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Gibiino G, Binda C, Secco M, Giuffrida P, Coluccio C, Perini B, Fabbri S, Liverani E, Jung CFM, Fabbri C. Endoscopic Management of Bleeding in Altered Anatomy after Upper Gastrointestinal Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1941. [PMID: 38003990 PMCID: PMC10672978 DOI: 10.3390/medicina59111941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
Postoperative non variceal upper gastrointestinal haemorrhage may occur early or late and affect a variable percentage of patients-up to about 2%. Most cases of intraluminal bleeding are an indication for urgent Esophagogastroduodenoscopy (EGD) and require endoscopic haemostatic treatment. In addition to the approach usually adopted in non-variceal upper haemorrhages, these cases may be burdened with difficulties in terms of anastomotic tissue, angled positions, and the risk of further complications. There is also extreme variability related to the type of surgery performed, in the context of oncological disease or bariatric surgery. At the same time, the world of haemostatic devices available in digestive endoscopy is increasing, meeting high efficacy rates and attempting to treat even the most complex cases. Our narrative review summarises the current evidence in terms of different approaches to endoscopic haemostasis in upper bleeding in altered anatomy after surgery, proposing an up-to-date guidance for endoscopic clinicians and at the same time, highlighting areas of future scientific research.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Matteo Secco
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Barbara Perini
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University Hospital of Padua, 35128 Padua, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Elisa Liverani
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Carlo Felix Maria Jung
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit Ospedale Morgagni—Pierantoni, Forlì—Ospedale M. Bufalini, Cesena—AUSL, 47521 Romagna, Italy; (G.G.); (M.S.); (P.G.); (C.C.); (B.P.); (S.F.); (E.L.); (C.F.M.J.); (C.F.)
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Ryou SH, Bang KB. Endoscopic management of postoperative bleeding. Clin Endosc 2023; 56:706-715. [PMID: 37915192 PMCID: PMC10665615 DOI: 10.5946/ce.2023.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 11/03/2023] Open
Abstract
Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.
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Affiliation(s)
- Sung Hyeok Ryou
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Ki Bae Bang
- Department of Internal Medicine, H+ Yangji Hospital, Seoul, Korea
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Babarinsa IA, Bashir M, AbdelRahman Ahmed H, Ahmed B, Konje JC. Bariatric surgery and reproduction-implications for gynecology and obstetrics. Best Pract Res Clin Obstet Gynaecol 2023; 90:102382. [PMID: 37506498 DOI: 10.1016/j.bpobgyn.2023.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
As the rates of obesity continue to rise across the world, there has been an increasing resort to bariatric surgery amongst the options for treatment. Through the reproductive lifespan, between menarche and menopause, women might benefit from this surgical intervention, which may have a bearing on other aspects of their health. The consequences of bariatric surgery have been reported and evaluated from various perspectives in obstetrics and gynecology. Fertility and sexuality are enhanced, but not all gynecological diseases are ameliorated. There are also psychological and behavioral sequelae to be cognizant of. With multi-disciplinary and responsive care, most post-bariatric pregnancies have satisfactory outcomes. The effects of bariatric surgery on the babies conceived thereafter remains a subject of interest, whereas the possible effect on the climacteric is speculative.
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Affiliation(s)
- Isaac A Babarinsa
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha.
| | | | | | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Department of Health Sciences University of Leicester, UK
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Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
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Lee SJ, Choi IS, Moon JI. Conversion to pancreaticogastrostomy for salvage of disrupted pancreaticojejunostomy following pancreaticoduodenectomy. Ann Surg Treat Res 2022; 103:217-226. [PMID: 36304194 PMCID: PMC9582620 DOI: 10.4174/astr.2022.103.4.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to report on a pancreas-preserving strategy consisting of the conversion to pancreaticogastrostomy (PG) for the salvage of disrupted pancreaticojejunostomy (PJ) following pancreaticoduodenectomy (PD). Methods This single-center retrospective study included 188 patients who underwent PD between March 2000 and June 2021. Conversion to PG was performed by placing the pancreatic stump with an internal stent in the stomach through the posterior gastrostomy and suturing the wound in 2 layers through the anterior gastrostomy. Results A total of 181 patients underwent PJ, while 7 underwent PG. Of all patients, 6 had International Study Group on Pancreatic Fistula grade C postoperative pancreatic fistulae (POPF; 3.3%) and 23 had grade B POPF (12.7%). Two of the 6 grade C patients underwent completion pancreatectomy and died of liver failure after common hepatic artery embolization due to pseudoaneurysm. Conversion to PG was performed in 4, all of whom survived and experienced no long-term pancreatic fistulae, remnant pancreatic atrophy, or newly developed diabetes after a median follow-up period of 11.5 months. Conclusion Conversion to PG for the salvage of disrupted PJ following PD is safe and effective in selected patients that can lower mortality rates while maintaining pancreatic function.
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Affiliation(s)
- Seung Jae Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Liao F, Yang Y, Zhong J, Zhu Z, Pan X, Liao W, Li B, Zhu Y, Chen Y, Shu X. Incidence and risk factors for rebleeding after emergency endoscopic hemostasis for marginal ulcer bleeding. Clin Res Hepatol Gastroenterol 2022; 46:101953. [PMID: 35605892 DOI: 10.1016/j.clinre.2022.101953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/14/2022] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Marginal ulcer bleeding is a cause of upper gastrointestinal bleeding, but the efficacy of emergency endoscopic hemostasis and risk factors for rebleeding have not been fully explored. The purpose of the current study was to investigate the rebleeding rate and risk factors after emergency endoscopic hemostasis for marginal ulcer bleeding. METHODS We conducted a retrospective study of 105 patients who underwent emergency endoscopic hemostasis due to marginal ulcer bleeding from January 2015 to July 2021. Patients included in this study were divided into rebleeding and non-rebleeding groups. RESULTS Among the 105 patients, 15.2% (16/105) patients developed rebleeding within 30 days after endoscopic hemostasis, and 87.5% of the patients had rebleeding within 7 days. The mean age of these patients was 60.3 ± 12.3 years, and 95 of them were male. In the univariate analysis, an ulcer size ≥10 mm, a PLT count <100 × 10^9/L and an AIMS65 score ≥2 were risk factors for rebleeding. According to the multivariable analysis, an ulcer size ≥10 mm (OR: 3.715; 95% CIs: 1.060-14.250; p = 0.043) and a PLT count <100 × 10^9/L (OR: 4.480; 95% CIs: 1.099-18.908; p = 0.035) were independent risk factors for rebleeding. CONCLUSION Emergency endoscopic hemostasis is an effective treatment for marginal ulcer bleeding. An ulcer size ≥10 mm and a PLT count <100 × 10^9/L were independent risk factors for rebleeding within 30 days after endoscopic hemostasis for marginal ulcer bleeding.
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Affiliation(s)
- Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yihan Yang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Jiawei Zhong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Zhenhua Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiaolin Pan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Wangdi Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Bimin Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China.
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Analysis of Symptomatic Marginal Ulcers in Patients Who Underwent Pancreaticoduodenectomy for Periampullary Tumors. Pancreas 2020; 49:208-215. [PMID: 32011522 DOI: 10.1097/mpa.0000000000001470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECT The objectives are to investigate the incidence and risk factors associated with symptomatic marginal ulcer (sMU) and analyze their relationship with the use of prophylactic proton pump inhibitors (PPIs) after pancreaticoduodenectomy. METHODS Clinical postoperative outcomes of 72 sMU and 1266 non-sMU were compared and analyzed. We performed a subanalysis of 72 patients with sMU diagnosed within (n = 18) and after 4 months (n = 54). The risk factors associated with sMU incidence were analyzed. RESULTS Of the 1338 patients, 72 (5.4%) were diagnosed as having sMU. Eighteen patients (25.0%) were diagnosed during the first 4 months, and 48 (66.7%), within 16 months. Cumulative sMU incidence differed according to the duration of prophylactic PPI use (≥4 months: 7.1% vs <4 months: 10.1%, P < 0.001). The duration of prophylactic PPI use was identified as a risk factor in the multivariable analysis (hazard ratio, 2.294; 95% confidence interval, 1.436-3.664; P = 0.001). CONCLUSIONS Two-thirds or more of the patients were diagnosed as having sMU within 16 months after surgery. The duration of the prophylactic PPI use was an independent risk factor. We recommend the use of prophylactic PPI for more than 16 months after pancreaticoduodenectomy for periampullary tumors.
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Bang KB, Shin HD. Endoscopic treatment of surgery or procedure-related gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ki Bae Bang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Deok Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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Lim R, Beekley A, Johnson DC, Davis KA. Early and late complications of bariatric operation. Trauma Surg Acute Care Open 2018; 3:e000219. [PMID: 30402562 PMCID: PMC6203132 DOI: 10.1136/tsaco-2018-000219] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 01/02/2023] Open
Abstract
Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient’s anatomy, which can lead to complications at any time during the course of a patient’s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen—acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease—for these are still among the most common etiologies of abdominal pathology in these patients.
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Affiliation(s)
- Robert Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, Hawaii, USA
| | - Alec Beekley
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dirk C Johnson
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Bowles-Cintron RJ, Perez-Ginnari A, Martinez JM. Endoscopic management of surgical complications. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chung KH, Lee SH, Park JM, Lee JM, Shin CM, Ahn SH, Park DJ, Kim HH, Ryu JK, Kim YT. Partially covered self-expandable metallic stent for postoperative benign strictures associated with laparoscopy-assisted gastrectomy. Gastric Cancer 2016; 19:280-6. [PMID: 25503478 DOI: 10.1007/s10120-014-0450-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND A partially covered self-expandable metallic stent (PCSEMS) is of proven benefit in palliation of unresectable or inoperable malignant gastric outlet obstruction. However, its use in patients with benign anastomotic stricture after laparoscopy-assisted gastrectomy (LAG) is not well established. METHODS Patients who between May 2007 and June 2012 underwent PCSEMS placement for management of benign gastrointestinal obstruction after LAG were included in this retrospective analysis. The primary outcomes were the technical success and clinical success of the PCSEMS. The secondary outcomes were procedure-related complications and PCSEMS dysfunction. RESULTS Eleven patients (six women, five men, mean age 53.5 years, range 15-76 years) underwent successful placement of a PCSEMS for management of benign anastomotic strictures after LAG and were followed-up for a mean of 20.6 months (range 7.9-55.6 months). The mean gastric outlet obstruction scoring system (GOOSS) score was 0.36 before PCSEMS placement and 1.55 (p = 0.010) 24-48 h after PCSEMS placement. All of the patients were able to tolerate a solid diet (GOOSS score 3) after 1 week. There were no major or minor procedure-related complications. Stent dysfunction occurred in four patients (three distal migrations, one proximal migration), and stent removal was successful in all of the remaining patients after a mean of 2.0 months (1.1-3.0 months). Obstructive symptoms recurred in two patients (one after proximal migration, one after stent removal) and were treated successfully with PCSEMS reinsertion and balloon dilation. CONCLUSIONS A PCSEMS may be a feasible and effective option for management of benign anastomotic strictures after LAG which could avoid secondary surgery.
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Affiliation(s)
- Kwang Hyun Chung
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Sang Hyub Lee
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Jin Myung Park
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Sang Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-Do, 463-707, Korea.
| | - Ji Kon Ryu
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Yong-Tae Kim
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
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Abstract
This article provides an overview of the evaluation and management of lower gastrointestinal bleeding (LGIB) in children. The common etiologies at different ages are reviewed. Conditions with endoscopic importance for diagnosis or therapy include solitary rectal ulcer syndrome, polyps, vascular lesions, and colonic inflammation and ulceration. Diagnostic modalities for identifying causes of LGIB in children include endoscopy and colonoscopy, cross-sectional and nuclear medicine imaging, video capsule endoscopy, and enteroscopy. Pre-endoscopic preparation and decision-making unique to pediatrics is highlighted. The authors conclude with a summary of current and emerging therapeutic hemostatic techniques that can be used in pediatric patients.
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Affiliation(s)
- Benjamin Sahn
- Division of Pediatric Gastroenterology & Nutrition, Steven & Alexandra Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, North Shore - Long Island Jewish Health System, 1991 Marcus Avenue, Suite M 100, New Hyde Park, NY 11042, USA.
| | - Samuel Bitton
- Division of Pediatric Gastroenterology & Nutrition, Steven & Alexandra Cohen Children's Medical Center of New York, Hofstra North Shore-LIJ School of Medicine, North Shore - Long Island Jewish Health System, 1991 Marcus Avenue, Suite M 100, New Hyde Park, NY 11042, USA
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Essential bariatric emergencies for the acute care surgeon. Eur J Trauma Emerg Surg 2015; 42:571-584. [PMID: 26669688 DOI: 10.1007/s00068-015-0621-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
Bariatric surgery is the most effective treatment for morbid obesity. Due to the high volume of weight loss procedures worldwide, the general surgeon will undoubtedly encounter bariatric patients in his or her practice. Liberal use of CT scans, upper endoscopy and barium swallow in this patient population is recommended. Some bariatric complications, such as marginal ulceration and dyspepsia, can be effectively treated non-operatively (e.g., proton pump inhibitors, dietary modification). Failure of conservative management is usually an indication for referral to a bariatric surgery specialist for operative re-intervention. More serious complications, such as perforated marginal ulcer, leak, or bowel obstruction, may require immediate surgical intervention. A high index of suspicion must be maintained for these complications despite "negative" radiographic studies, and diagnostic laparoscopy performed when symptoms fail to improve. Laparoscopic-assisted gastric band complications are usually approached with band deflation and referral to a bariatric surgeon. However, if acute slippage that results in gastric strangulation is suspected, the band should be removed immediately. This manuscript provides a high-level overview of all essential bariatric complications that may be encountered by the acute care surgeon.
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Unique patterns and proper management of postgastrectomy bleeding in patients with gastric cancer. Surgery 2014; 155:1023-9. [PMID: 24856122 DOI: 10.1016/j.surg.2014.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 01/31/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bleeding after gastrectomy is a less frequent, but fatal complication. Because the pathophysiology and clinical manifestations differ considerably across cases, the exact outcome of postoperative bleeding is unclear. This study aimed to improve management practices for postgastrectomy bleeding by the analysis of risk factors and clinical patterns. METHODS From January 2001 to December 2010, 5,739 patients underwent gastrectomy for gastric cancer at the National Cancer Center, Korea. Clinical data from patients with postoperative bleeding were obtained from a prospectively established database, and risk factors for bleeding were analyzed using multivariate binary logistic regression. RESULTS Incidence of the postoperative bleeding was 0.8% (n = 48) and the subsequent mortality rate was 10% (5/48). Majority of anastomotic bleeding occurred early within 1 day of the operation (5/7; 71%). It was successfully managed with conservative treatment in 3 patients, endoscopic intervention in 2, and relaparotomy in 2. Arterial bleeding occurred in 24 patients, with the main site being the splenic artery (11/24; 46%), and mostly manifested in the delayed period (median, 12 days). Fifteen of them underwent radiologic intervention, and 4 of these patients were referred for operation eventually. The other 9 patients underwent relaparotomy as first-line treatment. Independent risk factors for the bleeding were male (hazard ratio [HR] 2.253; 95% CI, 1.079-4.704), comorbidity (HR, 2.709; 95% CI, 1.440-5.095), previous abdominal operation (HR, 2.785; 95% CI, 1.322-5.867), and palliative surgery (HR, 4.142; 95% CI, 1.443-11.889). CONCLUSION Postgastrectomy bleeding can be managed properly considering its origin, severity, onset, and the risk factors.
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Zhou CG, Shi HB, Liu S, Yang ZQ, Zhao LB, Xia JG, Zhou WZ, Li LS. Transarterial embolization for massive gastrointestinal hemorrhage following abdominal surgery. World J Gastroenterol 2013; 19:6869-6875. [PMID: 24187463 PMCID: PMC3812487 DOI: 10.3748/wjg.v19.i40.6869] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/29/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical results of angiography and embolization for massive gastrointestinal hemorrhage after abdominal surgery.
METHODS: This retrospective study included 26 patients with postoperative hemorrhage after abdominal surgery. All patients underwent emergency transarterial angiography, and 21 patients underwent emergency embolization. We retrospectively analyzed the angiographic features and the clinical outcomes of transcatheter arterial embolization.
RESULTS: Angiography showed that a discrete bleeding focus was detected in 21 (81%) of 26 patients. Positive angiographic findings included extravasations of contrast medium (n = 9), pseudoaneurysms (n = 9), and fusiform aneurysms (n = 3). Transarterial embolization was technically successful in 21 (95%) of 22 patients. Clinical success was achieved in 18 (82%) of 22 patients. No postembolization complications were observed. Three patients died of rebleeding.
CONCLUSION: The positive rate of angiographic findings in 26 patients with postoperative gastrointestinal hemorrhage was 81%. Transcatheter arterial embolization seems to be an effective and safe method in the management of postoperative gastrointestinal hemorrhage.
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Chung WC, Jeon EJ, Lee KM, Paik CN, Jung SH, Oh JH, Kim JH, Jun KH, Chin HM. Incidence and clinical features of endoscopic ulcers developing after gastrectomy. World J Gastroenterol 2012; 18:3260-6. [PMID: 22783050 PMCID: PMC3391763 DOI: 10.3748/wjg.v18.i25.3260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the precise incidence and clinical features of endoscopic ulcers following gastrectomy.
METHODS: A consecutive series of patients who underwent endoscopic examination following gastrectomy between 2005 and 2010 was retrospectively analyzed. A total of 78 patients with endoscopic ulcers and 759 without ulcers following gastrectomy were enrolled. We analyzed differences in patient age, sex, size of the lesions, method of operation, indications for gastric resection, and infection rates of Helicobacter pylori (H. pylori) between the nonulcer and ulcer groups.
RESULTS: The incidence of endoscopic ulcers after gastrectomy was 9.3% and that of marginal ulcers was 8.6%. Ulcers were more common in patients with Billroth II anastomosis and pre-existing conditions for peptic ulcer disease (PUD). Infection rates of H. pyloridid not differ significantly between the two groups. The patients who underwent operations to treat PUD had lower initial levels of hemoglobin and higher rates of hospital admission.
CONCLUSION: H. pylori was not an important factor in ulcerogenesis following gastrectomy. For patients who underwent surgery for PUD, clinical course of marginal ulcers was more severe.
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Abstract
Significant gastrointestinal (GI) bleeding in the postoperative period is an uncommon complication of surgery. The management of GI bleeding within the postoperative period is complex because of a larger differential for the source of bleeding and a more complex risk/benefit analysis. There is minimal published literature specific to the management of postoperative GI bleeding, and the infrequency, complexity, and variability of the clinical setting of this complication confound simplistic consideration of its cause and therapy. This article outlines a systematic evaluation of the patient, treatment options, and assessment of risk/benefit ratio for various treatment options.
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Affiliation(s)
- Seon Jones
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN 37212-3755, USA
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Ozaslan E, Purnak T, Tenlik I, Yildiz A, Haznedaroglu IC. An alternative hemostatic method for early GI bleeding caused by anastomotic ulcer. Gastrointest Endosc 2010; 72:902-3. [PMID: 20883870 DOI: 10.1016/j.gie.2010.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 01/12/2010] [Indexed: 02/08/2023]
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The use of endoclips in the treatment of nonvariceal gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech 2009; 19:2-10. [PMID: 19238058 DOI: 10.1097/sle.0b013e31818e9297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Acute nonvariceal gastrointestinal bleeding is the most common emergency managed by endoscopists and the endoscopic therapy has generally been recommended as the first-line treatment. Traditionally, endoscopic treatment included injections of epinephrine and sclerosing solutions or the use of thermocoagulation. In the last decade with the introduction of hemoclips and band ligators, we have witnessed a significant improvement in the clinical outcome of nonvariceal gastrointestinal bleeding. Endoclipping is a safe and effective technique that contributes to hemostasis of bleeding lesions of the gastrointestinal tract.
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Conway JD, Adler DG, Diehl DL, Farraye FA, Kantsevoy SV, Kaul V, Kethu SR, Kwon RS, Mamula P, Rodriguez SA, Tierney WM. Endoscopic hemostatic devices. Gastrointest Endosc 2009; 69:987-96. [PMID: 19410037 DOI: 10.1016/j.gie.2008.12.251] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 12/29/2008] [Indexed: 12/15/2022]
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Yuan Y, Wang C, Hunt RH. Endoscopic clipping for acute nonvariceal upper-GI bleeding: a meta-analysis and critical appraisal of randomized controlled trials. Gastrointest Endosc 2008; 68:339-51. [PMID: 18656600 DOI: 10.1016/j.gie.2008.03.1122] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 03/31/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Acute nonvariceal upper-GI bleeding (NVUGIB) is common, with a high rate of recurrent bleeding and substantial mortality rate. Endoscopic clipping has the theoretical advantage of minimizing tissue injury and is increasingly used. OBJECTIVE We conducted a systematic review and meta-analysis to investigate any potential benefits of clipping over other endoscopic techniques for NVUGIB. DESIGN Randomized controlled trials (RCT) that compared clipping with other endoscopic hemostatic methods to treat NVUGIB were included. Summary effect size was estimated by odds ratio (OR) with a random-effects model. RESULTS Twelve RCTs met inclusion criteria. For peptic ulcer bleeding (PUB), the hemoclip (n = 351 patients) was compared with the heat probe alone, thermal therapy plus injection, and injection alone in 2, 2, and 5 studies, respectively (n = 348 patients). The rate of the initial hemostasis was nonsignificantly increased in the control group compared with the hemoclip group (92% vs 96%, OR 0.58 [95% CI, 0.19-1.75]). The rebleeding rate was nonsignificantly decreased with hemoclips compared with controls (8.5% vs 15.5%, OR 0.56 [95% CI, 0.30-1.05]). Emergency surgery and the mortality rate were not significantly different between the hemoclip and controls. Subgroup analysis conducted in studies that compared hemoclips with injection alone show similar results. Two studies and one study reported outcomes of interest for Dieulafoy's lesions and Mallory-Weiss syndrome, respectively. CONCLUSIONS RCTs that compared clipping alone with other endoscopic hemostatic techniques for NVUGIB were limited. Current evidence suggests that the hemoclip is not superior to other endoscopic modalities in terms of initial hemostasis, rebleeding rate, emergency surgery, and the mortality rate for treatment of PUB.
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Affiliation(s)
- Yuhong Yuan
- Division of Gastroenterology, McMaster University Health Science Centre, Hamilton, Ontario, Canada
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22
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Raju GS, Kaltenbach T, Soetikno R. Endoscopic mechanical hemostasis of GI arterial bleeding (with videos). Gastrointest Endosc 2007; 66:774-85. [PMID: 17905022 DOI: 10.1016/j.gie.2007.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 04/14/2007] [Indexed: 01/09/2023]
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van den Broek JW, Jones DP, Godino J. Hemodynamically significant upper-GI bleeding after hemoclip application. Gastrointest Endosc 2007; 66:843-5. [PMID: 17905033 DOI: 10.1016/j.gie.2007.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 03/04/2007] [Indexed: 12/30/2022]
Affiliation(s)
- Jeffery W van den Broek
- Department of Medicine, Brooke Army Medical Center, Division of Gastroenterology, Fort Sam Houston, Texas 78234, USA
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Marmo R, Rotondano G, Piscopo R, Bianco MA, D'Angella R, Cipolletta L. Dual therapy versus monotherapy in the endoscopic treatment of high-risk bleeding ulcers: a meta-analysis of controlled trials. Am J Gastroenterol 2007; 102:279-89; quiz 469. [PMID: 17311650 DOI: 10.1111/j.1572-0241.2006.01023.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no definite recommendation on the use of dual endoscopic therapy in patients with severe peptic ulcer bleeding. A systematic review and meta-analysis were performed to determine whether the use of two endoscopic hemostatic procedures improved patient outcomes compared with monotherapy. METHODS A search for randomized trials comparing dual therapy (i.e., epinephrine injection plus other injection or thermal or mechanical method) versus monotherapy (injection, thermal, or mechanical alone) was performed between 1990 and 2006. Heterogeneity between studies was tested with chi(2) and explained by metaregression analysis. RESULTS Twenty studies (2,472 patients) met inclusion criteria. Compared with controls, dual endoscopic therapy reduces the risk of recurrent bleeding (OR [odds ratio] 0.59 [0.44-0.80], P= 0.0001) and the risk of emergency surgery (OR 0.66 [0.49-0.89], P= 0.03) and showed a trend toward a reduction in the risk of death (OR 0.68 [0.46-1.02], P= 0.06). Subcategory analysis showed that dual therapy was significantly superior to injection therapy alone for all the outcomes considered, but failed to demonstrate that any combination of treatments is better than either mechanical therapy alone (OR 1.04 [0.45-2.45] for rebleeding, 0.49 [0.50-4.87] for surgery, and 1.28 [0.34-4.86] for death) or thermal therapy alone (OR 0.67 [0.40-1.20] for rebleeding, 0.89 [0.45-1.76] for surgery, and 0.51 [0.24-1.10] for death). CONCLUSIONS Dual endoscopic therapy proved significantly superior to epinephrine injection alone, but had no advantage over thermal or mechanical monotherapy in improving the outcome of patients with high-risk peptic ulcer bleeding.
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Affiliation(s)
- Riccardo Marmo
- Department of Medicine, Division of Gastroenterology, Hospital L. Curto, Polla, Italy
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Chuttani R, Barkun A, Carpenter S, Chotiprasidhi P, Ginsberg GG, Hussain N, Liu J, Silverman W, Taitelbaum G, Petersen B. Endoscopic clip application devices. Gastrointest Endosc 2006; 63:746-50. [PMID: 16650531 DOI: 10.1016/j.gie.2006.02.042] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Arasaradnam RP, Donnelly MT. Acute endoscopic intervention in non-variceal upper gastrointestinal bleeding. Postgrad Med J 2005; 81:92-8. [PMID: 15701740 PMCID: PMC1743205 DOI: 10.1136/pgmj.2004.020867] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Upper gastrointestinal bleeding is one of the commonest emergencies encountered by general physicians. Once haemodynamic stability has been achieved, therapeutic endoscopy is vital in control and arrest of bleeding. Various methods are available and the evidence is reviewed as to the most optimal approach. Clinical parameters including timing of endoscopy, risk stratification, and predictors of failure will also be discussed together with a summary of recommendations based on current available evidence.
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Warneke RM, Walser E, Faruqi S, Jafri S, Bhutani MS, Raju GS. Cap-assisted endoclip placement for recurrent ulcer hemorrhage after repeatedly unsuccessful endoscopic treatment and angiographic embolization: case report. Gastrointest Endosc 2004; 60:309-12. [PMID: 15278071 DOI: 10.1016/s0016-5107(04)01681-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Richard M Warneke
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0764, USA
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Affiliation(s)
- Gottumukkala S Raju
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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