Vaptins should not be used in hyponatremia in cirrhosis

This systematic review of clinical trials of the use of vaptans (tolvaptan, satavaptan, and lixivaptan) in patients with cirrhosis and hyponatremia found no difference in mortality, variceal bleeding, hepatic encephalopathy, SBP, hepatorenal syndrome, or renal failure, compared to placebo. The use of vaptans did increase serum sodium and reduced weight, but also increased the risk of adverse events. The weight of evidence does not support the use of vaptans in cirrhotics with hyponatremia (abstract).

Resuming warfarin after GI bleed

This large cohort of patients on warfarin who experienced a GI bleed found 59% resumed warfarin within 90 days. Those that resumed were significantly less likely to experience thrombosis (hazard ratio 0.05, CI 0.01-0.58) or death (hazard ratio 0.31, CI 0.15-0.62), and did not have a higher risk of bleeding, compared to those that did not resume warfarin within 90 days. This study suggests that early re-initiation of warfarin after a GI bleed results in better clinical outcomes that waiting for 90 days or later (abstract)

Probiotics for hepatic encephalopathy

In this open label trial, 235 patients with a history of hepatic encephalopathy were randomized to placebo, lactulose tid, or probiotics tid. Within 12 months of follow up, hepatic encephalopathy developed in 38 placebo patients, 22 probiotic patients, and 18 lactulose patients. Although a small trial, this suggests that probiotics may be added to the options for secondary prevention of hepatic encephalopathy (abstract)

Capsule endoscopy for acute GI bleeding?

In this small trial, patients with acute GI bleeding without a source despite upper and lower endoscopy were randomized to capsule endoscopy or angiography; the diagnostic yield was 53% for capsule endoscopy and 20% for angiography, and there was no difference in long term outcomes between the groups. Capsule endoscopy is a non-invasive option to diagnose acute GI bleeding when endoscopy is unrevealing (abstract)

Early lap chole safe and effective for gallstone pancreatitis

In this retrospective cohort, early lap chole (<48 hours) for gallstone pancreatitis was associated with lower LOS, with no difference in complication rates. There is ongoing evidence of the safety and effectiveness of early lap chole for uncomplicated gallstone pancreatitis (abstract)