scholarly journals Is upper gastrointestinal bleeding still a life-threatening condition?

2019 ◽  
Vol 13 (2) ◽  
pp. 18-23
Author(s):  
Dariusz Janczak ◽  
Paweł Marschollek ◽  
Karol Marschollek ◽  
Marcin Owczarzak ◽  
Wojciech Bąkowski ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Conservative Treatment ◽  
Gastrointestinal Bleeding ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Problem ◽  
Endoscopic Hemostasis ◽  
Peptic Ulcers ◽  
First Choice ◽  
Upper Gastrointestinal

Background: Upper gastrointestinal bleeding is a common clinical problem and one of the main reasons for emergency hospitalization. It is associated with an overall mortality rate of 2% to 13%, despite advances in medical therapy. First-choice management is conservative treatment with endoscopic hemostasis. Aim of the study: The aim of the study was to examine the epidemiological and clinical characteristics of patients with upper gastrointestinal bleeding with a focus on the course of hospitalization based on the etiology Material and methods: A retrospective study was conducted in the Department of Surgery at the 4th Military Teaching Hospital in the years 2011–2016, comprising a total of 200 hospitalizations. 150 (75%) of the study group were men, and the mean age was 63.6±15.8 years. Results: Patients most frequently presented with melena (n=105; 53.1%) and hematemesis (n=79; 40%) or coffee ground vomiting (n=57; 28.7%). . 138 (69%) of hemorrhages were managed with endoscopic hemostasis, and in 43 (21.5%) of cases conservative treatment was adequate. In 12 (6%) of cases, laparotomy was the first-choice therapy and in 7 (3.5%) cases, surgery was performed after an attempt at endoscopic treatment had failed. The sources of bleeding were: gastric ulcer – 58 (29%), duodenal ulcer – 48 (24%), esophageal varices – 31 (15.5%), gastric tumor – 15 (7.5%), Mallory-Weiss syndrome – 10 (5%), and Dieulafoy’s lesion – 3 (1.5%). 16 (8%) of the hospitalizations were fatal. Conclusions: Upper gastrointestinal bleeding still has a high mortality rate (8%). It more frequently affects men and the elderly. Gastric and duodenal ulcers are the most common etiologies of bleeding. Esophageal varices and neoplasms are also a significant source of bleeding. Despite the progress in the pharmacological treatment of peptic ulcers, the complications resulting from gastrointestinal bleeding continue to be a serious clinical problem.

scholarly journals Prognostic factors associated with upper gastrointestinal bleeding based on the French multicenter SANGHRIA trial

2021 ◽  
Vol 09 (10) ◽  
pp. E1504-E1511
Author(s):  
Vincent Quentin ◽  
André-Jean Remy ◽  
Gilles Macaigne ◽  
Rachida Leblanc-Boubchir ◽  
Jean-Pierre Arpurt ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Peptic Ulcers ◽  
Charlson Score ◽  
Factors Associated ◽  
Rockall Score ◽  
Upper Gastrointestinal

Abstract Background and study aims Prognostic and risk factors for upper gastrointestinal bleeding (UGIB) might have changed overtime because of the increased use of direct oral anticoagulants and improved gastroenterological care. This study was undertaken to assess the outcomes of UGIB in light of these new determinants by establishing a new national, multicenter cohort 10 years after the first. Methods Consecutive outpatients and inpatients with UGIB symptoms consulting at 46 French general hospitals were prospectively included between November 2017 and October 2018. They were followed for at least for 6 weeks to assess 6-week rebleeding and mortality rates and factors associated with each event. Results Among the 2498 enrolled patients (mean age 68.5 [16.3] years, 67.1 % men), 74.5 % were outpatients and 21 % had cirrhosis. Median Charlson score was 2 (IQR 1–4) and Rockall score was 5 (IQR 3–6). Within 24 hours, 83.4 % of the patients underwent endoscopy. The main causes of bleeding were peptic ulcers (44.9 %) and portal hypertension (18.9 %). The early in-hospital rebleeding rate was 10.5 %. The 6-week mortality rate was 12.5 %. Predictors significantly associated with 6-week mortality were initial transfusion (OR 1.54; 95 %CI 1.04–2.28), Charlson score > 4 (OR 1.80; 95 %CI 1.31–2.48), Rockall score > 5 (OR 1.98; 95 %CI 1.39–2.80), being an inpatient (OR 2.45; 95 %CI 1.76–3.41) and rebleeding (OR 2.6; 95 %CI 1.85–3.64). Anticoagulant therapy was not associated with dreaded outcomes. Conclusions The 6-week mortality rate remained high after UGIB, especially for inpatients. Predictors of mortality underlined the weight of comorbidities on outcomes.

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

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.

scholarly journals Evaluation of endoscopic secondary prophylaxis in children and adolescents with esophageal varices

2017 ◽  
Vol 54 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Júlio Rocha PIMENTA ◽  
Alexandre Rodrigues FERREIRA ◽  
Eleonora Druve Tavares FAGUNDES ◽  
Paulo Fernando Souto BITTENCOURT ◽  
Alice Mendes MOURA ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Bleeding ◽  
Children And Adolescents ◽  
Esophageal Varices ◽  
Upper Gastrointestinal Bleeding ◽  
Secondary Prophylaxis ◽  
Gastric Fundus ◽  
Portal Hypertensive Gastropathy ◽  
Band Ligation ◽  
Upper Gastrointestinal

ABSTRACT BACKGROUND Bleeding of esophageal varices is the main cause of morbidity and mortality in children and adults with portal hypertension and there are few studies involving secondary prophylaxis in children and adolescents. OBJECTIVE To evaluate the efficacy of endoscopic secondary prophylaxis in prevention of upper gastrointestinal bleeding in children and adolescents with esophageal varices. METHODS This is a prospective analysis of 85 patients less than 18 years of age with or without cirrhosis, with portal hypertension. Participants underwent endoscopic secondary prophylaxis with sclerotherapy or band ligation. Eradication of varices, incidence of rebleeding, number of endoscopic sessions required for eradication, incidence of developing gastric fundus varices and portal hypertensive gastropathy were evaluated. RESULTS Band ligation was performed in 34 (40%) patients and sclerotherapy in 51 (60%) patients. Esophageal varices were eradicated in 81.2%, after a median of four endoscopic sessions. Varices relapsed in 38 (55.1%) patients. Thirty-six (42.3%) patients experienced rebleeding, and it was more prevalent in the group that received sclerotherapy. Gastric varices and portal hypertensive gastropathy developed in 38.7% and 57.9% of patients, respectively. Patients undergoing band ligation showed lower rebleeding rates (26.5% vs 52.9%) and fewer sessions required for eradication of esophageal varices (3.5 vs 5). CONCLUSION Secondary prophylaxis was effective in eradicating esophageal varices and controlling new upper gastrointestinal bleeding episodes due to the rupture of esophageal varices. Band ligation seems that resulted in lower rebleeding rates and fewer sessions required to eradicate varices than did sclerotherapy.

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.

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