The edition · Gastroenterology & Hepatology
Endoscopy within six hours of a non-variceal upper GI bleed did not beat endoscopy within 24
A meta-analysis of 10,785 patients found no gain in mortality or rebleeding from ultra-early endoscopy, even in high-risk patients. Also: adding embolisation to TIPS for gastric varices, and whether MASH risk genes blunt resmetirom.
The edition in brief
Pooling nine studies of 10,785 adults with non-variceal upper gastrointestinal bleeding, endoscopy within six hours did not reduce mortality (OR 0.88, 0.58 to 1.34) or rebleeding (OR 1.23, 0.90 to 1.67) compared with later endoscopy, and was linked to more ICU admissions; results held in high-risk patients. A meta-analysis of 14 studies (3,079 patients with decompensated cirrhosis and variceal bleeding) found adding embolisation to TIPS lowered rebleeding (RR 0.67), driven by gastric varices (RR 0.50), and lowered hepatic encephalopathy (RR 0.82), without changing survival. A prespecified genetic analysis of 738 MAESTRO-NASH participants found resmetirom's effects on MASH resolution, fibrosis and liver fat were similar regardless of PNPLA3, HSD17B13, TM6SF2 and other risk genotypes, though the study could not detect small differences. The pearl covers using the Glasgow-Blatchford score to identify very low-risk bleeds.
Adding embolisation to TIPS reduced rebleeding from gastric varices, but not survival
Adding embolisation to TIPS halved rebleeding from gastric varices, without changing survival; the benefit was not seen for oesophageal varices.
Resmetirom worked similarly regardless of common MASH risk genotypes
Common MASH risk genotypes did not measurably change response to resmetirom; genetic risk is not a reason to withhold it where available.
A fibre blend during a low FODMAP diet raised fibre intake without worsening IBS symptoms
Adding a fibre blend during a low FODMAP diet raised fibre intake without worsening symptoms in a small pilot.
The very low-risk upper GI bleed
A Glasgow-Blatchford score of 0 or 1 identifies upper GI bleeds that can often be managed without admission.
Ultra-early endoscopy for non-variceal upper GI bleeding did not reduce death or rebleeding
In non-variceal upper GI bleeding, resuscitate first and scope within 24 hours; endoscopy within six hours did not improve outcomes.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for gastroenterology & hepatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free