scholarly journals Effectiveness of TC-325 (Hemospray) for treatment of diffuse or refractory upper gastrointestinal bleeding – a single center experience

2017 ◽  
Vol 05 (11) ◽  
pp. E1159-E1164 ◽  
Author(s):  
Oscar Cahyadi ◽  
Markus Bauder ◽  
Benjamin Meier ◽  
Karel Caca ◽  
Arthur Schmidt
Keyword(s):  
Gastrointestinal Bleeding ◽  
Salvage Therapy ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Success ◽  
Treatment Algorithm ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Recurrent Bleeding ◽  
Technical Success ◽  
Upper Gastrointestinal

Abstract Background and study aims TC-325 (Hemospray, Cook Medical) is a powder agent for endoscopic hemostasis in patients with upper gastrointestinal bleeding (UGIB). Although most publications are based on case-reports and retrospective studies, data on efficacy are promising. Here we report our experience with TC-325 for diffuse or refractory UGIB. Patients and methods Data on patients receiving TC-325 for endoscopic hemostasis from November 2013 to February 2017 at our center were analyzed retrospectively. Primary endpoints were technical success (successful immediate hemostasis) and clinical success (effective hemostasis and no recurrent bleeding). Secondary endpoints were recurrent bleeding within 3 and 7 days, hospital mortality and TC-325 associated complications. TC-325 was used for bleeding not amenable to standard endoscopic treatment (e. g. diffuse bleeding) or as salvage therapy after failure of conventional methods Results Fifty-two patients received TC-325 treatment. Most of the patients were treated for peptic ulcer bleeding (18/52 patients, 34.6 %) and post-interventional bleeding (13/52 patients, 25 %). Hemospray was used in 23/52 (44.2 %) patients as monotherapy and in 29/52 (55.8 %) patients as a salvage therapy. Application of the powder on the bleeding source was successful in all patients with no therapy-related adverse events (AEs). Immediate hemostasis was achieved in 51/52 (98.1 %) patients. Recurrent bleeding within 3 and 7 days was observed in 22/51 and 25/51 patients respectively (43.1 % and 49 %). The overall clinical success was 56.9 % on day 3 and 51 % on day 7. Total mortality was 15.4 % (8 patients), bleeding associated mortality was 3.8 % (2 patients). There were no therapy-related AEs. Conclusions TC-325 showed a high technical success rate as monotherapy for bleeding sources not amenable to standard methods or as an “add-on” therapy after unsuccessful hemostasis. However, rebleeding was frequent in this cohort and further studies are warranted to exactly define a treatment algorithm for TC-325 use.

scholarly journals Endoscopic suturing for management of peptic ulcer-related upper gastrointestinal bleeding: a preliminary experience

2018 ◽  
Vol 06 (12) ◽  
pp. E1439-E1444 ◽  
Author(s):  
Amol Agarwal ◽  
Petros Benias ◽  
Olaya Brewer Gutierrez ◽  
Vivien Wong ◽  
Yuri Hanada ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Case Series ◽  
Endoscopic Hemostasis ◽  
Recurrent Bleeding ◽  
Technical Success ◽  
Endoscopic Suturing ◽  
Ulcer Disease ◽  
Upper Gastrointestinal

Abstract Background and study aims Acute non-variceal upper gastrointestinal bleeding (UGIB) due to peptic ulcer disease (PUD) remains a common and challenging emergency managed by gastroenterologists. The proper role of endoscopic suturing on the management of PUD-related UGIB is unknown. Patients and methods This is an international case series of patients who underwent endoscopic suturing for bleeding PUD. Primary outcome was rate of immediate hemostasis and rate of early rebleeding (within 72 hours). Secondary outcomes included technical success, delayed rebleeding (> 72 hours), and rate of adverse events (AEs). Results Ten patients (mean age 66.7 years, 30 % female) were included in this study. Nine (90 %) had prior failed endoscopy hemostasis with an average of 1.4 ± 0.7 (range 1 – 3) prior endoscopic sessions. Forrest classification was Ib in 5 (50 %), IIa in 3 (30 %), IIb in 1(10 %), and IIc in 1 (10 %). Mean suturing time was 13.4 ± 5.6 (range 3.5 to 20) minutes. Technical success was 100 %. Rate of immediate hemostasis was 100 % and rate of early rebleeding was 0 %. Mean number of sutures was 1.5 (range, 1 – 4). No AEs were observed. Delayed recurrent bleeding was not observed in any cases after a median of 11 months (range 2 – 56), after endoscopic suturing. Conclusions Oversewing of a bleeding or high-risk ulcer using endoscopic suturing appears to be a safe and effective method for achieving endoscopic hemostasis. It may be considered as rescue endoscopic therapy when primary endoscopic hemostasis fails to control the bleeding or when hemorrhage recurs after successful control of bleeding.

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 Approach to Upper Gastrointestinal Bleeding - When to Treat?

1990 ◽  
Vol 4 (9) ◽  
pp. 647-649
Author(s):  
P Rutgeerts
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Surgical Treatment ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Fatal Outcome ◽  
Ulcer Bleeding ◽  
Recurrent Bleeding ◽  
Life Threatening ◽  
Upper Gastrointestinal

Upper gastrointestinal bleeding from peptic ulcer is a life threatening emergency. Clinical risk factors for fatal outcome have been defined, and endoscopic predictors for rebleeding have been identified. Active ulcer bleeding at endoscopy carries an 80% chance of persistent or recurrent bleeding. A non bleeding visible vessel is associated with a 50% chance of rebleeding. These endoscopic lesions should be treated endoscopically. Failure to obtain definitive hemostasis endoscopically will necessitate emergency surgical treatment.

scholarly journals Predictors of Early Rebleeding after Endoscopic Therapy in Patients with Nonvariceal Upper Gastrointestinal Bleeding Secondary to High-Risk Lesions

2013 ◽  
Vol 27 (8) ◽  
pp. 454-458 ◽  
Author(s):  
Davide Maggio ◽  
Alan N Barkun ◽  
Myriam Martel ◽  
Sara Elouali ◽  
Ian M Gralnek ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Nasogastric Tube ◽  
Upper Gastrointestinal Bleeding ◽  
National Registry ◽  
Endoscopic Hemostasis ◽  
Ulcer Bleeding ◽  
Peptic Ulcer Bleeding ◽  
Multivariable Analyses ◽  
Upper Gastrointestinal

BACKGROUND: In an era of increasingly shortened admissions, data regarding predictors of early rebleeding among patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) exhibiting high-risk stigmata (HRS) having undergone endoscopic hemostasis are lacking.OBJECTIVES: To determine predictors of early rebleeding, defined as rebleeding before completion of recommended 72 h intravenous proton pump inhibitor infusion postendoscopic hemostasis.METHODS: Data from a national registry of patients with upper gastrointestinal bleeding (the REASON registry) were accessed. Univariable and multivariable analyses were sequentially performed to identify significant independent predictors among a comprehensive list of clinical and laboratory characteristics.RESULTS: Overall, 393 patients underwent endoscopic hemostasis for NVUGIB with HRS. Forty patients rebled ≤72 h thereafter (32.5% female, mean [± SD] age 70.2±11.8 years, 2.88±2.11 comorbidities), while 21 rebled later (38.1% female, mean 70.5±14.1 years of age, 2.62±2.06 comorbidities). Hematemesis or bright red blood per nasogastric tube aspirate was identified as the sole independent significant predictor of early rebleeding versus later among both NVUGIB and, more specifically, patients with peptic ulcer bleeding (OR 7.94 [95% CI 1.80 to 35.01]; P<0.01, and OR 8.41 [95% CI 1.54 to 46.10]; P=0.014, respectively).CONCLUSIONS: When attempting to determine the optimal duration of pharmacotherapy and timing of discharge for patients following endoscopic hemostasis for NVUGIB with HRS, it is noteworthy that individuals who present with hematemesis or bright red blood per nasogastric tube aspirate are at particularly high risk for rebleeding within the first 72 h.

scholarly journals Transcatheter Arterial Embolization in Acute Non-Variceal Gastrointestinal Bleedings: A Ten-Year Single-Center Experience in 91 Patients and Review of the Literature

2021 ◽  
Vol 10 (21) ◽  
pp. 4979
Author(s):  
Federico Fontana ◽  
Filippo Piacentino ◽  
Christian Ossola ◽  
Andrea Coppola ◽  
Marco Curti ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Success ◽  
Therapeutic Option ◽  
Arterial Embolization ◽  
Gelatin Sponge ◽  
Technical Success ◽  
Single Center Experience ◽  
Embolic Agents ◽  
Upper Gastrointestinal

Objective: To report the safety and efficacy of trans-arterial embolization (TAE) for upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB) due to different etiologies in 91 patients for ten years. Methods: A retrospective analysis of GIB treated between January 2010 and December 2020 was performed. TAE was performed using different embolic agents (coils, particles, glue, gelatin sponge, and EVOH-based agents). Technical success, secondary technical success, clinical success, and complications were evaluated. Results: Technical success was achieved in 74/91 (81.32%) patients. Seventeen patients (18.68%) required re-intervention. Secondary technical success was achieved in all cases (100.0%). Clinical success was achieved in 81/91 patients (89.01%). No major complications were recorded; overall, minor complications occurred in 20/91 patients. Conclusions: TAE is a technically feasible and safe therapeutic option for patients with GIB from a known or blind anatomic source where endoscopic therapy has failed or is deemed unfeasible.

scholarly journals Endoscopic reinforcement of the anastomosis followed by targeted endoscopic hemostasis for massive upper gastrointestinal bleeding after Whipple’s surgery

Endoscopy ◽  
2016 ◽  
Vol 48 (S 01) ◽  
pp. E22-E23
Author(s):  
Marco D’Assunçao ◽  
Paul Kröner ◽  
Ujjwal Kumar ◽  
Juan Gutierrez ◽  
Lucia Fry ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Upper Gastrointestinal

scholarly journals Clinical profile of patients presenting to emergency with upper gastrointestinal bleeding in a tertiary hospital of Nepal

2021 ◽  
Vol 8 (2) ◽  
pp. 105-111
Author(s):  
Sunil Adhikari ◽  
Suraj Rijal ◽  
Darlene Rose House
Keyword(s):  
Emergency Department ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Clinical Presentation ◽  
Upper Gastrointestinal Bleeding ◽  
Tertiary Hospital ◽  
Clinical Profile ◽  
Ulcer Bleeding ◽  
Cross Sectional ◽  
Upper Gastrointestinal

Introduction: Upper gastrointestinal bleeding is an acute emergency condition. It is an important cause for the hospital admission. This study descriptively analyses the clinical profile of upper gastrointestinal bleeding presenting to a tertiary hospital in Nepal. Method: This is a cross-sectional study of patients presenting with upper gastrointestinal bleeding from 01 Oct 2018 to 30 Sep 2019 at Patan Hospital Emergency Department, Patan Academy of Health Sciences, Nepal. Patient’s demographics, clinical presentation, duration of illness before presenting to Emergency, vitals, and laboratory parameters were descriptively analyzed. Ethical approval was obtained. Result: There were 121 patients, male 82(67.8%) and female 38(31.4%) aging 14 to 90 years. Fifty-three patients (43.8 %) presented with hematemesis, 38(31.4%) with melena, and 27(22.3%) with both hematemesis and melena. Variceal bleeding was the main cause of upper gastrointestinal bleeding found in 73(60.33%) followed by ulcer bleeding in 48(39.66%). Conclusion: Variceal bleeding was the main cause of upper gastrointestinal bleeding and hematemesis was the most common clinical presentation in patients presenting to the Emergency Department.

CLINICAL EVALUATION OF EMERGENCY ENDOSCOPIC HEMOSTASIS WITH BIPOLAR FORCEPS IN NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING

2010 ◽  
Vol 22 (2) ◽  
pp. 151-155 ◽  
Author(s):  
Mikinori Kataoka ◽  
Takashi Kawai ◽  
Kenji Yagi ◽  
Chizuko Tachibana ◽  
Hiroyuki Tachibana ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Clinical Evaluation ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Upper Gastrointestinal

Endoscopic Hemostasis in Nonvariceal Upper Gastrointestinal Bleeding: Comparison of Physician Practice in the East and the West

2009 ◽  
Vol 54 (11) ◽  
pp. 2418-2426 ◽  
Author(s):  
Shou-jiang Tang ◽  
Sun-Young Lee ◽  
Linda S. Hynan ◽  
Jingsheng Yan ◽  
Fransell C. Riley ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Physician Practice ◽  
The West ◽  
Upper Gastrointestinal
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