Acute Upper Gastrointestinal Bleeding Research Articles

Gaps in acute upper GI bleed (AUGIB) endoscopy training: a UK trainees and trainers’ survey

IntroductionTrainees report inadequate exposure and training barriers in acute upper gastrointestinal bleed (AUGIB) endoscopic management. This UK-wide survey evaluated the experiences of trainees and trainers in AUGIB endoscopy training.MethodsA questionnaire...

A novel predictive model for Intensive Care Unit admission in Emergency Department patients with upper gastrointestinal bleeding

Acute upper gastrointestinal bleeding (UGIB) is a critical emergency. Conventional scoring models for patients with UGIB have limitations; thus, more suitable tools for the Emergency Department are necessary. We aimed to develop a new model that can identify significant predictors of Intensive Care Unit (ICU) admission in Emergency Department patients with UGIB and to compare its predictive accuracy with that of existing models. We retrospectively analyzed data from patients with UGIB treated between January 2020 and July 2022 at the Emergency Department of a single tertiary medical center. Using multivariable logistic regression and the area under the receiver operating characteristic curve (AUROC), we developed a new model to predict the probability of ICU admission. Among 433 patients, multiple logistic regression analysis identified sex, systolic blood pressure, diastolic blood pressure, hemoglobin level, platelet count, alanine transaminase level, and prothrombin time as significant predictors of ICU admission. Our model demonstrated superior predictive accuracy with an AUROC of 0.8539 (95% confidence interval [CI]: 0.8078–0.8999), outperforming the Glasgow–Blatchford score and AIMS65 score, which had AUROCs of 0.7598 (95% CI: 0.7067–0.8130) and 0.6930 (95% CI: 0.6324–0.7537), respectively. We implemented this model in a user-friendly calculator for clinical use. We identified key predictors of ICU admission that are crucial for hemodynamic stabilization in patients with UGIB. Our model, combined with this probability calculator, will enhance clinical decision-making and patient care for UGIB in emergency settings.

Application of machine learning in acute upper gastrointestinal bleeding: bibliometric analysis.

In the past decade, the application of machine learning (ML) in the clinical management of acute upper gastrointestinal bleeding (AUGIB) has received much attention and has become a hot research topic. However, no scientometric report has systematically summarized and outlined the research progress in this field. This study aims to utilize bibliometric analysis methods to delve into the applications of machine learning in AUGIB and the collaborative network behind it over the past decade. Through a thorough analysis of relevant literature, we uncover the research trends and collaboration patterns in this field, which can provide valuable references and insights for further in-depth exploration in the same field. Using the Web of Science (WOS) as the data source, this study explores academic development in a specific field from December 2013 to December 2023. The search strategy included terms related to "Machine Learning" and "Acute Upper Gastrointestinal Bleeding". Only original articles in English focusing on ML in AUGIB were included. The analysis of downloaded literature with Citespace software, including keyword co-occurrence, author collaboration networks, and citation relationship networks, reveals academic dynamics, research hotspots, and collaboration trends. After sorting and compiling, we have collected 73 academic papers written by 217 authors from 133 institutions in 29 countries worldwide. Among them, China and AM J GASTROENTEROL have made significant contributions in this field, providing many high-quality research achievements. The study found that these papers mainly focus on three core research hotspots: deepening clinical consensus, precise analysis of medical images, and optimization of data integration and decision support systems. This study summarizes the latest advancements in the application of machine learning to AUGIB research. Through bibliometric analysis and network visualization, it reveals emerging trends, origins, leading institutions, and hot topics in this field. While this area has already demonstrated significant potential in medical artificial intelligence, our findings will provide valuable insights for future research directions and clinical practices.

Relationship between proton pump inhibitor and acute gout attacks in patients with acute upper gastrointestinal bleeding combined with gout

Relationship between proton pump inhibitor and acute gout attacks in patients with acute upper gastrointestinal bleeding combined with gout

Predictive value of a noninvasive serological model for disease outcomes in patients with acute upper gastrointestinal bleeding

Predictive value of a noninvasive serological model for disease outcomes in patients with acute upper gastrointestinal bleeding

Capsule Endoscopy for the Risk Stratification and Management of Acute Upper Gastrointestinal Bleeding in Emergency Departments: A Systematic Review on Triage, Risk Stratification, and Management.

Gastrointestinal bleeding is a common occurrence in emergency departments. The standard of care for it is an esophagogastroduodenoscopy within 24 hours to diagnose and potentially treat the bleeding. Several tools and pre-endoscopic risk assessment scores are used to help evaluate and manage upper gastrointestinal bleeding. Additionally, capsule endoscopy providesanon-invasive method to visualize thegastrointestinal tract and identify lesions. The aim of this review was to explore the role of capsule endoscopy in thetriage, stratification, and management of upper gastrointestinal bleeding patients in the emergency department. Four databases, PubMed, Scopus, Embase, and the Cochrane Library, were searched using keywords related to capsule endoscopy and gastrointestinal bleeding in the emergency department. Studies were included if they assessed the use of capsule endoscopy in emergency settings for managing upper gastrointestinal bleeding. After screening titles, abstracts, and full texts and reviewing bibliographies for relevant articles, data on study design, participant demographics, capsule endoscopy procedure description, and outcomes were collected into a pre-designed spreadsheet. The review focused on the triage, risk stratification, management impact, and safety of capsule endoscopy. The literature search identified 712 records, with 37 studies screened for full-text review, resulting in nine studies included in the review. These studies involved 634 patients and primarily compared capsule endoscopy with standard care in emergency settings. Capsule endoscopy demonstrated potential advantages, including improved identification of high-risk lesions and reduced hospital admissions. Capsule endoscopy effectively detected bleeding and reduced the need for invasive procedures compared to standard practices. Capsule endoscopy also had lower costs relative to traditional triaging methods. The use of capsule endoscopy in the risk stratification and management of upper gastrointestinal bleeding in emergency settings is promising. Its high diagnostic accuracy can enhance patient outcomes by enabling timely and precise diagnosis, reducing the need for invasive procedures. Future research should focus on larger randomized trials to validate capsule endoscopy's efficacy and explore its cost-effectiveness.

Using Transparent Cap of Endoloop in Emergency Hemostasis as a Novel Rapid Clot Removal Procedure for Acute Upper Gastrointestinal Hemorrhage.

Using Transparent Cap of Endoloop in Emergency Hemostasis as a Novel Rapid Clot Removal Procedure for Acute Upper Gastrointestinal Hemorrhage.

S843 Social Determinants of Therapeutic Endoscopy and Procedure Time in Patients With Acute Upper Gastrointestinal Bleeding

S843 Social Determinants of Therapeutic Endoscopy and Procedure Time in Patients With Acute Upper Gastrointestinal Bleeding

ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study

Abstract Aims Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient. Methods A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3. Results 150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8). Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p<0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456). The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group. Conclusion While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.

WP3.16 - Comparing Outcomes in Acute Upper Gastrointestinal Bleeding: Initial Presentation versus In-hospital Incidence - A Single-Centre Investigation

Abstract Aims Acute upper gastrointestinal bleeding (AUGIB) is a gastrointestinal emergency with varied patient outcomes. We aimed to compare the outcomes of patients whose primary admission presentation was AUGIB versus inpatients who subsequently developed AUGIB as a complication. Methods This was a retrospective study of all adult patients receiving endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, laboratory results, medical history and clinical progress, 30 and 90-day mortality were compared. Results 145 patients were identified, 75 (51.7%) were male and median age was 65 years (IQR 53-75). 117 presented to hospital with AUGIB (group 1) and 28 developed AUGIB as an inpatient (group 2). Median length-of-stay was 3.3 vs 10 days, respectively (p=0.014). Group 2 were more likely to present with symptomatic anaemia (p=0.001), higher National Early Warning System scores (p<0.001), shock (p<0.001), higher Glasgow-Blatchford score (p<0.001) and require blood transfusions (p<0.001). Group 2 had higher ASA Scores (p<0.001) and higher 30-day and 90-day all-cause mortality. No statistical correlations were noted regarding the distribution of endoscopic diagnoses obtained between both groups.Group 1(n=117)Group 2(n=28)P-Value30-Day all-cause Mortality4 (3.4%)4 (14.3%)0.02490-Day all-cause Mortality9 (7.7%)8 (28.6)0.002 Conclusion Our results echo previous studies that patients who develop AUGIB whilst an inpatient have significantly poorer outcomes. Causation is likely multifactorial and warrants further study. It remains important to closely apply the AUGIB care bundle and early critical care input to optimize outcome.

Unlikely Death From Esophageal Variceal Hemorrhage in a Post-Orthotopic Liver Transplant Patient.

Gastrointestinal bleeding is one of the complications seen after a liver transplant with a poor prognosis and low survival. The most common cause of gastrointestinal bleeding after a liver transplant is ulcers followed by hemorrhagic enteritis and portal hypertensive lesions. We present a case of a middle-aged male, with improving liver function labs and imaging, who passed away from large-volume hematemesis approximately 2 months after a liver transplant. On autopsy, the cause of death was concluded to be from acute upper gastrointestinal hemorrhage due to esophageal variceal bleeding.

Comparing Endoscopic Treatment Modalities for Gastric Antral Vascular Ectasia: Efficacy, Safety, and Outcomes in a Network Meta-analysis.

Gastric antral vascular ectasia (GAVE) is characterized by vascular ectasias accounting for 4% of nonvariceal upper gastrointestinal bleeds, which can range from occult bleeds to severe acute upper gastrointestinal bleeding. In turn, GAVE can lead to severe morbidity and recurrent hospitalization. Current endoscopic treatments for GAVE include argon plasma coagulation (APC), endoscopic band ligation (EBL), and radiofrequency ablation. With this significant burden in mind, a systematic review and network meta-analysis were conducted to compare the efficacy and safety of various modalities in the treatment of GAVE. All studies that involved adults and children with endoscopic characteristics of GAVE undergoing treatment with APC, EBL, radiofrequency ablation, or a combination of 2 treatment modalities were included. There was no statistical difference in the rate of adverse events and the number of red blood cell transfusions across all 3 groups (APC, EBL, and APC + EBL). However, statistical differences were noted for outcomes of bleeding recurrence, length of hospitalization, and change in hemoglobin status. EBL exhibited a significant decrease in bleeding recurrence when compared with APC. Moreover, shorter hospitalization stays were seen in APC + EBL and EBL groups compared with APC, and a beneficial change in hemoglobin status was also more often seen in APC + EBL and EBL groups compared with APC. Based on this study, EBL was found to have superior efficacy when compared with APC for the treatment of GAVE; however, there was no significant difference in rates of adverse events between APC, EBL, and combination therapy.

Machine Learning Models for Predicting Mortality in Patients with Cirrhosis and Acute Upper Gastrointestinal Bleeding at an Emergency Department: A Retrospective Cohort Study.

Cirrhosis is a major global cause of mortality, and upper gastrointestinal (GI) bleeding significantly increases the mortality risk in these patients. Although scoring systems such as the Child-Pugh score and the Model for End-stage Liver Disease evaluate the severity of cirrhosis, none of these systems specifically target the risk of mortality in patients with upper GI bleeding. In this study, we constructed machine learning (ML) models for predicting mortality in patients with cirrhosis and upper GI bleeding, particularly in emergency settings, to achieve early intervention and improve outcomes. In this retrospective study, we analyzed the electronic health records of adult patients with cirrhosis who presented at an emergency department (ED) with GI bleeding between 2001 and 2019. Data were divided into training and testing sets at a ratio of 90:10. The ability of three ML models-a linear regression model, an XGBoost (XGB) model, and a three-layer neural network model-to predict mortality in the patients was evaluated. A total of 16,025 patients with cirrhosis and 32,826 ED visits for upper GI bleeding were included in the study. The in-hospital and ED mortality rates were 11.2% and 2.2%, respectively. The XGB model exhibited the highest performance in predicting both in-hospital and ED mortality (area under the receiver operating characteristic curve: 0.866 and 0.861, respectively). International normalized ratio, renal function, red blood cell distribution width, age, and white blood cell count were the strongest predictors in all the ML models. The median ED length of stay for the ED mortality group was 17.54 h (7.16-40.01 h). ML models can be used to predict mortality in patients with cirrhosis and upper GI bleeding. Of the three models, the XGB model exhibits the highest performance. Further research is required to determine the actual efficacy of our ML models in clinical settings.

Study Of The Endoscopic Findings In Children with Acute Upper Gastrointestinal Bleeding At Minia Children University Hospital

Study Of The Endoscopic Findings In Children with Acute Upper Gastrointestinal Bleeding At Minia Children University Hospital

Should Prophylactic Endotracheal Intubation Be Performed in Upper Gastrointestinal Bleeding?

No consensus exists on the standard of intraoperative airway management approach to prevent endoscopy complications in acute gastrointestinal (GI) bleeding. Eight years after our initial meta-analysis, we reassessed the effect of prophylactic endotracheal intubation in acute GI bleeding in hospitalized patients. Multiple databases were reviewed in 2024, identifying 10 studies that compared prophylactic endotracheal intubation (PEI) versus no intubation in acute upper GI bleeding in hospitalized patients. Outcomes of interest included pneumonia, length of hospital stay, aspiration, and mortality. The odds ratio (OR) or mean difference (MD) using the random effects model was calculated for each outcome. In total, 11 studies (10 retrospective, one prospective) were included in the meta-analysis (n = 7,332). PEI demonstrated statistically significant higher odds of pneumonia (OR = 5.83; 95% confidence interval (CI) = 3.15-10.79; p < 0.01) and longer length of stays (MD = 0.84; 95% CI = 0.12-1.56; p = 0.02). However, mortality (OR = 1.68; 95% CI = 0.78-3.64; p = 0.19) and aspiration (OR = 2.79; 95% CI = 0.89-8.7; p = 0.08) were not statistically significant. PEI before esophagogastroduodenoscopy for hospitalized upper GI bleeding patients is associated with an increased incidence of pneumonia within 48 hours and prolonged hospitalization but no statistically significant increased risk of mortality or aspiration.

Haemostatic spray in the management of acute nonvariceal upper gastrointestinal bleeding in children: A single-centre experience in Singapore.

Haemostatic spray (HS; Hemospray) is a powder agent for endoscopic haemostasis in patients with acute upper gastrointestinal bleeding (UGIB). It has been shown to be effective and easy to administer. However, published data on efficacy and safety in children remain scarce. Our aim was to describe our experience with the use of HS in the management of UGIB. A retrospective review was conducted of patients aged 0-18 receiving HS for endoscopic haemostasis from January 2017 to December 2021. Information was obtained on demographics, clinical presentation and comorbidities. Outcomes were successful initial haemostasis and rates of re-bleeding. A total of 25 applications of HS occurred in 23 patients. The median patient age was 8 years (range: 4 months to 16 years). HS was used in 17/25 (68%) applications as monotherapy. Other treatments employed were clip application and adrenaline injection. One hundred per cent initial haemostasis was achieved with three (13.0%) patients who experienced re-bleeding. All patients tolerated HS applications with no adverse events. Our finding supports the use of HS in the management of UGIB in children. HS, either as monotherapy or in combination with other conventional therapy, could potentially be the treatment of choice in children with UGIB with its excellent feasibility and good safety profile.

An update on management of Acute Upper GI bleeding

An update on management of Acute Upper GI bleeding

Endoscopy for acute upper gastrointestinal bleeding: a protocol for systematic review and network meta-analysis of randomized controlled trials

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.

Examining the Frequency of Second Endoscopy and Its Effect on Patient Outcomes With Upper Gastrointestinal Bleeding in Southeast of Iran.

This study investigated the frequency and impact of repeat endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) in a referral hospital in Southeast Iran. A cross-sectional descriptive-analytical study was conducted on the records of 190 patients who underwent endoscopy for AUGIB in 2019. The study compared the demographic and clinical characteristics, outcomes, and treatments of patients who had a second endoscopy (n=64) with those who did not (n=126). The data were analyzed with SPSS software, and a P value less than 0.05 was considered significant. The results showed that repeat endoscopy was not significantly associated with age, gender, initial symptoms, bleeding site, first endoscopy time, or disease outcome. However, repeat endoscopy was significantly associated with higher bleeding severity, different wound types, different bleeding causes, longer hospital stay, and different treatments in the first endoscopy. The main reasons for repeat endoscopy were poor visibility and recurrent bleeding. The majority of repeat endoscopies were performed within 2 days of the first one. Most patients who had a second endoscopy did not receive any treatment, and those who did received combined thermal and epinephrine injections. The study concluded that routine second endoscopy is not necessary for all patients with AUGIB, but it may be beneficial for some cases. Further research is needed to clarify the indications and timing of repeat endoscopy in AUGIB.

Parvimonas micra Bacteremia: A Rare Complication After Esophagogastroduodenoscopy for Upper Gastrointestinal Bleeding

ABSTRACT Parvimonas micra bacteremia is rarely encountered in clinical practice. When it is, patients usually have underlying periodontal disease or colorectal carcinoma. To the best of our knowledge, this is the first case of P. micra bacteremia in a patient without the predisposing risk factors listed above. We postulate that this occurred because of translocation across an interrupted gut-blood barrier in the setting of an acute upper gastrointestinal bleed. We present this case to highlight the importance of identifying and treating P. micra bacteremia because it can prevent commonly encountered sequelae of untreated bacteremia and improve outcomes.