Effectiveness of the polysaccharide hemostatic powder in non-variceal upper gastrointestinal bleeding: Using propensity score matching

Background and Aims. Acute upper gastrointestinal bleeding (AUGIB) is a lethal complication of liver cirrhosis. We aimed to compare the outcomes of patients with liver cirrhosis and AUGIB who were admitted to hospital on regular hours and off-hours. Methods. This retrospective study screened all cirrhotic patients with AUGIB who were admitted to our hospital from January 2010 to June 2014 for the test cohort and from December 2014 to March 2018 for the validation cohort. A 1:1 propensity score matching analysis was performed to adjust the Child-Pugh and MELD scores. In-hospital mortality, 5-day rebleeding rate, length of stay, and total payment were primary outcomes. Results. Overall, 826 and 173 patients with liver cirrhosis and AUGIB were included in the test and validation cohorts, respectively. After propensity score matching, 226 and 40 patients were included in the test and validation cohorts, respectively. The overall analysis of the test cohort found significantly higher Child-Pugh score (P=0.006), 5-day rebleeding rate (18.69% versus 10.72%, P=0.001), and total payment (¥25,906.83 versus ¥22,017.42, P<0.001) in patients admitted on off-hours. By contrast, the overall analysis of the validation cohort did not find any difference in Child-Pugh score, 5-day rebleeding, in-hospital mortality, length of stay, or hospital payment between patients admitted on regular hours and off-hours. Similarly, the propensity score matching analyses of both test and validation cohorts found no difference in these primary outcomes between the two groups. Conclusions. Off-hours admission might not be negatively associated with the outcomes of patients with liver cirrhosis and AUGIB.

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Use of hemostatic powder in treatment of upper gastrointestinal bleeding: a systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-0977-2897 ◽

2019 ◽

Vol 07 (12) ◽

pp. E1704-E1713 ◽

Cited By ~ 4

Author(s):

Daniel Tavares de Rezende ◽

Vitor Ottoboni Brunaldi ◽

Wanderley Marques Bernardo ◽

Igor Braga Ribeiro ◽

Raquel Cristina Lins Mota ◽

...

Keyword(s):

Systematic Review ◽

Gastrointestinal Bleeding ◽

Latin American ◽

Upper Gastrointestinal Bleeding ◽

Rescue Therapy ◽

Meta Analysis ◽

Secondary Outcome ◽

Primary Hemostasis ◽

Hemostatic Powder ◽

Upper Gastrointestinal

Abstract Background and study aims TC-325 is a novel mineral hemostatic powder that creates a mechanical barrier by absorbing blood components and promoting clotting. Recently approved for use in humans, it has shown promise for treatment of upper gastrointestinal bleeding (UGIB). However, because there have been no large studies of TC-325, its true efficacy and safety profile remain unknown. We performed a systematic review and meta-analysis to determine the safety and efficacy of TC-325 in treating UGIB, based on rates of initial hemostasis, rebleeding, and adverse events (AEs). Methods We searched the MEDLINE/PubMed, EMBASE, CENTRAL, Latin-American and Caribbean Health Sciences Literature databases, as well as the gray literature, to identify articles describing use of TC-325 up to October 2018. Primary outcomes were initial hemostasis and rebleeding. AEs were described as a secondary outcome. Risk of bias was assessed with international scores. Results We identified 2077 records after removal of duplicates. We included 50 studies, involving a collective total of 1445 patients, in the quantitative synthesis. Primary hemostasis and rebleeding rates were 90.7 % and 26.1 %, respectively. Subgroup analyses showed similar results. Only eight AEs were reported. Conclusions TC-325 appears to be a safe, effective treatment for UGIB. The overall rate of initial hemostasis after TC-325 use is high, regardless of etiology of bleeding or whether TC-325 is used as a primary or rescue therapy. Although it is also associated with high rebleeding rates, rates of AEs and equipment failure after TC-325 use are extremely low.

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The Role of Hemostatic Powder in Endoscopic Hemostasis of Nonvariceal Upper Gastrointestinal Bleeding

Annals of Internal Medicine ◽

10.7326/m21-4267 ◽

2021 ◽

Author(s):

Alan N. Barkun ◽

Ali Alali

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Hemostatic Powder ◽

Upper Gastrointestinal

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Tu1094 THE USE OF HEMOSTATIC POWDER IN UPPER GASTROINTESTINAL BLEEDING: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2019.03.1321 ◽

2019 ◽

Vol 89 (6) ◽

pp. AB553

Author(s):

Daniel T. Rezende ◽

Wanderlei M. Bernardo ◽

Vitor O. Brunaldi ◽

Igor B. Ribeiro ◽

Sérgio E. Matuguma ◽

...

Keyword(s):

Systematic Review ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Meta Analysis ◽

Hemostatic Powder ◽

Upper Gastrointestinal

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A novel hemostatic powder for upper gastrointestinal bleeding: a multicenter study (the “GRAPHE” registry)

Endoscopy ◽

10.1055/s-0042-116148 ◽

2016 ◽

Vol 48 (12) ◽

pp. 1084-1095 ◽

Cited By ~ 49

Author(s):

Sami Haddara ◽

Jeremie Jacques ◽

Stéphane Lecleire ◽

Julien Branche ◽

Sarah Leblanc ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Multicenter Study ◽

Upper Gastrointestinal Bleeding ◽

Hemostatic Powder ◽

Upper Gastrointestinal

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Biopsy in emergency gastroscopy does not increase the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding combined with suspected malignant gastric ulcer: a multicenter retrospective cohort study

BMC Gastroenterology ◽

10.1186/s12876-021-01836-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Quchuan Zhao ◽

Tianyu Chi

Keyword(s):

Logistic Regression ◽

Gastric Ulcer ◽

Cohort Study ◽

Propensity Score ◽

Propensity Score Matching ◽

Retrospective Cohort ◽

Regression Models ◽

Upper Gastrointestinal Bleeding ◽

Logistic Regression Models ◽

Upper Gastrointestinal

Abstract Background Few studies have reported whether a biopsy in emergency gastroscopy (EG) increased the risk of rebleeding in patients with Forrest I acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) combined with suspected malignant gastric ulcer (SMGU). This study aims to conduct a multicenter retrospective cohort study using propensity score matching to verify whether a biopsy in EG increases the risk of rebleeding in patients diagnosed with Forrest I ANVUGIB combined with SMGU. Methods Using the data for propensity-matched patients, logistic regression models were fitted using rebleeding as the dependent variable. Survival time was defined as the length of time the patient experienced from visiting the emergency department to rebleeding. We used the Kaplan–Meier (KM) method to analyze the 30-day survival of the patients with and without a biopsy after matching, and the log-rank test was performed to examine the differences in survival. Results With the use of propensity score matching, 308 patients who underwent a biopsy in EG were matched with 308 patients who did not. In the five logistic regression models, there were no significant group differences in the risk of rebleeding in patients with Forrest I ANVUGIB combined with SMGU between the biopsy and no-biopsy groups. The probability of survival was not significantly different between the no-biopsy and biopsy groups. Conclusions In this multicenter, retrospective propensity score matching cohort study, compared with patients without a biopsy, patients with a biopsy during EG had no increased risk of rebleeding, and there was no significant difference in the rate of rebleeding.

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Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/6672440 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Daisuke Yamaguchi ◽

Naoyuki Tominaga ◽

Koichi Miyahara ◽

Nanae Tsuruoka ◽

Yasuhisa Sakata ◽

...

Keyword(s):

Pilot Study ◽

Propensity Score ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Endoscopic Hemostasis ◽

Antithrombotic Agents ◽

Safety And Efficacy ◽

Group A ◽

Group B ◽

Upper Gastrointestinal

Background and Aims. The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB). Methods. In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. Results. Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P < 0.001). Conclusions. Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.

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Severe upper gastrointestinal bleeding is halted by endoscopically delivered self-propelling thrombin powder: A porcine pilot study

Endoscopy International Open ◽

10.1055/a-1374-5839 ◽

2021 ◽

Vol 09 (05) ◽

pp. E693-E698

Author(s):

Nabil Ali-Mohamad ◽

Massimo Cau ◽

James Baylis ◽

Veronika Zenova ◽

Hugh Semple ◽

...

Keyword(s):

Pilot Study ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Vascular Bundles ◽

Average Mass ◽

Primary Hemostasis ◽

Needle Knife ◽

Hemostatic Powder ◽

Mean Time ◽

Upper Gastrointestinal

Abstract Background and study aims Hemostatic powders have emerged recently to treat upper gastrointestinal bleeding (UGIB). Previously, we developed a novel self-propelling thrombin powder (SPTP) that effectively manages external pulsatile arterial bleed without compression, by effervescing and carrying thrombin into the wound. Here, we tested if SPTP, sprayed endoscopically, can manage severe UGIB in a live porcine model. Materials and methods Anesthetized pigs underwent laparotomy to insert the gastroepiploic vascular bundles into the stomach lumen via a gastrotomy. Bleeding was initiated endoscopically in the stomach by needle knife. SPTP was delivered to the site of bleeding from a CO2-powered spray device using a 7 FR catheter. Successful primary hemostasis, time to hemostasis, and the mass of SPTP delivered were measured. Results Hemostasis was achieved at all bleeding sites using SPTP. Mean time to hemostasis was 4.2 ± 0.9 minutes (mean ± standard error of the mean, n = 12). The average mass of SPTP delivered was 2.4 ± 0.6 g. Conclusions In this pilot study, SPTP successfully stopped 12 cases of severe UGIB, demonstrating early promise asa novel hemostatic powder.

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