{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:57:47Z","timestamp":1785326267401,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100010479","name":"Cook Medical","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010479","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Erasme Hospital, ULB, Brussels, Belgium"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Gut"],"accepted":{"date-parts":[[2018,4,10]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute variceal bleeding (AVB) requires early therapeutic management by experienced endoscopists that often poses logistical challenges for hospitals. We assessed a different management concept with early application of haemostatic powder\u2014which does not require high endoscopic expertise\u2014added to conventional management in a randomised trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Cirrhotic patients with AVB received standard medical therapy and were randomised to either immediate endoscopy with haemostatic powder application within 2\u2009hours of admission, followed by early elective endoscopy on the next day, that is, within 12\u201324\u2009hours of admission for definitive treatment (study group) or to early elective endoscopy only (control group). In both groups, failures to achieve clinical haemostasis until the time of early elective endoscopy underwent rescue endoscopy with attempted conventional haemostasis. Primary outcome was endoscopic haemostasis at the elective endoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 86 randomised patients with AVB, 5\/43 in the study group required rescue endoscopy for failure of controlling spurting bleeding (n=4) after powder application or for early bleeding recurrence in one patient who died before repeating rescue endoscopy. In the control group, 13\/43 patients required rescue endoscopic haemostasis for failure of clinical haemostasis (12%vs30%, p=0.034). In the remaining patients, early elective endoscopic haemostasis was achieved in all 38 patients in the study group, while all remaining 30 patients in the control group had fresh gastric blood or (10%) spurting bleeding at early elective endoscopy with successful haemostasis in all of them. Six-week survival was significantly improved in the study group (7%vs30%, p=0.006).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The new concept of immediate powder application improves early clinical and endoscopic haemostasis. This simplified endoscopic approach may have an impact on early and 6-week survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT03061604\" ext-link-type=\"clintrialgov\">NCT03061604<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/gutjnl-2017-314653","type":"journal-article","created":{"date-parts":[[2019,4,8]],"date-time":"2019-04-08T11:57:29Z","timestamp":1554724649000},"page":"844-853","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":86,"title":["Early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding: a randomised trial"],"prefix":"10.1136","volume":"68","clinical-trial-number":[{"clinical-trial-number":"nct03061604","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03061604","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Mostafa","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium"},{"name":"Theodor Bilharz Research Institute, Department of Gastroenterology and Hepatology, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"El-Mikkawy","sequence":"additional","affiliation":[{"name":"Theodor Bilharz Research Institute, Department of Gastroenterology and Hepatology, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Abdel Hamid","sequence":"additional","affiliation":[{"name":"Theodor Bilharz Research Institute, 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