Evaluation Of GI Bleeding Research Articles

Video Capsule Endoscopy in the ICU for Evaluation of GI Bleeding

Video Capsule Endoscopy in the ICU for Evaluation of GI Bleeding

Safety of endoscopic interventions in patients with thrombocytopenia

The risk of endoscopic interventions in thrombocytopenia has received little attention in the medical literature. The aim of this study was to assess the safety of endoscopic interventions including evaluation of GI bleeding (GIB) in patients with thrombocytopenia. Retrospective study, tertiary oncology center. Review of consecutive endoscopies with preprocedure platelet counts (PCs) of 75× 10(3)/μL or lower. Risk of bleeding with routine endoscopic interventions and transfusion requirement after evaluation of GIB. A total of 617 (351 upper, 266 lower [90 colonoscopies]) endoscopies were performed in 395 patients. Forceps-biopsy specimens were obtained in 398 endoscopies (mean ± standard deviation [SD] PC: 38.21 ± 11.7× 10(3)/μL) and 45 polypectomies were performed in 17 endoscopies (mean ± SD PC: 39.65 ± 8.53× 10(3)/μL). The risk of bleeding was 1.5% (6 of 398 endoscopies) at the biopsy site and 4% (2 of 45 polypectomies) at the polypectomy site. Active GIB (mean ± SD PC: 32.85 ± 4.0× 10(3)/μL) was observed in 68 (11% of 617) endoscopies and intervention (mean ± SD PC: 33.68 ± 4.6× 10(3)/μL) was performed in 41 procedures. Together, angiodysplasias and ulcers were the most common etiology (51.2% of 41). Hemostasis was achieved in 39 (95.1% of 41) procedures. Comparison of blood transfusions ± 3 days of successful therapy showed a 52% reduction (P< .001). By multivariate analysis, a higher aggregate blood transfusion 3 days preceding endoscopy (odds ratio 1.32; 95% confidence interval, 1.16-1.50; P< .001) predicted endoscopic findings of active GIB. Retrospective design, single center. In the largest endoscopic experience reported in thrombocytopenic patients (Common Terminology Criteria for Adverse Events grade 3 or lower), bleeding caused by standard forceps biopsy and polypectomy (≤10mm) was minor and easily controlled. Endoscopic therapy for GIB is safe and significantly reduces the packed red blood cell requirement and should be considered in patients with thrombocytopenia in the setting of an appropriate transfusion strategy.

Safety of endoscopic interventions in patients with thrombocytopenia

Background The risk of endoscopic interventions in thrombocytopenia has received little attention in the medical literature. Objective The aim of this study was to assess the safety of endoscopic interventions including evaluation of GI bleeding (GIB) in patients with thrombocytopenia. Design and Setting Retrospective study, tertiary oncology center. Patients and Intervention Review of consecutive endoscopies with preprocedure platelet counts (PCs) of 75 × 10 3 /μL or lower. Main Outcome Measurements Risk of bleeding with routine endoscopic interventions and transfusion requirement after evaluation of GIB. Results A total of 617 (351 upper, 266 lower [90 colonoscopies]) endoscopies were performed in 395 patients. Forceps-biopsy specimens were obtained in 398 endoscopies (mean ± standard deviation [SD] PC: 38.21 ± 11.7 × 10 3 /μL) and 45 polypectomies were performed in 17 endoscopies (mean ± SD PC: 39.65 ± 8.53 × 10 3 /μL). The risk of bleeding was 1.5% (6 of 398 endoscopies) at the biopsy site and 4% (2 of 45 polypectomies) at the polypectomy site. Active GIB (mean ± SD PC: 32.85 ± 4.0 × 10 3 /μL) was observed in 68 (11% of 617) endoscopies and intervention (mean ± SD PC: 33.68 ± 4.6 × 10 3 /μL) was performed in 41 procedures. Together, angiodysplasias and ulcers were the most common etiology (51.2% of 41). Hemostasis was achieved in 39 (95.1% of 41) procedures. Comparison of blood transfusions ± 3 days of successful therapy showed a 52% reduction ( P P Limitations Retrospective design, single center. Conclusions In the largest endoscopic experience reported in thrombocytopenic patients (Common Terminology Criteria for Adverse Events grade 3 or lower), bleeding caused by standard forceps biopsy and polypectomy (≤10 mm) was minor and easily controlled. Endoscopic therapy for GIB is safe and significantly reduces the packed red blood cell requirement and should be considered in patients with thrombocytopenia in the setting of an appropriate transfusion strategy.

Evaluation of GI bleeding after implantation of left ventricular assist device

Left ventricular assist devices (LVADs) have revolutionized the management of end-stage heart failure (ESHF). However, unexpectedly high rates of GI bleeding (GIB) have been described, and etiology and outcome remain unclear. To determine the prevalence, etiology, and outcome of GIB in LVAD recipients. Retrospective case series. Tertiary care academic university hospital. 154 ESHF patients (55.4 years, 122 men/32 women) with LVADs implanted over a 10-year period. Overt or occult GIB prompting endoscopic evaluation ≥ 7 days after LVAD implantation. Over a mean of 0.9 ± 0.1 years of follow-up, 29 patients (19%) experienced 44 GIB episodes. Patients with GIB were older and received anticoagulation therapy before devices were implanted (P ≤ .02 for each). GIB was overt (n = 31) rather than occult (n = 13), and most patients presented with melena (n = 22, 50%); hemodynamic instability was observed in 13.6%. Each bleeding episode required 2.1 ± 0.1 diagnostic or therapeutic procedures, and a source was localized in 71%. Upper endoscopy provided the highest diagnostic yield; peptic bleeding (n = 14) and vascular malformations (n = 8) dominated the findings. Endoscopy was safe and well tolerated. Overall mortality was 35%, none directly from GIB. Retrospective design. Rates of GIB with LVADs are higher than that seen in other patient populations, including those receiving anticoagulation and antiplatelet therapy. GIB episodes are mostly overt and predominantly from the upper GI tract. Endoscopy is safe in the LVAD population.

Cardiac Pacemaker and Wireless Capsule Endoscopy Interference: Case Report in a Patient with Gastric Vascular Ectasias

Wireless capsule endoscopy is a new endoscopic tool for the diagnosis and management of small bowel diseases. The main indication at present is the evaluation of GI bleeding of obscure origin, Crohn’s disease, coeliac disease and small bowel tumors. Studies suggest that capsule endoscopy is associated with few adverse events. Whether cardiac pacemaker may interfere with capsule endoscopy is still a controversial issue. We here report a case showing that there is a possibility of interference between the two procedures, cardiac pacemaker affecting the proper functioning of capsule endoscopy and that this is related to the distance between the pacemaker and the recorder.

Video capsule endoscopy in life-threatening GI hemorrhage after negative primary endoscopy (with video)

Video capsule endoscopy (VCE) continues to evolve as a key diagnostic tool. Traditionally VCE has been used to detect occult and obscure GI bleeding in adult patients. VCE has not been documented or accepted as an early diagnostic tool for acute life-threatening GI hemorrhage. Our purpose was to demonstrate the use of VCE as an early diagnostic tool in acute life-threatening GI hemorrhage. Case series. Patients with life-threatening GI hemorrhage. VCE after negative primary endoscopy. VCE allowed rapid diagnosis and reliable data before surgical intervention. Although proving to be a beneficial diagnostic tool for acute GI hemorrhage, VCE was not associated with increased morbidity or mortality rates. This report only focuses on cases where VCE successfully led to a diagnosis. There is no prospective control group to which these patients can be compared. There were no other attempted acute VCE studies in patients with life-threatening bleeding during the time period of these case reports. The use of VCE is a simple and relatively safe diagnostic tool in the evaluation of continuing GI hemorrhaging in endoscopy-negative patients. The use of VCE can be considered as a another useful tool in the armamentarium of the endoscopist in the evaluation of GI bleeding. Prospective studies should be undertaken to determine the appropriate timing and clinical use in this group of patients.