Yidan Lu

Endoscopic Management of Acute Peptic Ulcer Bleeding

This review discusses the indications, technical aspects, and comparative effectiveness of the endoscopic treatment of upper gastrointestinal bleeding caused by peptic ulcer. Pre-endoscopic considerations, such as the use of prokinetics and timing of endoscopy, are reviewed. In addition, this article examines aspects of postendoscopic care such as the effectiveness, dosing, and duration of postendoscopic proton-pump inhibitors, Helicobacter pylori testing, and benefits of treatment in terms of preventing rebleeding; and the use of nonsteroidal anti-inflammatory drugs, antiplatelet agents, and oral anticoagulants, including direct thrombin and Xa inhibitors, following acute peptic ulcer bleeding.

Using Hemospray Improves the Cost-effectiveness Ratio in the Management of Upper Gastrointestinal Nonvariceal Bleeding

Goals: We compared the cost-effectiveness of traditional recommended endoscopic hemostatic therapies and Hemospray alone or in combination when treating nonvariceal upper gastrointestinal bleeding (NVUGIB). Background: Hemospray (TC-325) is a novel endoscopic hemostatic powder, achieving hemostasis through adherence to actively bleeding biological surfaces. Study: A decision tree of patients with NVUGIB assessed 4 possible treatment strategies: traditional therapy alone (T), Hemospray alone (H), traditional therapy completed by Hemospray if needed (T+H), or Hemospray completed by traditional therapy if needed (H+T). Using published probabilities, effectiveness was the likelihood of avoiding rebleeding over 30 days. Costs in 2014 US

Timing or Dosing of Intravenous Proton Pump Inhibitors in Acute Upper Gastrointestinal Bleeding Has Low Impact on Costs.

were based on the US National Inpatient Sample. A third-party payer perspective was adopted. Sensitivity and subgroup analyses were performed. Results: For all patients, T+H was more efficacious (97% avoiding rebleeding) and less expensive (average cost per patient of US

Is It Ethical to Silence Expertise in the Development of Clinical Practice Guidelines? Report & Analysis From an International Consensus Conference

9150) than all other approaches. The second most cost-effective approach was H+T (5.57% less effective and US

Conflicts of Interest Ethics: Silencing Expertise in the Development of International Clinical Practice Guidelines

635 more per patient). Sensitivity analyses showed T+H followed by a strategy of H+T remained more cost-effective than H or T alone when varying all probability assumptions across plausible ranges. Subgroup analysis showed that the inclusion of H (especially alone) was least adapted for ulcers and was more cost-effective when treating lesions at low risk of delayed rebleeding. Conclusions: Hemospray improves the effectiveness of traditional hemostasis, being less costly in most NVUGIB patient populations. A Hemospray first approach is most cost-effective for nonulcer bleeding lesions at low risk of delayed hemorrhage.

Adherence to Guidelines: A National Audit of the Management of Acute upper Gastrointestinal Bleeding. The REASON Registry

OBJECTIVES:High-dose intravenous proton pump inhibitors (PPIs) post endoscopy are recommended in non-variceal upper gastrointestinal bleeding (UGIB), as they improve outcomes of patients with high-risk lesions. Determine the budget impact of using different PPI regimens in treating non-variceal UGIB, including pre- and post-endoscopic use, continuous infusion (high dose), and intermittent bolus (twice daily) dosing.METHODS:A budget impact analysis using a decision model informed with data from the literature adopting a US third party payer’s perspective with a 30-day time horizon was used to determine the total cost per patient (US

A316 ANTIMICROBIAL LOCKS FOR THE PREVENTION OF CATHETER-RELATED BLOOD STREAM INFECTIONS (CRBSI) IN PATIENTS ON PARENTERAL NUTRITION (PN)– A SYSTEMATIC REVIEW

2014) presenting with acute UGIB. The base-case employing high-dose pre- and post-endoscopic IV PPI was compared with using only post-endoscopic PPI. For each, continuous or intermittent dosing regimens were assessed with associated incremental costs. Deterministic and probabilistic sensitivity analyses were performed.RESULTS:The overall cost per patient is

A51 COMPARISON OF THE BOSTON BOWEL PREPARATION SCALE WITH AN AUDITABLE APPLICATION OF THE US MULTI-SOCIETY TASK FORCE GUIDELINES

11,399 when high-dose IV PPIs are initiated before endoscopy. The incremental costs are all inferior in alternate-case scenarios:

Su1993 - The use of Antimicrobial Locks for the Prevention of Catheter-Related Blood Stream Infections (CRBSI) in Patients on Parenteral Nutrition - A Systematic Review

106 less if only post-endoscopic high-dose IVs are used; with intermittent IV bolus dosing, the savings are

Transparency ethics in practice: Revisiting financial conflicts of interest disclosure forms in clinical practice guidelines

223 if used both pre and post endoscopy and