Background and Aim
Upper gastrointestinal tumors account for 5% of upper gastrointestinal bleeds. These patients are challenging to treat due to the diffuse nature of the neoplastic bleeding lesions, high rebleeding rates, and significant transfusion requirements. TC‐325 (Cook Medical, North Carolina, USA) is a hemostatic powder for gastrointestinal bleeding. The aim of this study was to examine the outcomes of upper gastrointestinal bleeds secondary to tumors treated with Hemospray therapy.
Methods
Data were prospectively collected on the use of Hemospray from 17 centers. Hemospray was used during emergency endoscopy for upper gastrointestinal bleeds secondary to tumors at the discretion of the endoscopist as a monotherapy, dual therapy with standard hemostatic techniques, or rescue therapy.
Results
One hundred and five patients with upper gastrointestinal bleeds secondary to tumors were recruited. The median Blatchford score at baseline was 10 (interquartile range [IQR], 7–12). The median Rockall score was 8 (IQR, 7–9). Immediate hemostasis was achieved in 102/105 (97%) patients, 15% of patients had a 30‐day rebleed, 20% of patients died within 30 days (all‐cause mortality). There was a significant improvement in transfusion requirements following treatment (P < 0.001) when comparing the number of units transfused 3 weeks before and after treatment. The mean reduction was one unit per patient.
Conclusions
Hemospray achieved high rates of immediate hemostasis, with comparable rebleed rates following treatment of tumor‐related upper gastrointestinal bleeds. Hemospray helped in improving transfusion requirements in these patients. This allows for patient stabilization and bridges towards definitive surgery or radiotherapy to treat the underlying tumor.
Introduction: Text message-based interventions reduce colonoscopy no-show rates and improve bowel preparation scores. In this non-randomized study, we assessed whether an interactive text messaging system could improve colonoscopy outcomes. Methods: Colonoscopy pre-procedural instructions were programmed into a dedicated software platform created for this study. In the intervention arm, text messages were sent to veterans during a 4-week study period. Validated pre-procedural satisfaction questionnaires were completed by patients during standard protocol and intervention periods. Demographics and colonoscopy outcomes data were compared between the standard protocol and intervention arms, including procedure completion rate on scheduled date, Boston bowel preparation score (BPPS), adenoma detection rate, and satisfaction. Results: Of 241 patients, 128 were in the standard protocol arm and 113 in the intervention arm. Higher proportions of patients receiving text messages underwent colonoscopy on their scheduled date (69.9%) compared to the ones in the standard protocol (50.8%, p = 0.015). Patients with ≥3 interactions with the system had 80.6% likelihood of completing colonoscopy on the scheduled date compared to 56.9% with <3 interactions and 50.8% with standard protocol (p < 0.001). Frequency of interaction with the system was similar between older (>65 years) and younger patients (p = 1.0). Among older patients, colonoscopy was completed successfully in 84.2% when alert-based human interactions occurred compared to 65.6% in those without and 47.9% with standard protocol (p = 0.018). More than 90% indicated they would recommend the system to patients undergoing future colonoscopy. Conclusion: An interactive text messaging system improves successful colonoscopy rates in a VA setting, with greatest impact in older patients.
Background
Imperfect high‐resolution manometry (HRM) studies can impact clinical management of patients with esophageal symptoms.
Methods
Esophageal high‐resolution manometry (HRM) studies attempted and/or performed by trained motility operators at a tertiary care center over a 2‐year period were identified. When studies were attempted but not completed, reasons for an imperfect study (critically imperfect = LES not adequately traversed; non‐critically imperfect = diaphragm not traversed), and point of identification (identified by motility nurse vs. identified on physician review) were recorded. Prevalence and clinical predictors of critically and non‐critically imperfect studies were determined.
Key Results
Of 962 HRM studies attempted in 951 patients, 33 (3.4%) were critically imperfect (17 curled catheters), and 125 (13.0%) were non‐critically imperfect. A third of critically imperfect studies, and 64.7% of curled catheters had achalasia, while 99.2% of non‐critically imperfect studies had large hiatus hernias. Motility nurses detected 90.9% of critically imperfect and 55.8% of non‐critically imperfect studies in real‐time (p < 0.001). Achalasia independently predicted curled catheters; large hiatus hernias predicted non‐critically imperfect studies (p < 0.001 for each). Compared to technically perfect studies, catheter curling was encountered more often in older patients, catheter intolerance in younger patients, and non‐critically imperfect studies in females (p < 0.001 for each). No critical motor disorder was identified in intolerant patients.
Conclusions and Inferences
Achalasia should be suspected when a curled catheter is encountered especially in older patients, while intolerant patients do not have critical motor disorders. Critically imperfect HRM studies are rare when performed by trained motility operators, which are identified in real time and aborted.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.