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RE: Early application of haemostatic powder added to standard management for oesophagogastric variceal bleeding: a randomised trial
  1. Michael Johnston1,
  2. Charlotte Cook1,2,
  3. Ryan Malcolm Buchanan1,2
  1. 1Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  2. 2Primary Care and Population Sciences, University of Southampton, Southampton, UK
  1. Correspondence to Dr Ryan Malcolm Buchanan, Primary Care and Population Sciences, University of Southampton, Southampton SO14 0DA, UK; ryan.buchanan{at}

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We read with interest the article by Ibrahim et al, which describes a randomised controlled trial (RCT) of early endoscopy with Hemospray within 2 hours of admission versus ‘early elective endoscopy’ at 12–24 hours for acute variceal bleeding (AVB).1

We would like to make comments that relate to the internal and external validities of the study. The article indicates that participants consented and were randomised following admission with suspected AVB on the basis of probable underlying liver cirrhosis and fresh blood on nasogastric lavage. However, the article also described how 19 patients were excluded from the trial at endoscopy before randomisation. As the intervention was to undergo an immediate …

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