AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review

Mullady, Daniel; Wang, Andrew Y.; Waschke, Kevin

doi:10.1053/j.gastro.2020.05.095

Cited by 94 publications

(91 citation statements)

References 56 publications

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“…Those ulcer images requiring endoscopic therapy were further classified to determine the risk of endoscopic therapy after a review by two endoscopists. Ulcers with difficult locations such as the duodenum or the lesser curvature site or those with a big ulcer base or big visible vessels are considered high risk for endoscopic therapy as the primary endoscopic hemostasis may fail [17] and the remaining were considered low risk for endoscopic therapy.…”

Section: Patients and Data Preparationmentioning

confidence: 99%

Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease

Yen

et al. 2021

J. Med. Biol. Eng.

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Purpose Management of peptic ulcer bleeding is clinically challenging. Accurate characterization of the bleeding during endoscopy is key for endoscopic therapy. This study aimed to assess whether a deep learning model can aid in the classification of bleeding peptic ulcer disease. Methods Endoscopic still images of patients (n = 1694) with peptic ulcer bleeding for the last 5 years were retrieved and reviewed. Overall, 2289 images were collected for deep learning model training, and 449 images were validated for the performance test. Two expert endoscopists classified the images into different classes based on their appearance. Four deep learning models, including Mobile Net V2, VGG16, Inception V4, and ResNet50, were proposed and pre-trained by ImageNet with the established convolutional neural network algorithm. A comparison of the endoscopists and trained deep learning model was performed to evaluate the model’s performance on a dataset of 449 testing images. Results The results first presented the performance comparisons of four deep learning models. The Mobile Net V2 presented the optimal performance of the proposal models. The Mobile Net V2 was chosen for further comparing the performance with the diagnostic results obtained by one senior and one novice endoscopists. The sensitivity and specificity were acceptable for the prediction of “normal” lesions in both 3-class and 4-class classifications. For the 3-class category, the sensitivity and specificity were 94.83% and 92.36%, respectively. For the 4-class category, the sensitivity and specificity were 95.40% and 92.70%, respectively. The interobserver agreement of the testing dataset of the model was moderate to substantial with the senior endoscopist. The accuracy of the determination of endoscopic therapy required and high-risk endoscopic therapy of the deep learning model was higher than that of the novice endoscopist. Conclusions In this study, the deep learning model performed better than inexperienced endoscopists. Further improvement of the model may aid in clinical decision-making during clinical practice, especially for trainee endoscopist.

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Section: Patients and Data Preparationmentioning

confidence: 99%

Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease

Yen

et al. 2021

J. Med. Biol. Eng.

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“…19,20 Various guidelines recommend to continue aspirin if started as monotherapy or in combination for secondary cardiovascular prevention. [21][22][23][24][25][26] Aspirin for primary cardiovascular prophylaxis should be stopped temporarily and if indicated can be resumed within 5 days. 25 Platelet transfusion can be considered in patients with severe UGI bleed with thrombocytopenia.…”

Section: Management Of Antiplatelet and Anticoagulantsmentioning

confidence: 99%

“…25 Platelet transfusion can be considered in patients with severe UGI bleed with thrombocytopenia. All the anticoagulants need to be stopped temporarily and can be resumed within 1 week of hemostasis 26 and can be bridged with heparin in patients with high risk of thromboembolism. Reversal of anticoagulation using vitamin K, prothrombin complex concentrate (PCC), or fresh frozen plasma (FFP), and reversal agents for direct oral anticoagulants (DOAC) should be considered in case of hemodynamic instability.…”

Section: Management Of Antiplatelet and Anticoagulantsmentioning

confidence: 99%

“…35 Majority of the available guidelines recommend an early endoscopy (<24 hours), except for those with GBS of 0 to 1, where elective endoscopy on an out-patient basis can be considered. 25,26 However, the timing for patients with hemodynamic instability has not been considered in many of them. To address this issue, the recent AGA guidelines advocates urgent endoscopy (<12 hours) in patients with moderate-to-large volume hematemesis, in-hospital bleed, and those with hemodynamic instability despite adequate resuscitation.…”

Section: When To Do?mentioning

confidence: 99%

“…To address this issue, the recent AGA guidelines advocates urgent endoscopy (<12 hours) in patients with moderate-to-large volume hematemesis, in-hospital bleed, and those with hemodynamic instability despite adequate resuscitation. 26 Early esophagogastroduodenoscopy (EGD) is associated with better outcomes in UGIB. Early EGD is associated with a decreased risk of hypovolemia, acute kidney injury, acute respiratory failure, significant reduction in mortality, hospital stay, and lower total hospital cost.…”

Section: When To Do?mentioning

confidence: 99%

See 2 more Smart Citations

Endotherapy for Nonvariceal Upper Gastrointestinal Hemorrhage

Birda

Kumar

Samanta

2021

Journal of Digestive Endoscopy

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Nonvariceal upper gastrointestinal hemorrhage (NVUGIH) is a common GI emergency with significant morbidity and mortality. Triaging cases on the basis of patient-related factors, restrictive blood transfusion strategy, and hemodynamic stabilization are key initial steps for the management of patients with NVUGIH. Endoscopy remains a vital step for both diagnosis and definitive management. Multiple studies and guidelines have now defined the optimum timing for performing the endoscopy after hospitalization, to better the outcome. Conventional methods for achieving endoscopic hemostasis, such as injection therapy, contact, and noncontact thermal therapy, and mechanical therapy, such as through-the-scope clips, have reported to have 76 to 90% efficacy for primary hemostasis. Newer modalities to enhance hemostasis rates have come in vogue. Many of these modalities, such as cap-mounted clips, coagulation forceps, and hemostatic powders have proved to be efficacious in multiple studies. Thus, the newer modalities are recommended not only for management of persistent bleed and recurrent bleed after failed initial hemostasis, using conventional modalities but also now being advocated for primary hemostasis. Failure of endotherapy would warrant radiological or surgical intervention. Some newer tools to optimize endotherapy, such as endoscopic Doppler probes, for determining flow in visible or underlying vessels in ulcer bleed are now being evaluated. This review is focused on the technical aspects and efficacy of various endoscopic modalities, both conventional and new. A synopsis of the various studies describing and comparing the modalities have been outlined. Postendoscopic management including Helicobacter pylori therapy and starting of anticoagulants and antiplatelets have also been outlined.

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Therapeutic Upper Endoscopy

2023

Cotton and Williams’ Practical Gastrointestinal Endoscopy

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AGA Clinical Practice Update on Endoscopic Therapies for Non-Variceal Upper Gastrointestinal Bleeding: Expert Review

Cited by 94 publications

References 56 publications

Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease

Performance Comparison of the Deep Learning and the Human Endoscopist for Bleeding Peptic Ulcer Disease

Endotherapy for Nonvariceal Upper Gastrointestinal Hemorrhage

Therapeutic Upper Endoscopy

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