Efficacy of topical hemostatic agents in malignancy-related GI bleeding: a systematic review and meta-analysis

BACKGROUND AND AIMS

Despite advances in endoscopic therapies, malignancy-related GI bleeding remains difficult to manage with high rates of treatment failure and rebleeding. Topical hemostatic agents (THAs) are easier to apply to the wide bleeding surface of tumors. We conducted this systematic review and meta-analysis to evaluate the efficacy of THAs in malignancy-related GI bleeding.

METHODS

We conducted a comprehensive search of multiple electronic databases to identify studies reporting on the use of THAs in malignancy-related GI bleeding. The primary outcome was the achievement of hemostasis; secondary outcomes were early rebleeding (≤3 days), delayed rebleeding (>3 days), aggregate rebleeding, all-cause mortality, and GI bleeding-related mortality. A meta-analysis of proportions was done for all outcomes.

RESULTS

Out of 355 citations, 16 studies with 530 patients were included. Primary hemostasis was achieved in 94.1% (95% confidence interval [CI], 91.5-96.0). Early rebleeding was seen in 13.9% (95% CI, 9.7-19.4) and delayed rebleeding in 11.4% (95% CI, 5.8-21.1). Aggregate rebleeding was seen in 24.2% (95% CI, 18.5-31.0). All-cause mortality was 33.1% (95% CI, 23.7-44.0), whereas GI bleeding-related mortality occurred in 5.9% (95% CI, 2.2%-14.8).

CONCLUSIONS

THAs are highly effective for achieving primary hemostasis in malignancy-related GI bleeding. It should be considered as an alternative to traditional endotherapy methods in malignancy-related GI bleeding. Future studies should be designed to evaluate its efficacy and safety as a primary method of hemostasis as compared with traditional endotherapy measures.

Cancer and older adult patient care

Cancer occurs most frequently in patients aged 65 and older. With the increasing age of the world's population, there will be a significant increase in cancer diagnoses in older adults. Aging imposes a wide variety of physiological responses, comorbidities, and ailments, but older patients are less represented in clinical studies. Specific needs of older patients with cancer often go under-recognized and consequently unmet. In this review, common diagnoses that can affect the outcomes of this population, including frailty, malnutrition, and delirium, are discussed. Areas that need further research to improve the care of geriatric cancer patients, particularly in the hospital settings, are also identified.

Spectroscopic properties of lead fluoroborate glasses doped with ytterbium

A new lead fluoroborate glass (PbO-PbF2-B2O3) doped with ytterbium (Yb:PbFB) is presented. Samples with different concentrations of Yb3+ were produced and had their emission cross-sections, fluorescence lifetimes and minimum pump intensities determined. They have high refractive index of 2.2 and a density of 4.4 g/cm3. For a doping level of 1.153x1020 ions/cm3, the fluorescence lifetime, after excitation at 968 nm, is 0.81 ms, which is comparable to Yb:tellurite laser glass. Also, an emission band at 1022 nm is measured with emission cross-section of approximately 1.07x10-20 cm2 and fluorescence effective linewidth of 60 nm, which is comparable to Yb:phosphate laser glass.

Optical properties of Nd doped Bi2O3-PbO-Ga2O3 glasses

The optical properties of a new family of neodymium doped BPG (Bi2O3-PbO-Ga2O3 ) glasses are presented. We measured a high refractive index, of 2.5, and a transmission cutoff in the far infrared at 8microm. Three intense emission bands are observed centered at 877nm, 1066nm and 1341nm. The emission cross-section is 10 -20 cm 2 and the total spectral linewidth is 30nm at 1066nm. The Judd-Ofelt parameters are calculated and used to evaluate transition probability, radiative lifetime and branching ratios. The optical properties of these Nd:BPG glasses show promise for their use as a new active laser material.