Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding

BACKGROUND: The role of capsule endoscopy (CE) in the diagnosis of active mild-to-moderate GI bleeding (GIB) immediately after a negative EGD and ileocolonoscopy has not been prospectively evaluated. OBJECTIVE: To estimate the diagnostic yield and clinical significance of CE in patients with acute, obscure, overt, mild-to-moderate GIB. DESIGN: A single-center prospective study. PATIENTS: During a 3-year period, 573 patients admitted to the hospital with acute mild-to-moderate GIB were included in this study. Among them, 37 patients (6.5%) with negative endoscopic findings, after urgent upper- and lower-GI endoscopies, underwent CE within the first 48 hours to identify the source of bleeding. RESULTS: CE revealed active bleeding in 34 patients and a diagnostic yield of 91.9%, including angiodysplasias in 18 patients, ulcers in 3 patients, and tumors in 2 patients. In the remaining 11 patients (32%), CE revealed the site of bleeding: distal duodenum in 1 case (9%), jejunum in 6 cases (54%), ileum in 2 cases (18%), and cecum in 2 cases (18%). From the 37 bleeders, 16 were managed conservatively, 14 endoscopically, and 7 surgically. During a 12-month follow-up period, bleeding recurrence was observed in 5 of 32 (15.6%). LIMITATIONS: This study had a limited number of patients. CONCLUSIONS: CE appeared to have a high diagnostic yield in patients with acute, mild-to-moderate, active hemorrhage of obscure origin when performed in the hospital after a negative standard endoscopic evaluation and has important clinical value in guiding medical management.     

von Willebrand Factor and Management of Heart Valve Disease: JACC Review Topic of the Week

For decades, numerous observations have shown an intimate relationship between von Willebrand factor (VWF) multimer profile and heart valve diseases (HVD). The current knowledge of the unique biophysical properties of VWF helps us to understand the longstanding observations concerning the bleeding complications in patients with severe HVD. Not only does the analysis of the VWF multimer profile provide an excellent evaluation of HVD severity, it is also a strong predictor of clinical events. Also of importance, VWF responds within minutes to any significant change in hemodynamic valve status, making it an accurate marker of the quality of surgical and transcatheter therapeutic interventions. The authors provide in this review a practical, comprehensive, and evidence-based framework of the concept of VWF as a biomarker in HVD, advocating for its implementation into the clinical decision-making process besides usual clinical and imaging evaluation. They also delineate critical knowledge gaps and research priorities to definitely validate this concept.     

无创血红蛋白监测在消化道出血诊治中的应用

【】　目的　评价消化道出血患者应用Masimo Radical-7脉搏氧测量仪连续、无创地监测血红蛋白的临床价值。方法　选择41例行消化道出血成年患者,应用Masimo Radical-7脉搏氧测量仪按需连续监测并分别记录患者出血即刻、24hr后的血红蛋白水平(SpHb值),同时于出血即刻及出血后24hr抽取２ｍＬ动脉血即刻行动脉血气分析并测定血红蛋白水平(THb值),并对应作记录后进行相关分析。结果　出血即刻SpHb值与THb值均呈线性相关(ｒ=0.56),回归方程为ｙ＝0.60+0.19x; SpHb与THb的差值的平均值为7.957?2.08ｇ／Ｌ。出血后24小时呈线性相关(ｒ＝0.75,Ｐ＜0.0001),回归方程为ｙ＝1.20＋0.86ｘ;结论　脉搏氧测量仪连续无创监测血红蛋白值与同时间点动脉血气分析测得的血红蛋白值之间具有良好的相关性,无创连续血红蛋白监测技术准确性良好,可有效指导消化道出血患者临床诊治。