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Background and study aims Hemospray (TC-325) is a mineral powder with adsorptive properties designed for use in various gastrointestinal bleeding (GIB) scenarios. We conducted a systematic review & meta-analysis of randomized controlled trials (RCTs) comparing TC-325 to standard endoscopic therapy (SET) for non-variceal GIB (NVGIB). Methods Multiple databases were searched through October 2022. Meta-analysis was performed using a random-effects model to determine pooled relative risk (RR) and proportions with 95 % confidence intervals (CI) for primary hemostasis, hemostasis failure, 30-day rebleeding, length of stay (LOS), and need for rescue interventions. Heterogeneity was assessed using I2%. Results Five RCTs with 362 patients (TC-325 178, SET 184) – 123 females and 239 males with a mean age 65 ± 16 years). The most common etiologies were peptic ulcer disease (48 %), malignancies (35 %), and others (17 %). Bleeding was characterized as Forrest IA (7 %), IB (73 %), IIA (3 %), and IIB (1 %). SET included epinephrine injection, electrocautery, hemoclips, or a combination. No statistical difference in primary hemostasis between TC-325 compared to SET, RR 1.09 (CI 0.95–1.25; I2 43), P = 0.2, including patients with oozing/spurting hemorrhage, RR 1.13 (CI 0.98–1.3; I2 35), P = 0.08. Failure to achieve hemostasis was higher in SET compared to TC-325, RR 0.30 (CI 0.12–0.77, I2 0), P = 0.01, including patients with oozing/spurting hemorrhage, RR 0.24 (CI 0.09 – 0.63, I2 0), P = 0.004. We found no difference between the two interventions in terms of rebleeding, RR 1.13 (CI 0.62–2.07, I2 26), P = 0.8 and LOS, standardized mean difference (SMD) 0.27 (CI, –0.20–0.74; I2 62), P = 0.3. Finally, pooled rate of rescue interventions (angiography) was statistically higher in SET compared to TC-325, RR 0.68 (CI 0.5–0.94; I2 0), P = 0.02. Conclusions Our analysis shows that for acute NV GIB, including oozing/spurting hemorrhage, TC-325 does not result in higher rates of primary hemostasis compared to SET. However, lower rates of failures were seen with TC-325 than SET. In addition, there was no difference in the two modalities when comparing rates of rebleeding and LOS.

Background and study aims Endoscopic retrograde appendicitis therapy (ERAT) is an endoscopic procedure for management of patients with acute appendicitis (AA). In addition to being minimally invasive, it has the added advantages of preservation of appendix and simultaneous inspection of colon. We performed a systematic review and meta-analysis on ERAT in patients with AA. Methods We conducted a comprehensive search of multiple electronic databases (from inception through January 2022) to identify studies reporting ERAT in AA. The primary outcome was to evaluate the overall clinical and technical success of ERAT. The secondary outcome was to study the total and individual adverse events (AEs). The meta-analysis was performed using Der Simonian and Laird random effect model. Results Seven studies reporting on 298 patients were included. The majority of the patient population was male (55.3 %), with mean age of 31 ± 12.39 years. The pooled technical success rate was 99.36 % (95 % CI 97.61–100, I2 = 0) and the pooled clinical success rate was 99.29 % (95 % CI 97.48–100, I2 = 0). The pooled AE rate was 0.19 % (95 % CI 0–1.55, I2 = 0). The most common AE was perforation with 0.19 % (95 % CI 0–1.55, I2 = 0). The recurrence rate was 6.01 % (95 % CI 2.9–9.93, I2 = 20.10). Average length of procedure was 41.1 ± 7.16 min. Low heterogeneity was noted in in our meta-analysis. Conclusions ERAT is a safe procedure with high rates of clinical and technical success in patients with AA. Further randomized controlled trials should be performed to assess the utility of ERAT in AA as compared to laparoscopic appendectomy.

Background and study aims We compared the diagnostic yield and specimen adequacy in EUS-guided parenchymal biopsies between two types of EUS 19 G core needles. Patients and methods This is a retrospective study of 420 patients at two tertiary medical centers in Florida with unexplained abnormal liver associated tests were referred for EUS evaluation of biliary obstruction and pancreatic pathology. EUS-guided liver biopsy (EUS-LB) was performed at the same session after biliary obstruction was excluded. We compared intact specimen length (ISL), total specimen length (TSL), complete portal triads (CPT) and adverse events (AE). Welch’s T and Tukey tests were used for ISL, TSL and CPT. Results A total of 210 patients underwent EUS-LB using a Franseen needle, 210 patients using a fork-tip needle. Median patient age was 52 years (15.63) and 238 (56.7 %) were female. The fork-tip needle had a mean ISL of 2.7 (1.1 SD) cm, TSL of 6 cm (2.1 SD), and mean 19.5 CPT (8.5 SD) Abdominal pain occurred in 35 patients (17 %) post-procedure and was managed with supportive care. Two patients required intravenous (IV) narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) patients. The Franseen needle had a mean ISL of 3.1 cm (1.3 SD), TSL of 6.5 cm (2.6 SD), and mean of 24 CPT (8.8 SD). Abdominal pain occurred in four patients (2 %) post-procedure, which resolved in all patients after IV narcotic administration. Subcapsular hematomas occurred in 1 (0.5 %) and bile leak in 1(0.4 %) patients. Conclusions Use of the Franseen needle resulted in better liver core samples than that obtained with a fork-tip needle.

Background: Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD., Methods: We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using I 2 statistics., Results: We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; I 2 =53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; I 2 =71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; I 2 =57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; I 2 =28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; I 2 =3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; I 2 =59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; I 2 =85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; I 2 =44%]., Conclusion: BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery., Competing Interests: Conflict of Interest: DGA: Consultant for Boston Scientific; all other authors declare no conflicts of interest., (Copyright: © 2024 Hellenic Society of Gastroenterology.)

Background: Left ventricular assist devices (LVADs) are indicated for patients with end-stage heart failure and require systemic anticoagulation. Gastrointestinal (GI) bleeding is a major adverse event following LVAD implantation. There is paucity of data on healthcare resource utilization in patients with LVAD and the risk factors of associated bleeding, despite the increase in GI bleeding. We investigated the in-hospital outcomes of GI bleeding in patients with continuous-flow (CF) LVAD., Methods: This was a serial cross-sectional study of the Nationwide Inpatient Sample (NIS) in the CF-LVAD era from 2008-2017. All adults admitted to hospital with a primary diagnosis of GI bleeding were included. GI bleeding was diagnosed by ICD-9/ICD-10 codes. Patients with CF-LVAD (cases) and without CF-LVAD (controls) were compared using univariate and multivariate analyses., Results: A total of 3,107,471 patients were discharged with a primary diagnosis of GI bleeding during the study period. Of these, 6569 (0.21%) had CF-LVAD-related GI bleeding. Overall, bleeding angiodysplasia accounted for the majority (69%) of LVAD-related GI bleeding. There was no statistical difference in mortality, but the length of hospital stay increased by 2.53 days (95% confidence interval [CI] 1.78-2.98; P<0.001) and the mean hospital charge per stay increased by $25,980 (95%CI 21,267-29,874; P<0.001) in 2017 compared to 2008. The results were consistent after propensity score matching., Conclusion: Our study highlights that patients with LVAD admitted to the hospital for GI bleeding experience longer hospital stays and greater healthcare costs that warrant risk-based patient evaluation and careful implementation of management strategies., Competing Interests: Conflict of Interest: None, (Copyright: © Hellenic Society of Gastroenterology.)