Does off-hours endoscopic hemostasis affect outcomes of nonvariceal upper gastrointestinal bleeding?

2022 ◽  
Author(s):  
Jia-Lun Guan ◽  
Ge Wang ◽  
Dan Fang ◽  
Ying-Ying Han ◽  
Mu-Ru Wang ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Clinical Outcomes ◽  
Lower Risk ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
Composite Outcome ◽  
Risk Patients ◽  
Relationship Of ◽  
The Relationship ◽  
Upper Gastrointestinal

Aim: Different researches showed controversial results about the ‘off-hours effect’ in nonvariceal upper gastrointestinal bleeding (NVUGIB). Materials & methods: A total of 301 patients with NVUGIB were divided into regular-hours group and off-hours group based on when they received endoscopic hemostasis, and the relationship of the clinical outcomes with off-hours endoscopic hemostasis was evaluated. Results: Patients who received off-hours endoscopy were sicker and more likely to experience worse clinical outcomes. Off-hours endoscopic hemostasis was a significant predictor of the composite outcome in higher-risk patients (adjusted OR: 4.63; 95% CI: 1.35–15.90). However, it did not associate with the outcomes in lower-risk patients. Conclusion: Off-hours effect may affect outcomes of higher-risk NVUGIB patients receiving endoscopic hemostasis (GBS ≥12).

scholarly journals The management of the patient with non-variceal upper gastrointestinal bleeding: from evidence to clinical practice

2016 ◽  
Vol 11 ◽  
Author(s):  
Maddalena Zippi ◽  
Mariella Frualdo ◽  
Luciano Mucci ◽  
Marta Zanon ◽  
Chiara Marzano ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Endoscopic Hemostasis ◽  
High Dose ◽  
Cardiovascular Risks ◽  
High Risk Patients ◽  
Epinephrine Injection ◽  
Risk Patients ◽  
Upper Gastrointestinal

A multidisciplinary group of 7 experts developed this update and expansion of the recommendations on the management of acute non-variceal upper gastrointestinal bleeding (NVUGIH) from guidelines published from 2013. The Appraisal of Guidelines for Research and Evaluation (AGREE) process and independent ethics protocols were used. Sources of data included original and published systematic reviews. Recommendations emphasize early risk stratification, by using validated prognostic scales, and early endoscopy (within 24 hours). Endoscopic hemostasis remains indicated for high-risk lesions, whereas data support attempts to dislodge clots with hemostatic, pharmacologic, or combination treatment of the underlying stigmata. Clips or thermo-coagulation, alone or with epinephrine injection, are effective methods. Second-look endoscopy may be useful in selected high-risk patients, but is not routinely recommended. Intravenous high-dose PPI therapy after successful endoscopic hemostasis decreases both rebleeding and mortality in patients with high-risk stigmata. Although selected patients can be discharged promptly after endoscopy, high-risk patients should be hospitalized for at least 72 hours after endoscopic hemostasis. For patients with UGIH who require a nonsteroidal anti-inflammatory drug, a PPI is preferred to reduce the rebleeding. Patients with NVUGIH needing secondary cardiovascular prophylaxis should start receiving acetylsalicylic acid (ASA) again as soon as cardiovascular risks outweigh gastrointestinal risks (usually within 7 days).

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

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

Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB)

2016 ◽  
Vol 31 (8) ◽  
pp. 3339-3346
Author(s):  
Jin Woo Choi ◽  
Seong Woo Jeon ◽  
Jung Gu Kwon ◽  
Dong Wook Lee ◽  
Chang Yoon Ha ◽  
...  
Keyword(s):  
High Risk ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
High Risk Patients ◽  
Risk Patients ◽  
Upper Gastrointestinal

scholarly journals Semiautomated Glasgow-Blatchford Bleeding Score helps direct bed placement for patients with upper gastrointestinal bleeding

2020 ◽  
Vol 7 (1) ◽  
pp. e000479
Author(s):  
Drew B Schembre ◽  
Robson E Ely ◽  
Janice M Connolly ◽  
Kunjali T Padhya ◽  
Rohit Sharda ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Length Of Stay ◽  
Gastrointestinal Bleeding ◽  
Transfusion Requirement ◽  
Upper Gastrointestinal Bleeding ◽  
Low Risk ◽  
Risk Patients ◽  
Bleeding Score ◽  
Upper Gastrointestinal

ObjectiveThe Glasgow-Blatchford Bleeding Score (GBS) was designed to identify patients with upper gastrointestinal bleeding (UGIB) who do not require hospitalisation. It may also help stratify patients unlikely to benefit from intensive care.DesignWe reviewed patients assigned a GBS in the emergency room (ER) via a semiautomated calculator. Patients with a score ≤7 (low risk) were directed to an unmonitored bed (UMB), while those with a score of ≥8 (high risk) were considered for MB placement. Conformity with guidelines and subsequent transfers to MB were reviewed, along with transfusion requirement, rebleeding, length of stay, need for intervention and death.ResultsOver 34 months, 1037 patients received a GBS in the ER. 745 had an UGIB. 235 (32%) of these patients had a GBS ≤7. 29 (12%) low-risk patients were admitted to MBs. Four low-risk patients admitted to UMB required transfer to MB within the first 48 hours. Low-risk patients admitted to UMBs were no more likely to die, rebleed, need transfusion or require more endoscopic, radiographic or surgical procedures than those admitted to MBs. No low-risk patient died from GIB. Patients with GBS ≥8 were more likely to rebleed, require transfusion and interventions to control bleeding but not to die.ConclusionA semiautomated GBS calculator can be incorporated into an ER workflow. Patients with a GBS ≤7 are unlikely to need MB care for UGIB. Further studies are warranted to determine an ideal scoring system for MB admission.

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

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.

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