfusion or surgery during the first month between the two groups. RESULTS There were not significant statistical differences between the two groups in the volume of blood transfusion, mean duration of hospital stay, need to surgery, or mortality rates. However, the rates of re-bleeding were 2.3% (2:88) in the IV group and 3.3% (3:90) in the oral group (p = 0.6). CONCLUSION According to our findings, it seems that high dose oral PPI can be a good alternative to high dose IV PPI in patients with bleeding peptic ulcer who are at high risk of re-bleeding. Due to the lower cost and the availability of oral PPIs, their use can be economically much more affordable.

Management Of Gastrointestinal Bleeding In Rendu-Osler Disease

2020 ◽  
Vol 15 ◽  
Author(s):  
Annalisa Tortora ◽  
Clelia Marmo ◽  
Antonio Gasbarrini ◽  
Guido Costamagna ◽  
Maria Elena Riccioni
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Bleeding ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Autosomal Dominant ◽  
Endoscopic Therapy ◽  
The Body ◽  
High Rate ◽  
Venous Malformations ◽  
Online Activity ◽  
Autosomal Dominant Transmission

Background: Hereditary hemorrhagic telangiectasia (HHT, or Rendu-Osler-Weber disease) is a rare inherited syndrome, characterized by artero-venous malformations (AVMs or telangiectasia) with autosomal dominant transmission. AVMs can occur in any organ of the body, most commonly occur in nose, pulmonary, hepatic and cerebral circulations. In patients with HHT we report teleangectasia of mucosa of gastrointestinal tract. Methods: Research and online content related to HHT online activity is reviewed, and DOC writing excerpts are used to illustrate key themes. Results: Patients with HHT have a high rate of complications related to bleeding; of them gastrointestinal bleeding accounts for 10.8%. Several therapy, both medical and endoscopic, was utilized to reduce the need of transfusions and hospitalization. Conclusion: A combination of medical and endoscopic therapy is probably the best option.

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