Does off-hours endoscopic hemostasis affect outcomes of nonvariceal upper gastrointestinal bleeding?

Aim: Different researches showed controversial results about the ‘off-hours effect’ in nonvariceal upper gastrointestinal bleeding (NVUGIB). Materials & methods: A total of 301 patients with NVUGIB were divided into regular-hours group and off-hours group based on when they received endoscopic hemostasis, and the relationship of the clinical outcomes with off-hours endoscopic hemostasis was evaluated. Results: Patients who received off-hours endoscopy were sicker and more likely to experience worse clinical outcomes. Off-hours endoscopic hemostasis was a significant predictor of the composite outcome in higher-risk patients (adjusted OR: 4.63; 95% CI: 1.35–15.90). However, it did not associate with the outcomes in lower-risk patients. Conclusion: Off-hours effect may affect outcomes of higher-risk NVUGIB patients receiving endoscopic hemostasis (GBS ≥12).

Hemostatic Efficacy and Safety of the Hemostatic Powder UI-EWD in Patients with Lower Gastrointestinal Bleeding

Background and Aims: Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/NexpowderTM, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB. Patients and Methods: We conducted a retrospective cohort study of LGIB at a single tertiary center in south korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated. Results: The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded.Conclusion: Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.

FEATURE OF SURGICAL TREATMENT OF GASTRODUODENAL BLEEDING

Применение принципов комплексного использования эндоскопического гемостаза и использование эрадикационной, антисекреторной терапии у больных с гастродуоденальным кровотечением, находящихся на стационарном лечении в ЦГКБ г. Алматы, позволило улучшить результаты лечения больных, значительно снизить количество осложнений после операций, сократить частоту как общей, так и послеоперационной летальности. The application of the principles of the integrated use of endoscopic hemostasis and the use of eradication, antisecretory therapy in patients with gastroduodenal bleeding who are inpatient treatment at the Central City Clinical Hospital of Almaty, made it possible to improve the results of treatment of patients, significantly reduce the number of complications after surgery, and reduce the incidence of both general and postoperative mortality.

Development and Validation of a Model to Predict Rebleeding Within Three Days After Endoscopic Hemostasis for Peptic Ulcer Bleeding

Background: Peptic ulcer bleeding remains a typical medical emergency with significant morbidity and mortality. Peptic ulcer rebleeding often occurs within three days after emergency endoscopic hemostasis. Our study aims to develop a nomogram to predict rebleeding within three days after emergency endoscopic hemostasis for peptic ulcer bleedingMethods: We retrospectively reviewed the data of 386 patients with bleeding ulcers who underwent emergency endoscopic hemostasis between March 2014 and October 2018. The least absolute shrinkage and selection operator method were used to identified predictors. The model was displayed as a nomogram. Internal validation was carried out using bootstrapping. The model was evaluated using the calibration plot, decision-curve analyses and clinical impact curve. Results: Overall, 386 patients meeting the inclusion criteria were enrolled, with 48 patients developed rebleeding within three days after initial endoscopic hemostasis. Predictors contained in the nomogram included albumin, prothrombin time, shock, haematemesis/melena and Forrest classification. The model showed good discrimination and good calibration with a C-index of 0.854 (C-index: 0.830 via bootstrapping validation). Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable.Conclusion: This study presents a nomogram that incorporates clinical, laboratory, and endoscopic features, effectively predicting rebleeding within three days after emergency endoscopic hemostasis and identifying high-risk rebleeding patients with peptic ulcer bleeding.Trial registration: This clinical trial has been registered in the ClinicalTrials.gov (ID: NCT04895904) approved by the International Committee of Medical Journal Editors (ICMJE).