Management of Patients with Rebleeding

Wong, Sunny H.; Sung, Joseph J.Y.

doi:10.1016/j.giec.2015.02.007

Cited by 4 publications

(3 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In case of large fibrotic ulcers, large bleeding vessels or difficult anatomic locations, duodenal bulb TTS clip therapy often requires application of several clips with a primary failure rate of up to 10 % to 20 % and a high rate of rebleeding episodes (15 %) 12. Indeed, more than 40 % of our patients had been treated with conventional methods such as TTS clip application, fibrin glue or adrenaline injection without long-lasting success before OTSC application.…”

Section: Discussionmentioning

confidence: 92%

“…Indeed, more than 40 % of our patients had been treated with conventional methods such as TTS clip application, fibrin glue or adrenaline injection without long-lasting success before OTSC application. The effectiveness of OTSC placement as a rescue method for severe upper gastrointestinal bleeding has been shown in several studies that reported a 57 % to 100 % primary success rate with rebleeding rates between 7.4 % and 42.8 % 12 13 14 15 16. In contrast to use as a rescue method, 2 studies reported on lower or even no rebleeding episodes if the OTSC was used as first-line endoscopic treatment in patients with high-risk upper gastrointestinal bleeding 17 18.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

et al. 2017

View full text Add to dashboard Cite

Background and study aims In patients taking different regimens of antithrombotic and/or anticoagulant therapy, endoscopic management of gastrointestinal bleeding represents a major challenge due to failing endogenous hemostasis. In this retrospective study we report on success rates with the over-the-scope clip (OTSC) system in upper and lower gastrointestinal bleeding in this high-risk patient population. Patients and methods Between February 2011 and June 2014, 75 patients were treated with an OTSC for active gastrointestinal bleeding. Success rates with the first endoscopic therapy, rebleeding episodes, their management and the influence of antithrombotic or anticoagulant therapy were analyzed retrospectively. Results Application of the OTSC resulted in immediate hemostasis (primary success rate) in all 75 patients. However, in 34.7 % a rebleeding episode was noted that could be treated by further endoscopic interventions. Only 3 patients had to be sent to the operating room because of failure of endoscopic therapy. In the rebleeding group the use of antiplatelet therapies was higher (73.1 % vs. 48.9 %). Conclusions Application of the OTSC in GI bleeding results in a high rate of primary hemostasis. Rebleeding occurs in up to 35 % of patients receiving antithrombotic/anticoagulant therapy but can be managed successfully with further endoscopic treatments. Patients in the rebleeding group were more frequently treated with antiplatelet agents. Radiological or surgical therapy was reserved for a small subgroup not successfully managed by repeated endoscopic therapies. OTSC application is the treatment of choice in high-risk patients when conventional clips used as first-line treatment fail.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Endoscopic therapy can control acute peptic ulcer bleeding with high success. Primary hemostasis can be obtained in more than 90% of cases, but rebleeding can occur in up to 15% of cases after therapeutic endoscopic procedure [71].…”

Section: Endoscopic Doppler Ultrasoundmentioning

confidence: 99%

Peptic Ulcer Disease

Ahmed¹

2020

Digestive System - Recent Advances

View full text Add to dashboard Cite

Peptic ulcer disease (PUD) is one of the commonest diseases seen throughout the world. There are various risk factors for the development of peptic ulcer disease, but the most important ones are Helicobacter pylori infection and nonsteroidal antiinflammatory drugs (NSAIDs). Patients generally present with dyspepsia or peptic ulcer bleeding. Acid suppressant therapy, H. pylori eradication, and avoidance of nonsteroidal anti-inflammatory drugs are the cornerstones of treatment of peptic ulcer disease. Peptic ulcer bleeding could be life-threatening. It is managed by appropriate supportive care, intravenous proton pump inhibitor therapy, and endoscopic hemostasis. Transarterial embolization (TAE) and surgery are rarely required if endoscopic therapy fails.Keywords: peptic ulcer disease, dyspepsia, H. pylori infection, peptic ulcer bleeding, endoscopic treatment of peptic ulcer bleeding H. pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) account for majority of the cases of PUD. More than 90% of duodenal ulcers and >70% of gastric ulcers are H. pylori positive [8]. A prospective study from Turkey found that H. pylori infection alone was responsible for PUD in 75% of cases, both H. pylori infection and NSAIDs in 50% of cases and NSAIDs alone in 10% of cases [9]. A Japanese study showed that the long-term use of low-dose aspirin could cause PUD in 6.2% of cases. The risk is increased in diabetic patients and in patients taking anticoagulants [9]. Both NSAIDs and aspirin inhibit the cyclooxygenase pathway and decrease the production of prostaglandin which is responsible for cytoprotection of gastric mucosa by stimulating mucus and bicarbonate secretion and increasing mucosal blood flow [10]. The chance of developing NSAID-induced PUD increases in the presence of certain risk factors which include age more than 65, heart disease, past history of PUD, and co-administration of corticosteroid, antiplatelets, and anticoagulants [11]. All NSAIDs can cause gastrointestinal injuries which include inflammation, erosions, ulcerations, and bleeding. The relative risk varies: the highest risk is associated with piroxicam and ketorolac; high risk with indomethacin and naproxen; intermediate risk with meloxicam, diclofenac, and ketoprofen; and low risk with ibuprofen and celecoxib [12]. About 11% of the US population take NSAIDs on a regular basis. 15-30% of them have PUD on endoscopy although clinical upper gastrointestinal events can occur in 1.5-4.5% of patients taking NSAIDs [13].H. pylori virulence factors are important in the pathogenesis of PUD. Cytotoxinassociated gene A (Cag A), vacuolating cytotoxin A (Vac A), and induced by contact with epithelium antigen (ice A) are associated with PUD. After entering the stomach, H. pylori utilizes its urease enzyme to neutralize the gastric acidity. H. pylori then moves toward the gastric epithelium where it binds to the gastric epithelial cell receptors by its adhesion molecule [14]. Cag A is a strong immunogenic protein and measures the virulence of H. pylori infecti...

show abstract

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

et al. 2023

View full text Add to dashboard Cite

Short designer self‐assembling peptide (dSAP) biomaterials are a new addition to the hemostat group. It may provide a diverse and robust toolbox for surgeons to integrate wound microenvironment with much safer and stronger hemostatic capacity than conventional materials and hemostatic agents. Especially in noncompressible torso hemorrhage (NCTH), diffuse mucosal surface bleeding, and internal medical bleeding (IMB), with respect to the optimal hemostatic formulation, dSAP biomaterials are the ingenious nanofiber alternatives to make bioactive neural scaffold, nasal packing, large mucosal surface coverage in gastrointestinal surgery (esophagus, gastric lesion, duodenum, and lower digestive tract), epicardiac cell‐delivery carrier, transparent matrix barrier, and so on. Herein, in multiple surgical specialties, dSAP‐biomaterial‐based nano‐hemostats achieve safe, effective, and immediate hemostasis, facile wound healing, and potentially reduce the risks in delayed bleeding, rebleeding, post‐operative bleeding, or related complications. The biosafety in vivo, bleeding indications, tissue‐sealing quality, surgical feasibility, and local usability are addressed comprehensively and sequentially and pursued to develop useful surgical techniques with better hemostatic performance. Here, the state of the art and all‐round advancements of nano‐hemostatic approaches in surgery are provided. Relevant critical insights will inspire exciting investigations on peptide nanotechnology, next‐generation biomaterials, and better promising prospects in clinics.

show abstract

Management of Patients with Rebleeding

Cited by 4 publications

References 107 publications

Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

Use of over-the-scope clips (OTSC) for hemostasis in gastrointestinal bleeding in patients under antithrombotic therapy

Peptic Ulcer Disease

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

Contact Info

Product

Resources

About