Urgent vs. Non-Urgent Endoscopy in Stable Acute Variceal Bleeding

Cheung, Justin; Soo, Isaac; Bastiampillai, Ravin; Zhu, Qiaohao; Ma, Mang

doi:10.1038/ajg.2009.78

Cited by 61 publications

(65 citation statements)

References 17 publications

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“…3,4 In a retrospective study of patients who came with acute variceal bleeding but were hemodynamically stable, there was no significant difference in mortality in patients with endoscopy performed within 4 hours versus 8 hours or 12 hours. 5 In contrast, another study which found delayed endoscopy (endoscopy time > 15 hours) as a risk factor for increase mortality in acute variceal bleeding. 6 It is our opinion that the urgency is dictated by the severity of bleeding and the clinical setting.…”

Section: Endoscopic Diagnosis Of Variceal Hemorrhagementioning

confidence: 97%

Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding

Kapoor

Dharel

Sanyal

2015

Gastrointestinal Endoscopy Clinics of North America

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Gastroesophageal variceal hemorrhage is a medical emergency with high morbidity and mortality. Endoscopic therapy is the mainstay of management of bleeding varices. It requires attention to technique and the appropriate choice of therapy for a given patient at a given point in time. Subjects must be monitored continuously after initiation of therapy for control of bleeding and second line definitive therapies introduced quickly if endoscopic and pharmacologic treatment fails.

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Section: Endoscopic Diagnosis Of Variceal Hemorrhagementioning

confidence: 97%

Endoscopic Diagnosis and Therapy in Gastroesophageal Variceal Bleeding

Kapoor

Dharel

Sanyal

2015

Gastrointestinal Endoscopy Clinics of North America

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“…This is even more vital in patients admitted with hematemesis in whom the importance of early endoscopy is paramount. 22 Indeed, risk factors for inhospital mortality in patients with AVB not only include delayed endoscopy but also failure of first endoscopy, hematemesis, and severity of cirrhosis. If the application of hemostatic powder, through its simplicity, could reduce the proportion of delayed endoscopies, it would compare favorably with the best series reported to date 23 in terms of immediate hemostasis and failure to control bleeding.…”

Section: Discussionmentioning

confidence: 99%

Management of acute variceal bleeding using hemostatic powder

et al. 2015

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Background and objectives: This study aimed to test the safety and efficacy of Hemospray Õ for emergency control of acute variceal bleeding (AVB) due to portal hypertension in cirrhotic patients. Patients and methods: This single-arm, prospective trial, conducted at two hospitals in Belgium and Egypt, included patients admitted to the emergency room with hematemesis and/or melena and known or suspected liver cirrhosis. All patients received urgent hemodynamic stabilization, octreotide (50 mcg bolus then 25 mcg/hour for 24 hours) and intravenous ceftriaxone (1 g/hour). Endoscopy to confirm AVB and Hemospray Õ application (if indicated) was performed within six hours of admission. Patients were kept under observation for 24 hours and underwent second endoscopy and definitive therapy (band ligation and/or cyanoacrylate injection in cases of gastric varices) the next day. Results: Thirty-eight patients were admitted for suspected AVB, and 30 of these had confirmed AVB (70% male; mean age 59.5 years (range, 32.0-73 years)). Child-Pugh class C liver disease was present in 53.4%. Esophageal varices were observed in 83.4% of patients, gastric varices in 10%, and duodenal varices in 6.6%. Spurting bleeding at the time of endoscopy was observed in 43.4%. One patient developed hematemesis six hours after Hemospray Õ application and underwent emergency endoscopic band ligation. No major adverse events or mortalities were observed during 15-day follow-up. Conclusion: Hemospray Õ application was safe and effective at short-term follow-up for emergency treatment of AVB in cirrhotic patients.

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“…Second, because the sample size of our two cohorts can be considered as limited. However, it is in the range of previous published series where the number of patients included per year is compared [9,27,30]; furthermore, the substantial number of events (rebleeding and death) at six months allowed us to investigate through multivariate analysis the therapeutic changes observed during this last decade that significantly impact on survival. Finally, the non-use of early TIPS in our second period allows us to better evaluate the importance of the appropriate use of medical resources, available anywhere, to treat VB.…”

Section: Discussionmentioning

confidence: 99%