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Abosheaishaa H, Abdallfatah A, Ahmed OT, Elfert K, Mohamed I, AlabdulRazzak I, Abdalla M, Sethi A, Abdelhalim O, Gayam VR, Eskaros S, Boulay B. The efficacy of Hemospray in managing bleeding related to gastrointestinal tumors: systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2024:00042737-990000000-00391. [PMID: 39012642 DOI: 10.1097/meg.0000000000002828] [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] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Gastrointestinal (GI) bleeding stemming from malignant tumors is increasingly recognized, due to advancements in oncology and detection methods. Traditional endoscopic hemostatic techniques have shown variable success rates in managing hemorrhagic GI neoplasms. Hemospray, an emerging endoscopic hemostatic powder, offers promise in treating upper GI bleeding, potentially extending its utility to neoplastic bleeding sites. This meta-analysis aims to evaluate Hemospray's efficacy in managing bleeding related to GI tumors. METHODS We searched Embase, Scopus, Web of Science, Medline/PubMed, and Cochrane. Inclusion criteria encompassed studies focusing on malignancy-related GI bleeding and interventions utilizing Hemospray. Comparative studies contrasted Hemospray with standard endoscopic treatments (SET), while noncomparative studies assessed Hemospray's efficacy independently. The risk of bias was assessed using appropriate tools, and statistical analyses were performed using Review Manager and open Meta analyst software. RESULTS We included 19 studies in our meta-analysis. Hemospray demonstrated higher rates of immediate hemostasis compared to SET (odds ratio: 17.14, 95% confidence interval: 4.27-68.86), with consistent outcomes across studies. Rebleeding rates at 14 and 30 days were comparable between Hemospray and SET groups, suggesting similar efficacy in long-term hemostasis. Hemospray showed a significantly lower need for nonendoscopic hemostasis compared to SET (odds ratio: 0.51, 95% confidence interval: 0.30-0.87), indicating a potential reduction in supplementary interventions. Safety assessments revealed no confirmed adverse events directly linked to Hemospray. CONCLUSION This meta-analysis highlights Hemospray's efficacy in achieving immediate hemostasis in GI tumor-related bleeding, with potential benefits in reducing supplementary interventions and improving patient outcomes. Despite comparable rebleeding rates, Hemospray emerges as a valuable adjunctive therapy in managing malignant GI bleeding.
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Affiliation(s)
- Hazem Abosheaishaa
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals Queens, New York City, New York, USA
| | | | - Omar T Ahmed
- Department of Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, Illinois
| | - Khaled Elfert
- Department of Internal Medicine, St. Barnabas Hospital Health System, New York City, New York
| | - Islam Mohamed
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Kansas
| | - Iyiad AlabdulRazzak
- Department of Internal Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Monzer Abdalla
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, Illinois
| | - Arashi Sethi
- Department of Internal Medicine, Icahn school of medicine at Mount Sinai NYC H&H/Queens
| | - Omar Abdelhalim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai | Queens Hospital Center, New York City, New York
| | - Vijay Reddy Gayam
- Department of Internal Medicine, University of southwestern Medical Center, Dallas, Texas
| | - Saphwat Eskaros
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Brian Boulay
- Department of Gastroenterology and Hepatology, University of Illinois Hospital & Health Sciences System, Illinois, Chicago, USA
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Shah ED, Law R. Valuing innovative endoscopic techniques: hemostatic powder for the treatment of GI tumor bleeding. Gastrointest Endosc 2024; 100:49-54. [PMID: 38184119 DOI: 10.1016/j.gie.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/18/2023] [Accepted: 12/25/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIMS Access to new endoscopic treatment modalities often depends on price. To resolve this gap and therefore help to ensure that care delivery can occur on a clinical basis, we aimed to establish the value to insurers of novel hemostatic powder to treat GI tumor bleeding. METHODS A decision-analytic model developed to assess the impact of endoscopic intervention on the risk of 30-day readmission for GI bleeding from an insurer perspective was adapted to assess GI tumor bleeding with hemostatic powder or standard endoscopic therapy. Costs were derived from Medicare populations. Outcomes were derived from a recent multicenter randomized clinical trial. RESULTS Costs ranged from $651 to $1613 to treat upper GI tumor bleeding and from $531 to $1014 to treat lower GI tumor bleeding based on risk reduction in 30-day hospital readmission for recurrent bleeding. These valuations should represent medical device and incremental facility costs in addition to incremental physician and staff time. CONCLUSIONS Coverage for novel endoscopic hemostatic powder therapy seems cost-saving to insurers.
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Affiliation(s)
- Eric D Shah
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Ryan Law
- Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA
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Allo G, Lang S, Martin A, Bürger M, Zhang X, Chon SH, Nierhoff D, Töx U, Goeser T, Kasper P. Learning curve of achieving competency in emergency endoscopy in upper gastrointestinal bleeding: how much experience is necessary? BMJ Open Gastroenterol 2024; 11:e001281. [PMID: 38458629 PMCID: PMC10921515 DOI: 10.1136/bmjgast-2023-001281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/16/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES The management of upper gastrointestinal bleeding (UGIB) has seen rapid advancements with revolutionising innovations. However, insufficient data exist on the necessary number of emergency endoscopies needed to achieve competency in haemostatic interventions. DESIGN We retrospectively analysed all oesophagogastroduodenoscopies with signs of recent haemorrhage performed between 2015 and 2022 at our university hospital. A learning curve was created by plotting the number of previously performed oesophagogastroduodenoscopies with signs of recent haemorrhage against the treatment failure rate, defined as failed haemostasis, rebleeding and necessary surgical or radiological intervention. RESULTS The study population included 787 cases with a median age of 66 years. Active bleeding was detected in 576 cases (73.2%). Treatment failure occurred in 225 (28.6%) cases. The learning curve showed a marked decline in treatment failure rates after nine oesophagogastroduodenoscopies had been performed by the respective endoscopists followed by a first plateau between 20 and 50 procedures. A second decline was observed after 51 emergency procedures followed by a second plateau. Endoscopists with experience of <10 emergency procedures had higher treatment failure rates compared with endoscopists with >51 emergency oesophagogastroduodenoscopies performed (p=0.039) or consultants (p=0.041). CONCLUSIONS Our data suggest that a minimum number of 20 oesophagogastroduodenoscopies with signs of recent haemorrhage is necessary before endoscopists should be considered proficient to perform emergency procedures independently. Endoscopists might be considered as advanced-qualified experts in managing UGIB after a minimum of 50 haemostatic procedure performed. Implementing recommendations on minimum numbers of emergency endoscopies in education programmes of endoscopy trainees could improve their confidence and competency in managing acute UGIB.
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Affiliation(s)
- Gabriel Allo
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sonja Lang
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Martin
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Bürger
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Xinlian Zhang
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Seung-Hun Chon
- Department of General, Visceral and Cancer and Transplant Surgery, University of Cologne, Cologne, Germany
| | - Dirk Nierhoff
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ulrich Töx
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Kasper
- Department of Gastroenterology and Hepatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Gajendran M, Loganathan P, Echavarria J. Hemostatic Powder in Gastrointestinal Tumor Bleeding: Are We There Yet? Gastroenterology 2024; 166:226. [PMID: 37414195 DOI: 10.1053/j.gastro.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Affiliation(s)
| | | | - Juan Echavarria
- Long School of Medicine, Health Science Center, University of Texas at San Antonio, San Antonio, Texas
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Pittayanon R, Barkun A. Reply. Gastroenterology 2024; 166:226-227. [PMID: 37866764 DOI: 10.1053/j.gastro.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Alan Barkun
- Division of Gastroenterology, McGill University and McGill University Health Center, Montreal, Quebec, Canada
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Gupta S, Anirvan P, Panigrahi MK. Use of Hemospray for Management of Malignant Gastrointestinal Bleeding: Game-Changing Strategy or Just Another Red Herring? Gastroenterology 2024; 166:225-226. [PMID: 37734422 DOI: 10.1053/j.gastro.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Shubham Gupta
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prajna Anirvan
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Elimeleh Y, Gralnek IM. Diagnosis and management of acute lower gastrointestinal bleeding. Curr Opin Gastroenterol 2024; 40:34-42. [PMID: 38078611 DOI: 10.1097/mog.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
PURPOSE OF REVIEW We review and summarize the most recent literature, including evidence-based guidelines, on the evaluation and management of acute lower gastrointestinal bleeding (LGIB). RECENT FINDINGS LGIB primarily presents in the elderly, often on the background of comorbidities, and constitutes a significant healthcare and economic burden worldwide. Therefore, acute LGIB requires rapid evaluation, informed decision-making, and evidence-based management decisions. LGIB management involves withholding and possibly reversing precipitating medications and concurrently addressing risk factors, with definitive diagnosis and therapy for the source of bleeding usually performed by endoscopic or radiological means. Recent advancements in LGIB diagnosis and management, including risk stratification tools and novel endoscopic therapeutic techniques have improved LGIB management and patient outcomes. In recent years, the various society guidelines on acute lower gastrointestinal bleeding have been revised and updated accordingly. SUMMARY By integrating the most recently published high-quality clinical studies and society guidelines, we provide clinicians with an up-to-date and comprehensive overview on acute LGIB diagnosis and management.
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Affiliation(s)
- Yotam Elimeleh
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula
- The Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
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Dhar J, Ramai D, Samanta J, Facciorusso A. Hemostatic powders and gels in gastrointestinal endoscopy: current perspective and future recommendations. Expert Rev Gastroenterol Hepatol 2023; 17:1061-1065. [PMID: 37864554 DOI: 10.1080/17474124.2023.2274913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Jahnvi Dhar
- Department of Gastroenterology, Sohana Multi-speciality Hospital, Mohali, Punjab, India
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Antonio Facciorusso
- Department Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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