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Urgent Or Emergency Endoscopy AND Nonvariceal Bleed

Gonçalo Alexandrino, Tiago Dias Domingues, Rita Carvalho, Mariana Nuno Costa, Luís Carvalho Lourenço, Jorge Reis
Background/Aims: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12-24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding. Methods: : This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission...
October 5, 2018: Clinical Endoscopy
Jennifer X Cai, John R Saltzman
Inhospital mortality from nonvariceal upper gastrointestinal bleeding has improved with advances in medical and endoscopy therapy. Initial management includes resuscitation, hemodynamic monitoring, proton pump inhibitor therapy, and restrictive blood transfusion. Risk stratification scores help triage bleeding severity and provide prognosis. Upper endoscopy is recommended within 24 hours of presentation; select patients at lowest risk may be effectively treated as outpatients. Emergent endoscopy within 12 hours does not improve clinical outcomes, including mortality, rebleeding, or need for surgery, despite an increased use of endoscopic treatment...
July 2018: Gastrointestinal Endoscopy Clinics of North America
Lauren R Klein, Joel Money, Kaveesh Maharaj, Aaron Robinson, Tarissa Lai, Brian E Driver
BACKGROUND: Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. METHODS: This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization...
November 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Soo-Han Cho, Yoon-Seon Lee, Youn-Jung Kim, Chang Hwan Sohn, Shin Ahn, Dong-Woo Seo, Won Young Kim, Jae Ho Lee, Kyoung Soo Lim
BACKGROUND & AIMS: We investigated clinical outcomes in high-risk patients with acute nonvariceal upper gastrointestinal bleeding (UGIB), and determined if urgent endoscopy is effective. METHODS: Consecutive patients with a Glasgow-Blatchford score greater than 7 who underwent endoscopy for acute nonvariceal UGIB at the emergency department from January 1, 2005, to December 31, 2014, were included. Urgent (<6 h) and elective (6-48 h) endoscopies were defined according to the time to endoscopy after the initial presentation...
March 2018: Clinical Gastroenterology and Hepatology
Hee Kyong Na, Hwoon-Yong Jung, Dong Woo Seo, Hyun Lim, Ji Yong Ahn, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim
BACKGROUND/AIMS: The aim of this study was to compare the effects of erythromycin infusion and gastric lavage in order to improve the quality of visualization during emergency upper endoscopy. METHODS: We performed a prospective randomized pilot study. Patients presented with hematemesis or melena within 12 hours and were randomly assigned to the erythromycin group (intravenous infusion of erythromycin), gastric lavage group (nasogastric tube placement with gastric lavage), or erythromycin + gastric lavage group (both erythromycin infusion and gastric lavage)...
November 2017: Korean Journal of Internal Medicine
Gian E Tontini, Helmut Neumann, Luca Pastorelli, Luisa Spina, Flaminia Cavallaro, Paola Soriani, Alessandro Rimondi, Barbara Bruni, Claudio Clemente, Filippo Fagnani, Pavlos Lagoussis, Luca Carmignani, Maurizio Vecchi
Background and study aims The thulium laser system (TLS) is an emerging surgical tool. The 2-μm wavelength provides a confined coagulation depth (0.2 - 0.4 mm) to reduce the potential for inadvertent injuries. For the first time ever, we assessed TLS feasibility for endoscopic hemostasis ex vivo in pigs. In addition, we performed the first in vivo hemostatic treatments in humans. Patients and methods Tissue damage induced by TLS using different settings and optical fibers was compared to that from argon plasma coagulation (APC) in established ex vivo animal models...
April 2017: Endoscopy
Elvira Teles-Sampaio, Luís Maia, Paulo Salgueiro, Ricardo Marcos-Pinto, Mário Dinis-Ribeiro, Isabel Pedroto
BACKGROUND: Nonvariceal upper gastrointestinal bleeding emerges as a major complication of using antiplatelet agents and/or anticoagulants and represents a clinical challenge in patients undergoing these therapies. AIM: To characterize patients with nonvariceal upper gastrointestinal bleeding related to antithrombotics and their management, and to determine clinical predictors of adverse outcomes. METHODS: Retrospective cohort of adults who underwent upper gastrointestinal endoscopy after nonvariceal upper gastrointestinal bleeding from 2010 to 2012...
November 2016: Revista Española de Enfermedades Digestivas
Navin L Kumar, Aaron J Cohen, Jennifer Nayor, Brian L Claggett, John R Saltzman
BACKGROUND AND AIMS: Current guidelines advise that upper endoscopy be performed within 24 hours of presentation in patients with acute nonvariceal upper GI bleeding (UGIB). However, the role of urgent endoscopy (<12 hours) is controversial. Our aim was to assess whether patients admitted with acute nonvariceal UGIB with lower-risk versus high-risk bleeding have different outcomes with urgent compared with nonurgent endoscopy. METHODS: A retrospective cohort study was conducted of patients admitted to an academic hospital with nonvariceal UGIB...
May 2017: Gastrointestinal Endoscopy
Jan C Prei, Christian Barmeyer, Nataly Bürgel, Severin Daum, Hans-Jörg Epple, Ute Günther, Jochen Maul, Britta Siegmund, Michael Schumann, Hanno Tröger, Andrea Stroux, Andreas Adler, Winfried Veltzke-Schlieker, Christian Jürgensen, Robert Wentrup, Bertram Wiedenmann, Jana Binkau, Dirk Hartmann, Ellen Nötzel, Dirk Domagk, Wolfram Wacke, Ulrich Wahnschaffe, Christian Bojarski
BACKGROUND AND STUDY AIMS: Hemostatic powders have been introduced to improve the management of gastrointestinal (GI) bleeding and to extend the variety of tools available for emergency endoscopy. The aim of the present pilot study was to evaluate the indication profiles and the short-term outcome of EndoClot. PATIENTS, MATERIALS AND METHODS: In a prospective observational pilot study patients with acute nonvariceal GI bleeding were included. Primary or secondary application of EndoClot was assessed...
November 2016: Journal of Clinical Gastroenterology
Jianzong Wang, Duanming Hu, Wen Tang, Chuanyin Hu, Qin Lu, Juan Li, Jianhong Zhu, Liming Xu, Zhenyu Sui, Mingjie Qian, Shaofeng Wang, Guojian Yin
The goal of this study is to evaluate how to predict high-risk nonvariceal upper gastrointestinal bleeding (NVUGIB) pre-endoscopically. A total of 569 NVUGIB patients between Match 2011 and January 2015 were retrospectively studied. The clinical characteristics and laboratory data were statistically analyzed. The severity of NVUGIB was based on high-risk NVUGIB (Forrest I-IIb), and low-risk NVUGIB (Forrest IIc and III). By logistic regression and receiver-operating characteristic curve, simple risk score systems were derived which predicted patients' risks of potentially needing endoscopic intervention to control bleeding...
June 2016: Medicine (Baltimore)
Dong-Won Ahn, Young Soo Park, Sang Hyub Lee, Cheol Min Shin, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hyang Jeong, Nayoung Kim, Dong Ho Lee
BACKGROUND/AIMS: This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. METHODS: A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. RESULTS: A total of 158 patients visited the emergency unit for ANVUGIB after hours...
May 2016: Korean Journal of Internal Medicine
Sun Wook Park, Young Wook Song, Dae Hyun Tak, Byung Moo Ahn, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
BACKGROUND/AIMS: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores. METHODS: This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC)...
November 2015: Clinical Endoscopy
Marie Ooi, Andrew Thomson
BACKGROUND AND STUDY AIMS: Endoscopist-Directed Nurse-Administered Propofol Sedation (EDNAPS) has been evaluated in community settings rather than tertiary referral centers. PATIENTS AND METHODS: A hospital-wide prospectively collected database of Medical Emergency Team Calls (METCALL), emergency responses triggered by medically unstable patients, was reviewed. Responses that followed EDNAPS were extracted and compared with a prospectively entered database of all endoscopies performed using EDNAPS over the same period...
October 2015: Endoscopy International Open
Vera Hoffmann, Henrik Neubauer, Julia Heinzler, Anna Smarczyk, Martin Hellmich, Andrea Bowe, Fabian Kuetting, Muenevver Demir, Agnes Pelc, Sigrid Schulte, Ullrich Toex, Dirk Nierhoff, Hans-Michael Steffen
Acute upper gastrointestinal bleeding (UGIB) is the leading indication for emergency endoscopy. Scoring schemes have been developed for immediate risk stratification. However, most of these scores include endoscopic findings and are based on data from patients with nonvariceal bleeding. The aim of our study was to design a pre-endoscopic score for acute UGIB--including variceal bleeding--in order to identify high-risk patients requiring urgent clinical management. The scoring system was developed using a data set consisting of 586 patients with acute UGIB...
September 2015: Medicine (Baltimore)
Matthew DeLaney, Christopher James Greene
Upper gastrointestinal bleeding results from a variety of conditions that may vary in severity from merely bothersome to imminently life-threatening. While stabilization is standard for nearly all causes of bleeding, identifying whether the bleed is from variceal or nonvariceal sources is critical. Testing and treatments such as nasogastric lavage, antibiotics, somatostatin analogues, proton pump inhibitors, and emergent endoscopy may benefit some patients, depending upon the bleeding source and other clinical factors; however, some therapies that are routinely used have very little evidence demonstrating effectiveness...
April 2015: Emergency Medicine Practice
Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Hiroshi Miyamoto, Tetsuji Takayama
Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued...
March 2015: Clinical Endoscopy
Amir Klein, Ian M Gralnek
PURPOSE OF REVIEW: Acute, nonvariceal upper gastrointestinal bleeding (UGIB) is a common medical emergency encountered worldwide. Despite medical and technological advances, it remains associated with significant morbidity and mortality. RECENT FINDINGS: Rapid patient assessment and management are paramount. When indicated, upper endoscopy in patients presenting with acute UGIB is effective for both diagnosis of the bleeding site and provision of endoscopic hemostasis...
April 2015: Current Opinion in Critical Care
Elif Yaka, Serkan Yılmaz, Nurettin Özgür Doğan, Murat Pekdemir
OBJECTIVES: The aim of this study was to compare the performance of the Glasgow-Blatchford and the AIMS65 scoring systems as early risk assessment tools for accurately identifying patients with upper gastrointestinal (GI) bleeding who are at a low risk of requiring clinical interventions, including emergency endoscopy. The secondary objective was to compare their performance regarding relevant clinical outcomes. METHODS: Data were collected prospectively over a 2-year period in the emergency department of a university hospital...
January 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Louis M Wong Kee Song, Michael J Levy
Several new devices and innovative adaptations of existing modalities have emerged as primary, adjunctive, or rescue therapy in endoscopic hemostasis of gastrointestinal hemorrhage. These techniques include over-the-scope clip devices, hemostatic sprays, cryotherapy, radiofrequency ablation, endoscopic suturing, and endoscopic ultrasound-guided angiotherapy. This review highlights the technical aspects and clinical applications of these devices in the context of nonvariceal upper gastrointestinal bleeding.
December 2014: Gastroenterology Clinics of North America
Eric T T L Tjwa, I Lisanne Holster, Ernst J Kuipers
Upper gastrointestinal bleeding (UGIB) is the most common emergency condition in gastroenterology. Although peptic ulcer and esophagogastric varices are the predominant causes, other conditions account for up to 50% of UGIBs. These conditions, among others, include angiodysplasia, Dieulafoy and Mallory-Weiss lesions, gastric antral vascular ectasia, and Cameron lesions. Upper GI cancer as well as lesions of the biliary tract and pancreas may also result in severe UGIB. This article provides an overview of the endoscopic management of these lesions, including the role of novel therapeutic modalities such as hemostatic powder and over-the-scope-clips...
December 2014: Gastroenterology Clinics of North America
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