P65 The ovesco OTSC for acute upper gastrointestinal bleeding – a large propensity score-matched UK series

Abstract

Serum urea level >6.5 mmol/L and change in urea concentration >1.3 fold from baseline predicted the need for endotherapy with a sensitivity/specificity of 85%/32% and 85%/ 46%, respectively; the latter predicted severe AUGIB (X 2 =10.2, p=0.001). The corresponding area under the receiver operating curve (AUROC) were 0.59 (95% CI 0.49-0.69) and 0.71 (95% CI 0.61-0.81) (figure 1). In a subgroup analysis of patients with chronic kidney disease (n=46), AUROC for urea trend was 0.65 compared to that of absolute urea levels (0.53). There were no significant associations between urea concentrations, acute and chronic kidney disease with rebleeding rates at 72 hours, inpatient mortality and readmissions for AUGIB. Conclusions We demonstrate that an increase in urea concentration of >1.3 fold from baseline is superior at predicting severe AUGIB requiring endoscopic intervention and is a useful discriminator in patients with chronic kidney disease.

Efficacy of new hemostatic techniques in nonvariceal gastrointestinal bleeding: A systematic review and network meta‐analysis

“…Fifty‐one potentially relevant articles were retrieved for further review, of which 29 were further excluded based on the publication type of case report (n = 1), data not extractable (n = 7), duplication (n = 19) and cost‐effectiveness analysis (n = 2) (Supplementary Table S2). Finally, 16 full‐text articles and 6 conference abstracts including a total of 2099 individuals 17,28–48 were enrolled for the systematic review and meta‐analysis. Among them, ten studies were RCTs, 28–37 two were prospective cohort studies, 38,39 and 10 were retrospective cohort studies 17,40–48 .…”

“…Finally, 16 full‐text articles and 6 conference abstracts including a total of 2099 individuals 17,28–48 were enrolled for the systematic review and meta‐analysis. Among them, ten studies were RCTs, 28–37 two were prospective cohort studies, 38,39 and 10 were retrospective cohort studies 17,40–48 . Eleven studies compared OTSC with CET 28,31,33,36,37,40–42,44–46 .…”

“…Among them, ten studies were RCTs, [28][29][30][31][32][33][34][35][36][37] two were prospective cohort studies, 38,39 and 10 were retrospective cohort studies. 17,[40][41][42][43][44][45][46][47][48] Eleven studies compared OTSC with CET. 28,31,33,36,37,[40][41][42][44][45][46] The other eleven studies compared HP with CET, in which six studies used TC-325 (Hemospray; Cook Medical), 29,32,34,35,38,47 two studies used UI-EWD (NexPowder; Next Biomedical), 30,48 two studies used EndoClot (Vitramed or EndoClot Plus, Santa Clara, CA, USA), 17,43 and one study used both TC-325 and EndoClot.…”

“…17,[40][41][42][43][44][45][46][47][48] Eleven studies compared OTSC with CET. 28,31,33,36,37,[40][41][42][44][45][46] The other eleven studies compared HP with CET, in which six studies used TC-325 (Hemospray; Cook Medical), 29,32,34,35,38,47 two studies used UI-EWD (NexPowder; Next Biomedical), 30,48 two studies used EndoClot (Vitramed or EndoClot Plus, Santa Clara, CA, USA), 17,43 and one study used both TC-325 and EndoClot. 39 Detailed information is provided in Supplementary Table S3.…”

“…Based on the 22 studies (2099 patients), OTSC showed superior efficacy compared with CET in terms of the 30-day rebleeding rate (RR 0.41, 95% CI 0.25-0.63); while HP ± CET had comparable efficacy with CET alone (RR 0.73, 95% CI 0.45-1.13) or OTSC alone (RR 0.56, 95% CI 0.30-1.05), showing no statistically significant difference. In addition, the data for responder analysis with short-term rebleeding was available from 14 studies (1409 patients), 28,30,31,34,[36][37][38][39][40]43,[45][46][47][48] including two studies in which only the 3-day rebleeding rates could be extracted. 28,30 OTSC was superior to CET in terms of short-term rebleeding rate (RR 0.35, 95% CI 0.14-0.74), while no statistically significant differences were found in the comparisons of HP ± CET vs OTSC or CET.…”