1
|
Martino A, Di Serafino M, Orsini L, Giurazza F, Fiorentino R, Crolla E, Campione S, Molino C, Romano L, Lombardi G. Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review. World J Gastroenterol 2023; 29:4222-4235. [PMID: 37545636 PMCID: PMC10401659 DOI: 10.3748/wjg.v29.i27.4222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/11/2023] [Accepted: 05/09/2023] [Indexed: 07/13/2023] Open
Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. Gastroenterologists and other involved clinicians are generally assisted by international guidelines in its management. However, NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines, with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and treatment. Conversely, the management of rare and extraordinary rare causes of NVUGIB is not covered by current guidelines. Given they are frequently life-threatening conditions, all the involved clinicians, that is emergency physicians, diagnostic and interventional radiologists, surgeons, in addition obviously to gastroenterologists, should be aware of and familiar with their management. Indeed, they typically require a prompt diagnosis and treatment, engaging a dedicated, patient-tailored, multidisciplinary team approach. The aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.
Collapse
Affiliation(s)
- Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Luigi Orsini
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Francesco Giurazza
- Department of Interventional Radiology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | | | - Enrico Crolla
- Department of Oncological Surgery, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Severo Campione
- Department of Pathology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Carlo Molino
- Department of Oncological Surgery, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Naples 80131, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Naples 80131, Italy
| |
Collapse
|
3
|
Martino A, Di Serafino M, Amitrano L, Orsini L, Pietrini L, Martino R, Menchise A, Pignata L, Romano L, Lombardi G. Role of multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: A comprehensive review. World J Gastrointest Endosc 2022; 14:739-747. [PMID: 36567823 PMCID: PMC9782566 DOI: 10.4253/wjge.v14.i12.739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/30/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022] Open
Abstract
Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common gastroenterological emergency associated with significant morbidity and mortality. Upper gastrointestinal endoscopy is currently recommended as the gold standard modality for both diagnosis and treatment, with computed tomography traditionally playing a limited role in the diagnosis of acute NVUGIB. Following the introduction of multidetector computed tomography (MDCT), this modality is emerging as a promising tool in the diagnosis of NVUGIB. However, to date, evidence concerning the role of MDCT in the NVUGIB diagnosis is still lacking. The aim of our study was to review the current evidence concerning the role of MDCT in the diagnosis of acute NVUGIB.
Collapse
Affiliation(s)
- Alberto Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Lucio Amitrano
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Luigi Orsini
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Lorena Pietrini
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Rossana Martino
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Antonella Menchise
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Luca Pignata
- Department of Clinical Medicine and Surgery, Gastroenterology and Hepatology Unit, University of Naples “Federico II”, Napoli 80131, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| | - Giovanni Lombardi
- Department of Gastroenterology and Digestive Endoscopy, AORN “Antonio Cardarelli”, Napoli 80131, Italy
| |
Collapse
|
5
|
Sachan A, Dhibar DP, Bhalla A, Prakash A, Taneja S, Sharma V. COMPARISON OF NON-ENDOSCOPIC SCORES FOR THE PREDICTION OF OUTCOMES IN PATIENTS OF UPPER GASTROINTESTINAL BLEED IN AN EMERGENCY OF A TERTIARY CARE REFERRAL HOSPITAL: A PROSPECTIVE COHORT STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:534-540. [PMID: 34909862 DOI: 10.1590/s0004-2803.202100000-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Traditionally peptic ulcer disease was the most common cause of upper gastrointestinal (UGI) bleed but with the changing epidemiology; other etiologies of UGI bleed are emerging. Many scores have been described for predicting outcomes and the need for intervention in UGI bleed but prospective comparison among them is scarce. OBJECTIVE This study was planned to determine the etiological pattern of UGI bleed and to compare Glasgow Blatchford score, Pre-Endoscopy Rockall score, AIMS65, and Modified Early Warning Score (MEWS) as predictors of outcome. METHODS In this prospective cohort study 268 patients of UGI bleed were enrolled and followed up for 8 weeks. Glasgow Blatchford score, Endoscopy Rockall score, AIMS65, and MEWS were calculated for each patient, and the area under the receiver operating characteristic (AUC-ROC) curve for each score was compared. RESULTS The most common etiology for UGI bleed were gastroesophageal varices 150 (63.55%) followed by peptic ulcer disease 29 (12.28%) and mucosal erosive disease 27 (11.44%). Total 38 (15.26%) patients had re-bleed and 71 (28.5%) patients died. Overall, 126 (47%) patients required blood component transfusion, 25 (9.3%) patients required mechanical ventilation and 2 (0.74%) patients required surgical intervention. Glasgow Blatchford score was the best in predicting the need for transfusion (cut off - 10, AUC-ROC= 0.678). Whereas AIMS65 with a score of ≥2 was best in predicting re-bleed (AUC-ROC=0.626) and mortality (AUC-ROC=0.725). CONCLUSION Gastrointestinal bleed was most commonly of variceal origin at our tertiary referral center in Northern India. AIMS65 was the best & simplest score with a score of ≥2 for predicting re-bleed and mortality.
Collapse
Affiliation(s)
- Anurag Sachan
- Post Graduate Institute of Medical Education and Research, Department of Gastroenterology, Chandigarh, India
| | - Deba Prasad Dhibar
- Post Graduate Institute of Medical Education and Research, Department of Internal Medicine, Chandigarh, India
| | - Ashish Bhalla
- Post Graduate Institute of Medical Education and Research, Department of Internal Medicine, Chandigarh, India
| | - Ajay Prakash
- Post Graduate Institute of Medical Education and Research, Department of Pharmacology, Chandigarh, India
| | - Sunil Taneja
- Post Graduate Institute of Medical Education and Research, Department of Hepatology, Chandigarh, India
| | - Vishal Sharma
- Post Graduate Institute of Medical Education and Research, Department of Gastroenterology, Chandigarh, India
| |
Collapse
|
7
|
Ba Y, Yue P, Leung JW, Wang H, Lin Y, Bai B, Zhu X, Zhang L, Zhu K, Wang W, Meng W, Zhou W, Liu Y, Li X. Percutaneous transhepatic biliary drainage may be the preferred preoperative drainage method in hilar cholangiocarcinoma. Endosc Int Open 2020; 8:E203-E210. [PMID: 32010755 PMCID: PMC6976325 DOI: 10.1055/a-0990-9114] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Preoperative biliary drainage of hilar cholangiocarcinoma (HC) is controversial. The goal of this study was to compare the clinical outcome and associated complications for types II, III, and IV HC managed by percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods Between January 2011 and June 2017, a total of 180 patients with II, III, and IV HC were enrolled in this retrospective cohort study. According to the drainage method, patients were divided into two groups: PTBD (n = 81) and ERCP (n = 99). This study was registered with ClinicalTrials.gov, NCT03104582, and was completed. Results Compared with the PTBD group, the ERCP group had a higher incidence of post-procedural cholangitis (37 [37.37 %] vs. 18 [22.22 %], P = 0.028) and pancreatitis (17 [17.17 %] vs. 2 [2.47 %], P = 0.001); required more salvaged biliary drainage (18 [18.18 %] vs. 5 [6.17 %], P = 0.029), and incurred a higher cost ( P < 0.05). Patients with type III and IV HC in the ERCP group had more cholangitis than those in the PTBD group (26 [36.62 %] vs. 11 [18.03 %], P = 0.018). The rate of cholangitis in patients who received endoscopic bilateral biliary stents insertion was higher than patients with unilateral stenting (23 [50.00 %] vs. 9 [26.47 %], P = 0.034), and underwent PTBD internal-external drainage had a higher incidence of cholangitis than those with only external drainage (11 [34.36 %] vs. 7 [14.29 %], P = 0.034). No significant difference in the rate of cholangitis was observed between the endoscopic unilateral stenting group and the endoscopic nasobiliary drainage group (9 [26.47 %] vs. 5 [26.32 %], P = 0.990). Conclusion Compared to ERCP, PTBD reduced the rate of cholangitis, pancreatitis, salvage biliary drainage, and decreased hospitalization costs in patients with types II, III, and IV HC. Risk of cholangitis for patients with types III and IV was significantly lower in the PTBD group.
Collapse
Affiliation(s)
- Yongjiang Ba
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China,The Second Department of General Surgery, The First People's Hospital of Qujing City, Qujing, China
| | - Ping Yue
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - Joseph W. Leung
- Division of Gastroenterology and Hepatology, UC Davis Medical Center, and Section of Gastroenterology, Sacramento VA Medical Center, Sacramento, California, United States
| | - Haiping Wang
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - Yanyan Lin
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - Bing Bai
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China
| | - Xiaoliang Zhu
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China,The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Lei Zhang
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China,The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Kexiang Zhu
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China,The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wenhui Wang
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,The Department of Interventional Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wenbo Meng
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China,Corresponding author Wenbo Meng The First Hospital of Lanzhou UniversityDepartment of Special Minimally Invasive SurgeryNO.1 DongGang West RoadLanZhou, Gansu 730000Lanzhou 730000China+86 931 8356022
| | - Wence Zhou
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China,The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ying Liu
- Foreign Languages Department of Lanzhou University, Lanzhou, China
| | - Xun Li
- The First Clinical Medical School of Lanzhou University, Lanzhou, China,Hepatopancreatobiliary Surgery Institute of Gansu Province, Lanzhou, Gansu, China,Key Laboratory of Biological Therapy And Regenerative Medicine Transformation Gansu Province, Lanzhou, China,Clinical Medical College Cancer Center of Lanzhou University, Lanzhou, China,The Fifth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| |
Collapse
|