Endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding

Tanabe, Satoshi

doi:10.1111/den.14165

Cited by 3 publications

(2 citation statements)

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“…Several previous studies[ 18 - 22 ] have affirmed the therapeutic efficacy of gastrointestinal endoscopy in the management of ANVUGIB. It has been shown to significantly enhance treatment outcomes, reduce the treatment duration, and improve Hb levels.…”

Section: Discussionmentioning

confidence: 95%

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

Wang,

Shi,

Wang

et al. 2024

World J Clin Cases

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BACKGROUND Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) constitutes a prevalent emergency within Gastroenterology, encompassing 80%-90% of all gastrointestinal hemorrhage incidents. This condition is distinguished by its abrupt onset, swift progression, and notably elevated mortality rate. AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis. METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023, utilizing our medical record system. Data pertaining to general patient information, etiological factors, disease outcomes, and other relevant variables were meticulously collected and analyzed. RESULTS Among the 532 patients diagnosed with ANVUGIB, the male-to-female ratio was 2.91:1, with a higher prevalence among males. Notably, 43.6% of patients presented with black stool as their primary complaint, while 27.4% had hematemesis as their initial symptom. Upon admission, 17% of patients exhibited both hematemesis and black stool, while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding. Urgent routine blood examinations at admission revealed that 75.8% of patients had anemia, with 63.4% experiencing moderate to severe anemia, and 1.5% having extremely severe anemia (hemoglobin < 30 g/L). With regard to etiology, 53.2% of patients experienced bleeding without a definitive trigger, 24.2% had a history of using gastric mucosa-irritating medications, 24.2% developed bleeding after alcohol consumption, 2.8% attributed it to improper diet, 1.7% to emotional excitement, and 2.3% to fatigue preceding the bleeding episode. Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals, while bleeding due to alcohol consumption showed the opposite trend. Additionally, diet-related bleeding was more common among the young age group compared to the middle-aged group. Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB (73.3%), followed by gastrointestinal malignancies (10.9%), acute gastric mucous lesions (9.8%), and androgenic upper gastrointestinal bleeding (1.5%) among inpatients with ANVUGIB. Of the 532 patients with gastrointestinal bleeding, 68 underwent endoscopic hemostasis, resulting in an endoscopic treatment rate of 12.8%, with a high immediate hemostasis success rate of 94.1%. CONCLUSION ANVUGIB patients exhibit diverse characteristics across different age groups, and endoscopic hemostatic treatments have demonstrated remarkable efficacy.

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Section: Discussionmentioning

confidence: 95%

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

Wang,

Shi,

Wang

et al. 2024

World J Clin Cases

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“…Сумніви в перевагах будь-якого способу ендоскопічного гемостазу висловлюють багато хірургів, які вважають, що всі ендоскопічні методи мають рівні можливості щодо зупинки та профілактики рецидивів виразкової кровотечі, а також рівним ступенем безпеки. У той самий час комбінований гемостаз, зазвичай, ін'єкційний, разом із тепловим чи механічним впливом більшість авторів вважають найбільш ефективним, попри відсутність достовірних статистичних доказів [6].…”

Section: вступunclassified

Peculiarities of Tactics Using Endoscopic Hemostasis in Recurrent Gastrointestinal Bleeding

Ivashchenko¹,

Dudchenko²,

Kravtsiv³

et al. 2022

Act. Probl. of the Modern Med.

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At present, endoscopic haemostasis is the main method to arrest bleeding and to prevent its recurrence in patients with gastroduodenal ulcer bleeding, but there is still no consensus on the superiority of one or another method of endoscopic haemostasis. Now, according to many specialists, the recurrence of ulcer bleeding is no longer an absolute indication for surgical treatment, especially in individuals with severe somatic diseases, but serves as an indication for repeated endoscopic haemostasis. The purpose of the study was to compare the effectiveness of different methods of endoscopic haemostasis in the prevention of ulcer bleeding recurrence, as well as to study the feasibility of repeated endoscopic haemostasis in case of bleeding recurrence. The study is based on the analysis of the treatment of 268 patients with gastrointestinal bleeding who were urgently admitted to surgical departments. Primary endoscopic haemostasis was performed in 142 (52.9%) cases: argon plasma coagulation was used in 56 (39.5%) observations, the injection method was used in 47 (33%) observations, and their combination was used in 39 (27.5%) observations. According to the research data, the majority of recurrences, 34 (51.5%) cases, occurred within the first day following the admission to the hospital. The study of the probability of bleeding recurrence depending on the initial intensity (Forrest) determined that the frequency of the recurrence is statistically higher in class I-A and I-B than in II-A and II-B. Out of 66 patients with recurrent bleeding, repeated haemostasis was found to be effective in 51 (77.3%). At the same time, the efficiency of the injection method made up 60%, argon plasma coagulation was found as more effective (81.4%), and the combined approach demonstrated the highest efficacy of 94.7%. According to the results, we can suggest that in case of bleeding recurrence, repeated endoscopic haemostasis is a quite adequate alternative to the surgical treatment, especially in patients with severe somatic diseases. The use of endoscopic repeated haemostasis in case of recurrent bleeding can reliably reduce the mortality rate from 28 to 13.6%.

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Artificial Plateletoids Recruit Blood Proteins to Shield Symbiotic Thrombin: a Silk Fibroin/Calcium Interface Medicated Thrombin Generation and Preservation

Shi,

Ma,

Shan

et al. 2024

Small

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Breaking the constraints of thrombin during storage and in vivo applications remains challenging because of its low stability and sensitivity to environmental temperature and acidity. Herein, an artificial plateletoid is developed for in situ thrombin generation through a co‐incubation approach with plasma in vitro, utilizing a silk fibroin/Ca2+ interface, to enhance the activity and stability of the generated thrombin. Notably, the enzymatic activity of the plateletoid thrombin platform is as high as 30 U g−1, leading to rapid clotting within 55 s, and it persisted for at least 90 days at as high as 37 °C. This considerably lessens the difficulties associated with maintaining the cold chain while storing and shipping thrombin formulations. Additionally, a gastric bleeding model confirmed that the plateletoid platform improved the acid resistance of thrombin by upregulating the pH of the gastric environment (pH 0.8), facilitating oral delivery of thrombin for effective hemorrhage control in highly acidic stomach conditions. This pioneering study addresses the constraints of thrombin in storage and in vivo applications and may provide a basis for further research on biological storage and delivery approaches.

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Endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding

Abstract: for editing a draft of the manuscript.

Cited by 3 publications

References 12 publications

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

Peculiarities of Tactics Using Endoscopic Hemostasis in Recurrent Gastrointestinal Bleeding

Artificial Plateletoids Recruit Blood Proteins to Shield Symbiotic Thrombin: a Silk Fibroin/Calcium Interface Medicated Thrombin Generation and Preservation

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