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Tang X, Long L, Wang X, Zhou Y. Endoscopy for acute upper gastrointestinal bleeding: a protocol for systematic review and network meta-analysis of randomized controlled trials. Int J Surg Protoc 2024; 28:47-51. [PMID: 38854709 PMCID: PMC11161301 DOI: 10.1097/sp9.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/24/2023] [Indexed: 06/11/2024] Open
Abstract
Background Previous studies have reached mixed conclusions regarding the timing of endoscopic approaches for managing individuals with acute upper gastrointestinal bleeding (AUGIB). Therefore, the authors performed a protocol for systematic review and meta-analysis to assess the efficacy of various timing endoscopic approaches in managing individuals with AUGIB. Methods The authors will search multiple databases, including PubMed, Embase, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, and Chinese Clinical Trial Register. The search will cover the entire duration, starting from the establishment of these databases until July 2023. The selection criteria will focus on randomized controlled trials that assess the efficacy of endoscopy with varying timing in managing patients with AUGIB. The primary outcomes will include primary hemostasis and inpatient death. The secondary outcomes will include recurrent bleeding, need for surgical intervention, admission to the ICU, blood transfusion needs, and duration of hospitalization. Two reviewers will select the studies, extract data, and assess the risk of bias. A Bayesian approach will be used to conduct a network meta-analysis. Results The results of this systematic review and meta-analysis will be published in peer-reviewed journals. Conclusion This network meta-analysis provides comprehensive evidence of different timing endoscopic approaches for managing individuals with AUGIB.
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Affiliation(s)
- Xiaofang Tang
- Emergency Department of West China Hospital/Emergency and Trauma Nursing Department of West China Nursing School
- Institute of Disaster Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Lixi Long
- Emergency Department of West China Hospital/Emergency and Trauma Nursing Department of West China Nursing School
- Institute of Disaster Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Xiaoyun Wang
- Emergency Department of West China Hospital/Emergency and Trauma Nursing Department of West China Nursing School
- Institute of Disaster Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yiwu Zhou
- Emergency Department of West China Hospital/Emergency and Trauma Nursing Department of West China Nursing School
- Institute of Disaster Medicine, Sichuan University, Chengdu, People’s Republic of China
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Minhem MA, Nakshabandi A, Mirza R, Alsamman MA, Mattar MC. Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions. World J Gastrointest Endosc 2021; 13:391-406. [PMID: 34630889 PMCID: PMC8474699 DOI: 10.4253/wjge.v13.i9.391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/27/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal hemorrhage (GIH) is a common complication with gastrointestinal cancers (GIC). There is no comprehensive research that examines GIH in different types of GIC.
AIM To study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC.
METHODS This is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients (≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality.
RESULTS Out of a total of 18173885 inpatients, 321622 (1.77%) cases had a diagnosis of GIC. Within GIC patients, 30507 (9.5%) inpatients had GIH, which was significantly (P < 0.001) more than the prevalence of GIH in patients without GIC (3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer (15.7%), liver cancer (13.0%), small bowel cancer (12.7%), esophageal cancer (9.1%), colorectal cancer (9.1%), pancreatic cancer (7.2%), bile duct cancer (6.0%), and gallbladder cancer (5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate (15.6%) than jejunal (11.1%) and ileal cancers (5.7%). Within esophageal cancers, lower third cancers had higher GIH (10.7%) than the middle third (8.0%) or upper third cancers (6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances (Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis (P < 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios (OR) = 0.74 (0.72-0.77), P < 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267 (53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42 (0.38-0.46), P < 0.001].
CONCLUSION The prevalence of GIH in patients with GIC varies significantly based on the tumor’s anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.
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Affiliation(s)
- Mohamad A Minhem
- Internal Medicine, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Ahmad Nakshabandi
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Rabia Mirza
- School of Medicine, Georgetown University, Washington, DC 20007, United States
| | - Mohd Amer Alsamman
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Mark C Mattar
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
- School of Medicine, Georgetown University, Washington, DC 20007, United States
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Ejtehadi F, Sivandzadeh GR, Hormati A, Ahmadpour S, Niknam R, Pezeshki Modares M. Timing of Emergency Endoscopy for Acute Upper Gastrointestinal Bleeding: A Literature Review. Middle East J Dig Dis 2021; 13:177-185. [PMID: 36606214 PMCID: PMC9489462 DOI: 10.34172/mejdd.2021.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/02/2021] [Indexed: 01/07/2023] Open
Abstract
Upper gastrointestinal (GI) bleeding is a common cause for Emergency Department and hospital admissions and has significant mortality and morbidity if it remains untreated. Upper endoscopy is the key procedure for both diagnosis and treatment of acute upper GI bleeding. The aim of this article is to review the optimal timing of endoscopy in patients with acute upper GI bleeding. The cost-effectiveness and the influence of urgent or emergent endoscopy on patients' outcomes are discussed. Also, we compare and contrast the available evidence and guidelines regarding the recommended time points for performing endoscopy in different clinical settings.
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Affiliation(s)
- Fardad Ejtehadi
- Associate Professor of Medicine, Gastroentrohepatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Sivandzadeh
- Assistant Professor of Medicine, Gatroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
,Corresponding Author: Gholam Reza Sivandzadeh, MD Department of Internal Medicine, Gasteroenetrohepatology Research Center, Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Namazi Hospital, Zand St., Shiraz, 7193711351, Fars, Iran. Tel: + 98 711 6473236 Fax: + 98 711 6474316
| | - Ahmad Hormati
- Assistant professor of Gastroenterology, Gastrointestinal and Liver Diseases Research Center, Firozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Sajjad Ahmadpour
- Assistant Professor of Radiopharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Ramin Niknam
- Associate Professor of Medicine, Gatroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahdi Pezeshki Modares
- Assistant professor of Gastroenterology, Gastrointestinal and Liver Diseases Research Center, Firozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Akin M, Alkan E, Tuna Y, Yalcinkaya T, Yildirim B. Comparison of heater probe coagulation and argon plasma coagulation in the management of Mallory–Weiss tears and high-risk ulcer bleeding. Arab J Gastroenterol 2017; 18:35-38. [DOI: 10.1016/j.ajg.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 10/28/2016] [Accepted: 12/23/2016] [Indexed: 12/24/2022]
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Changela K, Papafragkakis H, Ofori E, Ona MA, Krishnaiah M, Duddempudi S, Anand S. Hemostatic powder spray: a new method for managing gastrointestinal bleeding. Therap Adv Gastroenterol 2015. [PMID: 26082803 DOI: 10.1177/1756283x1557258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Gastrointestinal bleeding is a leading cause of morbidity and mortality in the United States. The management of gastrointestinal bleeding is often challenging, depending on its location and severity. To date, widely accepted hemostatic treatment options include injection of epinephrine and tissue adhesives such as cyanoacrylate, ablative therapy with contact modalities such as thermal coagulation with heater probe and bipolar hemostatic forceps, noncontact modalities such as photodynamic therapy and argon plasma coagulation, and mechanical hemostasis with band ligation, endoscopic hemoclips, and over-the-scope clips. These approaches, albeit effective in achieving hemostasis, are associated with a 5-10% rebleeding risk. New simple, effective, universal, and safe methods are needed to address some of the challenges posed by the current endoscopic hemostatic techniques. The use of a novel hemostatic powder spray appears to be effective and safe in controlling upper and lower gastrointestinal bleeding. Although initial reports of hemostatic powder spray as an innovative approach to manage gastrointestinal bleeding are promising, further studies are needed to support and confirm its efficacy and safety. The aim of this study was to evaluate the technical feasibility, clinical efficacy, and safety of hemostatic powder spray (Hemospray, Cook Medical, Winston-Salem, North Carolina, USA) as a new method for managing gastrointestinal bleeding. In this review article, we performed an extensive literature search summarizing case reports and case series of Hemospray for the management of gastrointestinal bleeding. Indications, features, technique, deployment, success rate, complications, and limitations are discussed. The combined technical and clinical success rate of Hemospray was 88.5% (207/234) among the human subjects and 81.8% (9/11) among the porcine models studied. Rebleeding occurred within 72 hours post-treatment in 38 patients (38/234; 16.2%) and in three porcine models (3/11; 27.3%). No procedure-related adverse events were associated with the use of Hemospray. Hemospray appears to be a safe and effective approach in the management of gastrointestinal bleeding.
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Affiliation(s)
- Kinesh Changela
- Division of Gastroenterology, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
| | - Haris Papafragkakis
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Emmanuel Ofori
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Mel A Ona
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Mahesh Krishnaiah
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sushil Duddempudi
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sury Anand
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Changela K, Papafragkakis H, Ofori E, Ona MA, Krishnaiah M, Duddempudi S, Anand S. Hemostatic powder spray: a new method for managing gastrointestinal bleeding. Therap Adv Gastroenterol 2015; 8:125-35. [PMID: 26082803 PMCID: PMC4454021 DOI: 10.1177/1756283x15572587] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Gastrointestinal bleeding is a leading cause of morbidity and mortality in the United States. The management of gastrointestinal bleeding is often challenging, depending on its location and severity. To date, widely accepted hemostatic treatment options include injection of epinephrine and tissue adhesives such as cyanoacrylate, ablative therapy with contact modalities such as thermal coagulation with heater probe and bipolar hemostatic forceps, noncontact modalities such as photodynamic therapy and argon plasma coagulation, and mechanical hemostasis with band ligation, endoscopic hemoclips, and over-the-scope clips. These approaches, albeit effective in achieving hemostasis, are associated with a 5-10% rebleeding risk. New simple, effective, universal, and safe methods are needed to address some of the challenges posed by the current endoscopic hemostatic techniques. The use of a novel hemostatic powder spray appears to be effective and safe in controlling upper and lower gastrointestinal bleeding. Although initial reports of hemostatic powder spray as an innovative approach to manage gastrointestinal bleeding are promising, further studies are needed to support and confirm its efficacy and safety. The aim of this study was to evaluate the technical feasibility, clinical efficacy, and safety of hemostatic powder spray (Hemospray, Cook Medical, Winston-Salem, North Carolina, USA) as a new method for managing gastrointestinal bleeding. In this review article, we performed an extensive literature search summarizing case reports and case series of Hemospray for the management of gastrointestinal bleeding. Indications, features, technique, deployment, success rate, complications, and limitations are discussed. The combined technical and clinical success rate of Hemospray was 88.5% (207/234) among the human subjects and 81.8% (9/11) among the porcine models studied. Rebleeding occurred within 72 hours post-treatment in 38 patients (38/234; 16.2%) and in three porcine models (3/11; 27.3%). No procedure-related adverse events were associated with the use of Hemospray. Hemospray appears to be a safe and effective approach in the management of gastrointestinal bleeding.
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Affiliation(s)
- Kinesh Changela
- Division of Gastroenterology, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA
| | - Haris Papafragkakis
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Emmanuel Ofori
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Mel A Ona
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Mahesh Krishnaiah
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sushil Duddempudi
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sury Anand
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
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7
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Li ZQ, Linghu EQ, Hu M, Wang XD, Wang HB, Meng JY, Du H. Endoscopic measurement of variceal diameter. World J Gastroenterol 2015; 21:2140-6. [PMID: 25717249 PMCID: PMC4326151 DOI: 10.3748/wjg.v21.i7.2140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/24/2014] [Accepted: 09/18/2014] [Indexed: 02/06/2023] Open
Abstract
AIM To measure in vitro diameter of imitational varices using a self-made endoscopic scale and confirm its accuracy and clinical feasibility. METHODS A catheter was introduced into the endoscope accessory channel and attached to a zebra wire guide that was used as a stylet. The wire guide was fixed onto the tip of the catheter by a soft and thin string. By gently advancing the stylet into the catheter, the width of the opening loop at the tip of the endoscope approximated the diameter of the imitational varices. Measurements performed in vitro using this self-made endoscopic ruler were compared to measurements of simulative varices. RESULTS At the handle, the sleeve moving distance ranged from 5 to 14 mm. There was no obvious proportional relationship between the sleeve movement distance and endoscopic measurement ruler. The results indicated that the gap between the endoscopic measurement and actual measurement of the object size tended to close. The in vitro measurement of the diameter of the simulative varices showed that the two kinds of measuring methods were not significantly different with respect to their accuracy (P=0.8499). CONCLUSION In vitro experiments confirmed that using a self-designed endoscopic ruler to measure the diameter of simulative varices was objective, accurate and feasible.
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8
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Hongsakul K, Pakdeejit S, Tanutit P. Outcome and predictive factors of successful transarterial embolization for the treatment of acute gastrointestinal hemorrhage. Acta Radiol 2014; 55:186-94. [PMID: 23904090 DOI: 10.1177/0284185113494985] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Transarterial embolization (TAE) is an effective procedure for the treatment of acute gastrointestinal bleeding (GIB). Factors associated with clinical success have not been well delineated. PURPOSE To evaluate the technical and clinical successes of TAE for acute GIB in order to identify factors influencing clinical success and in-hospital mortality. MATERIAL AND METHODS This was a retrospective study of 70 consecutive patients with GIB who underwent angiography and embolization between January 2004 and December 2011. The technical success rate, clinical success rate, and in-hospital mortality were calculated by percentage. Clinical parameters, angiographic, and embolization data were assessed for factors influencing clinical success and in-hospital survival using univariate and multivariate analysis. Statistical significance was set at P value <0.05. RESULTS The technical success rate was 98.6%. The primary clinical success rate was 71.4% and the secondary clinical success rate after repeat embolization was 78.6%. Bowel infarction was the most serious complication of three (4.3%) patients. Failure to achieve 30-day hemostasis can be predicted in patients who have one or more of the following factors: hemoglobin concentration <8 g/dL (P = 0.004), coagulopathy (P = 0.005), upper GIB (P = 0.02), contrast extravasation (P = 0.012), and more than one embolized vessel (P = 0.005). In-hospital survival is affected by the amount of transfused packed red blood cells before embolization (P = 0.008) and post-embolization bowel infarction (P = 0.005). CONCLUSION TAE is a feasible and effective management of acute GIB with high technical and clinical success rates. The factors influencing clinical success include hemoglobin concentration, coagulopathy, upper GIB, contrast extravasation, and more than one embolized vessel. The number of units of transfused packed red blood cells and post-embolization bowel infarction are important factors associated with in-hospital mortality.
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Affiliation(s)
- Keerati Hongsakul
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Songklod Pakdeejit
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pramot Tanutit
- Division of Interventional Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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9
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Endoscopic management of gastrointestinal bleeding in pediatrics. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2012.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kato M, Jung Y, Gromski MA, Chuttani R, Matthes K. Prospective, randomized comparison of 3 different hemoclips for the treatment of acute upper GI hemorrhage in an established experimental setting. Gastrointest Endosc 2012; 75:3-10. [PMID: 22196807 DOI: 10.1016/j.gie.2011.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/03/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recently, endoscopic clip application devices have undergone redesign and improvements to optimize their clinical use and effectiveness. Initially designed for the treatment of bleeding nonvariceal lesions, these devices are also increasingly used for the closure of perforations, fistulas, and anastomotic leaks. Several clinical studies, both randomized and nonrandomized, have used endoscopic hemoclips for hemostasis. However, no comparative studies have yet been reported in the literature comparing the latest endoscopic clip devices for usability and effectiveness for hemostasis of acute upper GI hemorrhage. OBJECTIVE We aimed to compare the usability and efficacy of 3 different types of endoscopic clip application devices in an established experimental setting by using a porcine ex-vivo simulator of upper GI hemorrhage. DESIGN Randomized, controlled, ex-vivo study. SETTING Academic medical center. METHODS Spurting vessels were created within ex-vivo porcine stomachs as published in prior studies. The vessels were attached to a pressure transducer to record the pressure of the circulating blood replacement. Before the initiation of bleeding, each vessel was randomized to 1 of 3 endoscopic clipping devices: 2 different commonly used hemoclips deployed through the working channel and 1 novel clip deployed via an over-the-scope applications device. Two investigators treated 45 bleeding sites (15 bleeding sites for each device at various randomized locations in the stomach: fundus, body, and antrum). MAIN OUTCOME MEASUREMENTS Usability was measured via the endpoints of procedure time and quantity of clips required to achieve hemostasis. Efficacy was measured via the endpoint of pressure increase (Δp) from baseline to after treatment. RESULTS All of the 45 hemostasis treatments were carried out successfully. The mean procedure times were significantly different among the hemoclips, with the clip deployed in an over-the-scope fashion requiring significantly less time to attain hemostasis compared with the other 2 clips. For number of clips needed to attain hemostasis, the clip deployed in an over-the-scope fashion was significantly superior to the others. There were also significant differences among the changes in pressure (Δp ± SD) among the different hemoclips tested. LIMITATIONS Ex-vivo study. CONCLUSIONS In this prospective, randomized ex-vivo study, we observed significant differences in the usability (time to achieve hemostasis and number of clips required) and the efficacy (change in pressure achieved by the hemoclips) among the 3 clips. The clip applied in the over-the-scope fashion was superior to the other 2 tested clips with regard to time to achieve hemostasis and number of clips required.
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Affiliation(s)
- Masayuki Kato
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Haznedaroglu BZ, Beyazit Y, Walker SL, Haznedaroglu IC. Pleiotropic cellular, hemostatic, and biological actions of Ankaferd hemostat. Crit Rev Oncol Hematol 2011; 83:21-34. [PMID: 22079213 DOI: 10.1016/j.critrevonc.2011.10.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 07/21/2011] [Accepted: 10/20/2011] [Indexed: 01/06/2023] Open
Abstract
Sustaining hemostasis in clinical hemorrhages is a challenging task and requires extensive effort to stabilize medically hard-to-treat traumatic injuries. Several hemostatic agents are preferred to control external and internal bleedings, yet commercially available products are not sufficiently effective or fast-acting to achieve hemostasis in extreme cases. Ankaferd Blood Stopper (ABS) is a herbal extract traditionally used as a hemostatic agent. Recent studies have shown that ABS could be utilized successfully as a hemostatic agent for the management of clinical hemorrhages when conventional methods were ineffective. This review serves as a basis to provide recent findings on several applications of ABS, specifically preclinical, biological, and clinical studies both in vitro and in vivo. Another section focuses on the ultrastructural morphology and protein network formation of ABS in an effort to understand the hemostatic mechanisms of this unique agent at tissue level.
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Affiliation(s)
- Berat Z Haznedaroglu
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT 06511, USA
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12
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Karaman A, Baskol M, Gursoy S, Torun E, Yurci A, Ozel BD, Guven K, Ozbakir O, Yucesoy M. Epinephrine plus argon plasma or heater probe coagulation in ulcer bleeding. World J Gastroenterol 2011; 17:4109-12. [PMID: 22039325 PMCID: PMC3203362 DOI: 10.3748/wjg.v17.i36.4109] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/28/2011] [Accepted: 03/07/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the effectiveness of argon plasma coagulation (APC) and heater probe coagulation (HPC) in non-variceal upper gastrointestinal bleeding.
METHODS: Eighty-five (18 female, 67 male) patients admitted for acute gastrointestinal bleeding due to gastric or duodenal ulcer were included in the study. Upper endoscopy was performed and HPC or APC were chosen randomly to stop the bleeding. Initial hemostasis and rebleeding rates were primary and secondary end-points of the study.
RESULTS: Initial hemostasis was achieved in 97.7% (42/43) and 81% (36/42) of the APC and HPC groups, respectively (P < 0.05). Rebleeding rates were 2.4% (1/42) and 8.3% (3/36) in the APC and HPC groups, respectively, at 4 wk (P > 0.05).
CONCLUSION: APC is an effective hemostatic method in bleeding peptic ulcers. Larger multicenter trials are necessary to confirm these results.
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Beyazit Y, Kekilli M, Haznedaroglu IC, Kayacetin E, Basaranoglu M. Ankaferd hemostat in the management of gastrointestinal hemorrhages. World J Gastroenterol 2011; 17:3962-70. [PMID: 22046083 PMCID: PMC3199553 DOI: 10.3748/wjg.v17.i35.3962] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/01/2011] [Accepted: 03/08/2011] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) bleeding refers to any hemorrhage ascribed to the pathologies of the gastrointestinal tract, extending from the mouth to the anal canal. Despite the recent improvements in the endoscopic, hemostatic and adjuvant pharmacologic techniques, the reported mortality is still around 5%-10% for peptic ulcer bleeding and about 15%-20% for variceal hemorrhages. Although endoscopic management reduces the rates of re-bleeding, surgery, and mortality in active bleeding; early recurrence ratios still occur in around 20% of the cases even with effective initial hemostatic measures. In this quest for an alternative pro-hemostatic agent for the management of GI bleedings, Ankaferd blood stopper (ABS) offers a successful candidate, specifically for “difficult-to-manage” situations as evidenced by data presented in several studies. ABS is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia officinarum, and Urtica dioica. It is effective in both bleeding individuals with normal hemostatic parameters and in patients with deficient primary and/or secondary hemostasis. ABS also modulates the cellular apoptotic responses to hemorrhagic stress, as well as hemostatic hemodynamic activity. Through its effects on the endothelium, blood cells, angiogenesis, cellular proliferation, vascular dynamics, and wound healing, ABS is now becoming an effective alternative hemostatic medicine for gastrointestinal bleedings that are resistant to conventional anti-hemorrhagic measurements. The aim of this review is to outline current literature experience suggesting the place of ABS in the management of GI bleeding, and potential future controlled trials in this complicated field.
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Jovanovic I, Vormbrock K, Wilcox CM, Mönkemüller K. Therapeutic and interventional endoscopy for gastrointestinal bleeding. Eur J Trauma Emerg Surg 2011; 37:339-51. [PMID: 26815271 DOI: 10.1007/s00068-011-0125-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 05/25/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Gastrointestinal (GI) bleeding remains a common clinical problem encountered by every emergency room and trauma physician. Endoscopy remains the main approach to the diagnosis and therapy of GI bleeding. OBJECTIVES To present the modern endoscopic approach for GI bleeding. METHODS Narrative review based on our expertise and inclusion of classic articles dealing with interventional and therapeutic GI endoscopy. RESULTS GI hemorrhage is now classified as upper, middle, and lower GI bleeding. Upper GI bleeding is defined as hemorrhage originating from the oropharynx to the ligament of Treitz (or papilla of Vater), middle GI bleeding occurs distal to the papilla of Vater to the terminal ileum, and lower GI bleeding is defined as bleeding distal to the ileocecal valve, including the entire colon and anorectum. Endoscopic methods used to diagnosed and treat GI bleeding include esophagogastroduodenoscopy, duodenoscopy, capsule endoscopy, double- and single-balloon enteroscopy, spiral enteroscopy, and colonosocopy. CONCLUSIONS This is the first review paper dedicated to endoscopic therapy for bleeding involving any part of the luminal GI tract (i.e., esophagus, stomach, small bowel, and colon). Modern endoscopy permits the investigation and treatment of the majority of conditions affecting the entire hollow GI tract.
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Affiliation(s)
- I Jovanovic
- Department of Internal Medicine and Gastroenterology, Marienhospital, Josef-Albers-Str. 70, 46236, Bottrop, Germany.,Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - K Vormbrock
- Department of Internal Medicine and Gastroenterology, Marienhospital, Josef-Albers-Str. 70, 46236, Bottrop, Germany
| | - C M Wilcox
- Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K Mönkemüller
- Department of Internal Medicine and Gastroenterology, Marienhospital, Josef-Albers-Str. 70, 46236, Bottrop, Germany. .,Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Division of Gastroenterology and Hepatology, University of Magdeburg, Magdeburg, Germany.
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Murinello A, Damásio H, Figueiredo A, Netta J, Carvalho A, Matos A, Murillo M, Albuquerque A. Estômago em melancia, pericardite hemorrágica, tumor de pequenas células do pulmão e carcinoma pavimentocelular síncrono da base da língua. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30060-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Coumaros D, Tsesmeli N. Active gastrointestinal bleeding: Use of hemostatic forceps beyond endoscopic submucosal dissection. World J Gastroenterol 2010; 16:2061-4. [PMID: 20419846 PMCID: PMC2860086 DOI: 10.3748/wjg.v16.i16.2061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To the best of our knowledge, this is the first report of the application of hemostatic forceps in active gastrointestinal (GI) bleeding that is not related to endoscopic submucosal dissection. An 86-year-old woman with chronic intake of low-dose aspirin had a Dieulafoy’s lesion of the third duodenal portion. Bleeding control with epinephrine injection was unsuccessful. A 60-year-old man presented with a bleeding ulcer in the duodenal bulb. Ten days after combined endotherapy, he had recurrent bleeding from two minimal lesions in the same location. A 66-year-old woman under combined antithrombotic treatment was referred to us for chronic GI bleeding of unexplained origin. Endoscopy revealed active diverticular bleeding in the second duodenal portion. A 61-year-old woman underwent endoscopic mucosal resection of superficial gastric adenocarcinoma, which was complicated with immediate bleeding. In all cases, the blood was washed out using a water-jet-equipped, single-channel gastroscope with a large working channel. The bleeding points were pinched and retracted with hemostatic forceps. Monopolar electrocoagulation was performed using an electrosurgical current generator. Hemostasis was achieved. No complications occurred. In conclusion, hemostatic forceps may be an effective as well as safe alternative approach for active GI bleeding of various origins.
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Mathews JC, Chin MS, Fernandez-Esparrach G, Shaikh SN, Pietramaggiori G, Scherer SS, Ryan MB, Ferrigno M, Orgill DP, Thompson CC. Early healing of transcolonic and transgastric natural orifice transluminal endoscopic surgery access sites. J Am Coll Surg 2010; 210:480-90. [PMID: 20347741 DOI: 10.1016/j.jamcollsurg.2010.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 01/04/2010] [Accepted: 01/06/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a developing, minimally invasive surgical approach whose potential benefits are being investigated. Little is known about secure access site closure and early healing kinetics of transvisceral access. STUDY DESIGN Transvisceral access incisions were created in the colon (C-NOTES, n = 8) and stomach (G-NOTES, n = 8) for peritoneal exploration. Incisions were closed primarily with endoloops, endoclips, or t-tags. Macroscopic and histologic analyses performed on postoperative day 7 assessed gross appearance, granulation tissue, inflammation, ulceration, and complications. RESULTS Macroscopically, incisions appeared closed without intraperitoneal spillage. Incisions closed by endoloop and t-tags showed intense granulation tissue fill of defect despite partial (G-NOTES, n = 3) and transmural ulceration (C-NOTES, n = 8; G-NOTES, n = 3). Of the 30 t-tags applied, 40% broke or deployed into the peritoneal cavity. Endoclip closures (C-NOTES, n = 1; G-NOTES, n = 1) did not show histologic mucosal continuity. Healing complications included transmural necrosis (C-NOTES, n = 1; G-NOTES, n = 1), foreign body material (C-NOTES, n = 3; G-NOTES, n = 2), and microabscesses (G-NOTES, n = 1). CONCLUSIONS This study provides a reproducible model to assess noninvasive repair of planned visceral perforations. Of investigated technologies, endoloop closure was favored for transcolonic incisions, and t-tags with omental patch for transgastric incisions, although these have significant limitations. Endoclips were inadequate for primary closure, but may be useful as an adjunctive closure modality. Additional studies are needed to examine visceral repair at later time points, as they will help determine the quality and kinetics of repair of a variety of incision closure strategies. This study demonstrates the need for improved technologies to more reliably close visceral transluminal defects.
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Affiliation(s)
- Jasmine C Mathews
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Abstract
Endoscopy is the primary diagnostic and therapeutic tool for upper gastrointestinal bleeding (UGIB). The performance of endoscopic therapy depends on findings of stigmata of recent hemorrhage (SRH). For peptic ulcer disease-the most common etiology of UGIB-endoscopic therapy is indicated for findings of major SRH, such as active bleeding, oozing, or the presence of a nonbleeding visible vessel, but not indicated for minor SRH, such as a pigmented flat spot or a simple ulcer with a homogeneous clean base. Endoscopic therapies include injection, ablation, and mechanical therapy. Monotherapy reduces the risk of rebleeding in patients with peptic ulcer disease with major SRH to about 20%. Combination therapy, especially injection followed by either ablation or mechanical therapy, is generally recommended to further reduce the risk of rebleeding to about 10%. Endoscopic dual hemostasis by an experienced endoscopist reduces the risk of rebleeding, the need for surgery, the number of blood transfusions required, and the length of hospital stay. This Review article comprehensively analyzes the principles, indications, instrumentation, techniques, and efficacy of endoscopic hemostasis.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, MOB 233, William Beaumont Hospital, 3535 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Cappell MS. A resident or fellow's dilemma: a medically incorrect order by a direct clinical supervisor. Dig Dis Sci 2010; 55:212-4. [PMID: 19160048 DOI: 10.1007/s10620-008-0690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 12/23/2008] [Indexed: 12/09/2022]
Abstract
The relative medicolegal responsibilities of residents or fellows versus attendings in the care of service patients have been well studied, but the subject of how a resident or fellow can protest or refuse an order believed to be medically wrong or contraindicated is unstudied and unknown. Two cases are reported in which a gastroenterology fellow was ordered by an attending to perform or assist in invasive procedures believed to be either contraindicated because of patient instability or unambiguously not indicated according to established procedure guidelines. These two novel cases highlight the dilemma encountered by a resident or fellow with regard to obeying an improper order to avoid complaining about an attending versus disobeying such an order to comply with the Hippocratic Oath of doing no harm. Although the reported cases involved gastroenterology fellows, this type of problem can occur during any medical residency or fellowship. These case reports suggest the need for a hospital-based administrative policy and mechanism to resolve such conflicts fairly, without confrontation, resident intimidation, or career consequences.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, MOB 233, William Beaumont Hospital, 3535 Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Current World Literature. Curr Opin Support Palliat Care 2009; 3:79-82. [DOI: 10.1097/spc.0b013e3283277013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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