S663 Evaluation of Efficacy of Mechanical versus Thermal Therapy Hemostasis in Non-Variceal Upper Gastrointestinal Bleed Patients on Dual Antiplatelet Therapy
Bibliographic record
Abstract
Introduction: Current endoscopic management of patients with non-variceal upper gastrointestinal bleeding (NVUGIB) who are on dual antiplatelet therapy (DAPT) is based upon institutional availability and user experience. There is no clear data available on efficacy of hemostatic clips with epinephrine as compared to bipolar cautery with epinephrine, the two commonly used hemostatic methods in patients with NVUGIB. Methods: A retrospective chart review was done for all consecutive adult patients between 2015-2020 who presented with NVUGIB on DAPT (aspirin, clopidogrel; aspirin, ticagrelor; aspirin, prasugrel) to Allegheny Health Network and underwent endoscopy. Patients who had DAPT discontinued prior to EGD as per ASGE guidelines were excluded from the study. Patients undergoing hemostatic clips (mechanical therapy) with epinephrine or bipolar cautery (thermal therapy) with epinephrine were included for final analysis. Primary outcome was achievement of primary hemostasis while secondary outcomes were need for 2nd hemostatic procedure, early rebleeding (within 7 days) and delayed rebleeding (within 30 days), length of stay and adverse events. Continuous normally distributed variables were reported as means and standard deviation. Categorical variables were expressed as counts and percentages. The Mann-Whitney U test and Fisher’s exact test were used for group comparisons. P-value < 0.05 was considered as level of significance. Results: Out of 203 patients presenting with NVUGIB on DAPT, 26 patients were included for the final analysis. Mean age was 71.4±11.8 years; range, 54 – 99 years; 20/26 (76.9%) patients were male. None of the comparisons were found to be statistically significant between patients in the two groups, however there was trend towards increased risk of rebleeding and need for reintervention in thermal therapy group. (Table 1) Conclusion: Although there was no statistical difference between the two hemostasis modalities, there was a trend towards increased need for 2nd hemostatic procedure and incidence of early rebleeding in thermal therapy group. These are the preliminary results of the study comparing efficacy of two methods on patients at high risk of bleeding from DAPT or DOAC. The study needs to be replicated in larger patient population to evaluate the efficacy of two methods, which would have real world practical significance.Table 1.: Study Methodology Quality Assessment on Newcastle-Ottawa Scale.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".