1.
Efficacy of New Hemostatic Techniques in Nonvariceal Gastrointestinal Bleeding: A Systematic Review and Network Meta-analysis
Liu K, Gao L, Bai J, Wang L, Zhu S, Zhao X, Han Y, Liu Z
Journal of digestive diseases. 2023
Abstract
OBJECTIVE This systematic review and network meta-analysis aimed to assess the relative efficacy of currently multiple hemostatic modalities in nonvariceal gastrointestinal bleeding (NVGIB). BACKGROUND Nonvariceal gastrointestinal bleeding is a frequent medical condition with significant mortality and morbidity. There are currently multiple hemostatic modalities, but their relative efficacy is still unknown. METHODS Major databases including PubMed, EMBASE and the Cochrane Library were searched for studies that compared the relative efficacy of different hemostatic techniques for NVGIB (over-the-scope-clip (OTSC), hemostatic powder (HP) and conventional endoscopic treatment (CET)). The 30-day rebleeding rate was the primary outcome. We performed pairwise and network meta-analyses for all treatments. The heterogeneity and transitivity were evaluated. RESULTS Twenty-two studies were included. OTSC and HP + CET showed superior efficacy compared with CET (OTSC vs CET: RR, 0.42 [95% CI, 0.28-0.60]; HP + CET vs CET: RR, 0.40 [95% CI, 0.17-0.87]) while their relative efficacy had not detected any statistically significant difference (OTSC vs HP + CET: RR, 0.95 [95% CI, 0.38-2.31]) in the 30-day rebleeding rate. HP + CET was ranked highest in the network ranking estimate. In addition, the sensitivity analysis showed that it was not robust that OTSC was superior to CET in the short-term rebleeding rate and the initial hemostasis rate. None of the other comparisons found a statistically significant difference. CONCLUSIONS This systematic review and network meta- analysis showed that OTSC and HP + CET significantly reduced 30-day rebleeding rates compared to CET and had similar efficacy. This article is protected by copyright. All rights reserved.
2.
Endoscopic Delivery of Polymers Reduces Delayed Bleeding after Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis
Chen Y, Zhao X, Wang D, Liu X, Chen J, Song J, Bai T, Hou X
Polymers. 2022;14(12)
Abstract
New endoscopic approaches for the prevention of delayed bleeding (DB) after gastric endoscopic submucosal dissection (ESD) have been reported in recent years, and endoscopic delivery of biodegradable polymers for iatrogenic ulcer hemostasis and coverage has emerged as one of the most promising techniques for post-ESD management. However, the comparative efficacy of these techniques remains uncertain. We performed a systematic search of multiple databases up to May 2022 to identify studies reporting DB rates as outcomes in patients undergoing gastric ESD who were treated with subsequent endoscopic management, including endoscopic closure (clip-based methods and suturing), PGA sheet tissue shielding, and hemostatic powder/gel spray (including polymeric sealants and other adhesives). The risk ratios (RRs) of delayed bleeding in treatment groups and control groups were pooled, and the Bayesian framework was used to perform a network meta-analysis (NMA). Among these studies, 16 head-to-head comparisons that covered 2742 lesions were included in the NMA. Tissue shielding using PGA sheets significantly reduced the risk of DB by nearly two thirds in high-risk patients, while hemostatic spray systems, primarily polymer-based, reduced DB in low-risk patients nine-fold. Researchers should recognize the essential role of polymers in the management of ESD-induced ulcers, and develop and validate clinical application strategies for promising materials.
3.
Quality Evaluation of the Non-Variceal Upper Gastrointestinal Bleeding Guidelines/Consensuses via AGREE II Tools
Wang Y, Guo J, Rao Y, Xiao GR, Zhao X
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2019;29(10):977-985
Abstract
Non-variceal upper gastrointestinal bleeding (NUGIB) is a common disease in clinical practice; and many related guidelines/consensuses have been published. The authors assessed the methodological quality of the NUGIB guidelines/ consensuses published in English, in order to uncover which guidelines/consensuses are of better quality in methodology and the deficiency in the area. Appraisal of guidelines for research and evaluation instrument tools were adopted to assess the quality of the guidelines/consensuses. Each guideline/consensus was assessed independently by three researchers. Intra-class correlation (ICC) among researchers was retrieved to reflect reliability. Eight guidelines/consensuses regarding the management of NUGIB published in English were obtained. The ICCs among the evaluators were all above 0.75, indicating satisfactory reliability. Quality evaluation of the obtained guidelines via the AGREE II tools showed that the overall quality of the included guidelines/consensuses was moderate in all domains. A few guidelines/consensuses were better developed in scientific and methodological aspects than the others. The grades of recommendations with the guidelines/consensuses, according to a brief and preliminary scheme, were of practical value. Moreover, the recommendations regarding the pharmacological treatments in the guidelines/consensuses above, are various according to the study. Overall, the quality of some NUGIB guidelines/consensuses were generally acceptable and applicable, those yet are with minor deficiencies. The others may be improved according to the AGREE II items, likely by evaluating the quality of the guidelines/consensuses when the guidelines/consensuses are updated.
4.
Minimally invasive approaches for the evacuation of intracerebral hemorrhage: a systematic review
Cavallo C, Zhao X, Abou Al-Shaar H, Weiss M, Gandhi S, Belykh E, Tayebi-Meybodi A, Labib M, Preul MC, Nakaji P
Journal of Neurosurgical Sciences. 2018;62((6):):718-733.
Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) is associated with a high rate of morbidity and mortality. Minimally-invasive surgery (MIS) has been increasingly used in recent years. We systematically reviewed the role of MIS in the acute management of ICH using various techniques. EVIDENCE ACQUISITION A comprehensive electronic search for relevant articles was conducted on several relevant international databases, including PUBMED (Medline), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). EVIDENCE SYNTHESIS Our primary literature research resulted in 1134 articles. In total, 116 publications finally met the eligibility criteria to be included in our systematic review. Five major MIS categories for the evacuation of ICH were identified, respectively: minimally invasive direct aspiration with or without thrombolytics, endoscope assisted technique, sonothrombolysis, aspiration-irrigation device and endoport-assisted evacuation. CONCLUSIONS The role of minimally invasive techniques in the management of ICH remains under dispute. However, a mounting evidence in the literature demonstrates that MIS is associated with significantly improved outcomes when compared with conservative treatment and conventional surgical evacuation strategy.