Endoscopy最新文献

英文中文

Hemospray as first-line treatment option for malignant gastrointestinal bleeding: A cost-utility analysis in the United Kingdom.

IF 11.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Endoscopy

Pub Date : 2024-12-03 DOI: 10.1055/a-2495-2813

Dawn Andrew Cooper, Benjamin Norton, Neil D Hawkes, Srisha Hebbar, Andrea Telese, John Morris, Rehan Haidry, Alan Barkun

Aims: For managing malignant upper gastrointestinal bleeding (MUGIB), randomised control trial data have shown the haemostatic powder; Hemospray (TC-325), results in greater immediate haemostasis and lower 30-day rebleeding rates than standard endoscopic therapy (SET). We sought to determine if using TC-325 as a first-line option for patients with MUGIB would be cost-effective compared with SET in the United Kingdom.

Methods: A decision tree was developed among patients with MUGIB, assessing initial therapy with TC-325 or SET over a 30-day time horizon. Patients with failed initial haemostasis, or a rebleed within 30 days, underwent further endoscopic treatment, escalation to either transcatheter arterial embolisation or surgery, or radiotherapy. Overall, 30-day mortality was applied. Costs, in Great British Pounds, were based on the United Kingdom National Health Services costs for 2023/2024. Results are reported as incremental differences in cost, quality-adjusted life years, and net monetary benefit. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed.

Results: The cost of treating MUGIB patients with TC-325 was £245.88 lower than SET, with an incremental increase of 0.001 Quality Adjusted Life Years (QALYs). TC-325 remained cost-saving for sensitivity and scenario analyses. Probabilistic sensitivity analysis revealed TC-325 as more effective and cost-saving in 82.0% of simulations (range 68.8-97.8%).

Conclusions: Initial treatment of MUGIB with TC-325 compared to SET is more effective (higher primary haemostasis and lower 30-day rebleeding) and cost-saving due to requiring fewer interventions, readmissions, and length of stay. Additional studies are needed to address model uncertainties in the follow-up management of these complex patients.

{"title":"Hemospray as first-line treatment option for malignant gastrointestinal bleeding: A cost-utility analysis in the United Kingdom.","authors":"Dawn Andrew Cooper, Benjamin Norton, Neil D Hawkes, Srisha Hebbar, Andrea Telese, John Morris, Rehan Haidry, Alan Barkun","doi":"10.1055/a-2495-2813","DOIUrl":"https://doi.org/10.1055/a-2495-2813","url":null,"abstract":"Aims: For managing malignant upper gastrointestinal bleeding (MUGIB), randomised control trial data have shown the haemostatic powder; Hemospray (TC-325), results in greater immediate haemostasis and lower 30-day rebleeding rates than standard endoscopic therapy (SET). We sought to determine if using TC-325 as a first-line option for patients with MUGIB would be cost-effective compared with SET in the United Kingdom.Methods: A decision tree was developed among patients with MUGIB, assessing initial therapy with TC-325 or SET over a 30-day time horizon. Patients with failed initial haemostasis, or a rebleed within 30 days, underwent further endoscopic treatment, escalation to either transcatheter arterial embolisation or surgery, or radiotherapy. Overall, 30-day mortality was applied. Costs, in Great British Pounds, were based on the United Kingdom National Health Services costs for 2023/2024. Results are reported as incremental differences in cost, quality-adjusted life years, and net monetary benefit. Deterministic and probabilistic sensitivity analyses and scenario analyses were performed.Results: The cost of treating MUGIB patients with TC-325 was £245.88 lower than SET, with an incremental increase of 0.001 Quality Adjusted Life Years (QALYs). TC-325 remained cost-saving for sensitivity and scenario analyses. Probabilistic sensitivity analysis revealed TC-325 as more effective and cost-saving in 82.0% of simulations (range 68.8-97.8%).Conclusions: Initial treatment of MUGIB with TC-325 compared to SET is more effective (higher primary haemostasis and lower 30-day rebleeding) and cost-saving due to requiring fewer interventions, readmissions, and length of stay. Additional studies are needed to address model uncertainties in the follow-up management of these complex patients.","PeriodicalId":11516,"journal":{"name":"Endoscopy","volume":" ","pages":""},"PeriodicalIF":11.5,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endoscopic hot snare resection of a type III biliary cyst (choledochocele). 内镜下热套管切除 III 型胆道囊肿（胆总管囊肿）。

IF 11.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Endoscopy

Pub Date : 2024-12-01 Epub Date: 2024-11-08 DOI: 10.1055/a-2446-2072

Andrea Sorge, Stefano Mazza, Francesca Torello Viera, Aurelio Mauro, Davide Scalvini, Alessandro Vanoli, Andrea Anderloni

引用次数: 0

Successful necrosectomy using the over-the-scope grasping device: a tool for solid necrotic debris. 使用镜上抓取装置成功进行坏死组织切除术：一种处理固体坏死碎片的工具。

IF 11.5 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Endoscopy

Pub Date : 2024-12-01 Epub Date: 2024-11-08 DOI: 10.1055/a-2443-4173

Rahul Karna, Suchapa Arayakarnkul, Natalie Wilson, Mohammad Bilal

引用次数: 0

Access to the left intrahepatic bile duct using an endoscopic ultrasound-guided rendezvous technique. 利用内窥镜超声引导会合技术进入左肝内胆管。