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Sankar A, Ladha KS, Grover SC, Jogendran R, Tamming D, Razak F, Verma AA. Predictors of ICU admission associated with gastrointestinal endoscopy in medical inpatients: A retrospective cohort study. J Gastroenterol Hepatol 2022; 37:2074-2082. [PMID: 35869833 DOI: 10.1111/jgh.15969] [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: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/05/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Gastrointestinal (GI) endoscopic procedures are commonly performed in medical inpatients. Limited prior research has examined factors associated with intensive care unit (ICU) admission after GI endoscopy in medical inpatients. METHODS This retrospective cohort study was conducted using routinely-collected clinical and administrative data from all general medicine hospitalizations at five academic hospitals in Toronto, Canada between 2010 and 2020. We describe ICU admission and death within 48 h of GI endoscopy in medical inpatients. We examined adjusted associations of patient and procedural factors with ICU admission or death using multivariable logistic regression. RESULTS Among 18 290 medical inpatients who underwent endoscopy, 900 (4.9%) required ICU admission or died within 48 h of endoscopy. Following risk adjustment, ICU admission or death were associated with the following procedural factors: endoscopy on the day of hospital admission (aOR 3.16 [2.38-4.21]) or 1 day after admission (aOR 1.92 [1.51-2.44]) and esophagogastroduodenoscopy (EGD) procedures; and the following patient factors: Charlson comorbidity index of two (aOR 1.38 [1.05-1.81]) or three or greater (aOR 1.84 [1.47-2.29]), older age, male sex, lower hemoglobin prior to endoscopy, increased creatinine prior to endoscopy, an admitting diagnosis of liver disease and certain medications (antiplatelet agents and corticosteroids). CONCLUSIONS ICU admission or death after endoscopy was associated with procedural factors such as EGD and timing of endoscopy, and patient factors indicative of acute illness and greater comorbidity. These findings can contribute to improved triage and monitoring for patients requiring inpatient endoscopy.
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Affiliation(s)
- Ashwin Sankar
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Karim S Ladha
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Samir C Grover
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of Gastroenterology, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Rohit Jogendran
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel Tamming
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Fahad Razak
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Amol A Verma
- St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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Randomized controlled trial of early endoscopy for upper gastrointestinal bleeding in acute coronary syndrome patients. Sci Rep 2022; 12:5798. [PMID: 35388113 PMCID: PMC8986851 DOI: 10.1038/s41598-022-09911-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/30/2022] [Indexed: 12/14/2022] Open
Abstract
Acute upper gastrointestinal bleeding (UGIB) in acute coronary syndrome (ACS) patients are not uncommon, particularly under dual antiplatelet therapy (DAPT). The efficiency and safety of early endoscopy (EE) for UGIB in these patients needs to be elucidated. This multicenter randomized controlled trial randomized recent ACS patients presenting acute UGIB to non-EE and EE groups. All eligible patients received intravenous proton pump inhibitor therapy. Those in EE group underwent therapeutic endoscopy within 24 h after bleeding. The data regarding efficacy and safety of EE were analyzed. It was early terminated because the UGIB rate was lower than expected and interim analysis was done. In total, 43 patients were randomized to non-EE (21 patients) and EE (22 patients) groups. The failure rate of control hemorrhage (intention-to-treat [ITT] 4.55% vs. 23.81%, p < 0.001; per-protocol [PP] 0% vs. 4.55%, p = 0.058) and 3-day rebleeding rate (ITT 4.55% vs. 28.57%, p = 0.033; PP 0% vs. 21.05%, p = 0.027) were lower in EE than non-EE group. The mortality, minor and major complication rates were not different between two groups. Male patients were at higher risk of minor and major complications after EE with OR (95% CI) of 3.50 (1.15–10.63) and 4.25 (1.43–12.63), respectively. In multivariate analysis, EE was associated with lower needs for blood transfusion (HR 0.13, 95% CI 0.02–0.98). Among patients who discontinued DAPT during acute UGIB, a higher risk (OR 5.25, 95% CI 1.21–22.74) of coronary artery stent re-thrombosis within 6 months was noticed. EE for acute UGIB in recent ACS patients has higher rate of bleeding control, lower 3-day rebleeding rate and lower needs for blood transfusion, but more complications in male patients. Further enrollment is mandatory to avoid bias from small sample size (ClinicalTrial.gov Number NCT02618980, registration date 02/12/2015).
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Hsu CH, Hu HY, Huang N, Chang SS. Early eradication has a lower risk of peptic ulcer bleeding in Helicobacter pylori-infected chronic kidney disease patients. Eur J Intern Med 2016; 33:112-7. [PMID: 27449117 DOI: 10.1016/j.ejim.2016.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND End stage renal disease (ESRD) contributes to a higher mortality rate in peptic ulcer bleeding (PUB) patients. A crucial question is whether early Helicobacter pylori (H. pylori) eradication therapy is necessary for H. pylori-infected chronic kidney disease (CKD) patients. To explore whether H. pylori eradication therapy has a lower risk of PUB at the pre-ESRD stage than at the ESRD stage. METHODS AND PATIENTS Patients meeting 2 criteria were defined as newly diagnosed ESRD cases: (1) patients diagnosed with ESRD and receiving regular dialysis between 2000 and 2009; and (2) patients with no history of dialysis between 1997 and 1999. We divided the study participants into pre-ESRD and ESRD groups on the basis of the time between H. pylori eradication and dialysis. The date of the first PUB diagnosis was defined as the primary endpoint. Stratified Cox proportional hazard regression analysis was used to estimate the effect of H. pylori eradication at the pre-ESRD and ESRD stage on the occurrence of PUB. RESULTS We included 476 patients in the pre-ESRD cohort and 476 patients in the matched ESRD cohort. After adjustment for age, sex, the presence of comorbidities, and medication use, the hazard ratio of PUB was 0.66 times less in the pre-ESRD cohort than in the ESRD cohort. Factors such as Charlson's score more than 3, and nonsteroidal anti-inflammatory drugs were associated with an increased risk of PUB. CONCLUSION Our result supports that early H. pylori eradication has a lower risk of PUB in H. pylori-infected CKD patients.
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Affiliation(s)
- Ching-Hui Hsu
- Division of Allergy, Immunology, Rheumatology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan; Department of Education and Research, Taipei City Hospital, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan
| | - Shen-Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan; School of Medicine, National Yang-Ming University, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan.
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Abstract
GOALS To examine ethnicity's role in the etiology and outcome of upper gastrointestinal hemorrhage (UGIH). BACKGROUND UGIH is a serious condition with considerable associated morbidity and mortality. MATERIALS AND METHODS We analyzed 2196 patients admitted with acute UGIH between January 2006 and February 2012. Complete clinical data were gathered prospectively and entered into our GI Bleed Registry, which captures demographic and clinical variables. Results were analyzed using the χ² analyses and the analysis of variance techniques with Tukey multiple comparisons. RESULTS Among 2196 patients, 620 (28%) were black, 625 (29%) white, 881 (40%) Hispanic, and 70 (3%) were members of other ethnicities. Gastroduodenal ulcers (25%), esophageal varices (25%), and esophagitis (12%) were the most frequently identified causes of UGIH. Blacks experienced a high rate of gastroduodenal ulcers (199/620), whereas Hispanics most commonly had esophageal varices. In all ethnicities, the most common cause of bleeding in patients younger than 35 or older than 65 years was gastroduodenal ulcer disease. However, among patients aged 35 to 64 years, there were differences in the etiology of UGIH. Blacks aged 50 to 64 years frequently experienced gastroduodenal ulcers, whereas Hispanics aged 35 to 49 years typically had esophageal varices. Rebleeding rates were significantly lower in whites (5.8%) than in Hispanics (9.9%) or blacks (8.7%) (P=0.02). CONCLUSIONS By examining a diverse population, we conclude that UGIH may follow trends. Hispanics were likely to have esophageal varices and higher rebleeding rates, whereas blacks were likely to have ulcers and the highest mortality. Whites were equally likely to have ulcers or varices, but a lower rate of rebleeding.
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Optimal and safe treatment of spider leg veins measuring less than 1.5 mm on skin type IV patients, using repeated low-fluence Nd:YAG laser pulses after polidocanol injection. Lasers Med Sci 2012; 28:925-33. [PMID: 22886138 DOI: 10.1007/s10103-012-1180-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
Treatment of micro-veins of less than 1.5 mm with laser and with chemical sclerosis is technically challenging because of their difficulty to remedy. Laser treatment is even more difficult when dark phototypes are involved.Three groups of 30 patients each, skin type IV, and vessels measuring less than 1.5 mm in diameter, were enrolled for two treatment sessions 8 weeks apart: group A, polidocanol (POL) micro-foam injection; group B, Nd:YAG laser alone; and group C, laser after POL injection. Repeated 8-Hz low-fluence pulses, moving the hand piece over a 3-cm vein segment with an average of five laser passes maximum and with a total time irradiation of 1 s were used. Sixteen weeks after the second treatment, statistically, degree of clearance after examining photographs and patients satisfaction index, plotted on a visual analogue scale and comparing results of all three groups, results were significantly better for group C (p<0.0001). No significant differences in complications were noticed between the three groups. Efficacy of combining POL and laser proved safe and satisfactory in 96 % of patients using low-fluence laser pulses with a total cumulative energy in the 3 cm venous segment, lower than that of conventional treatment. Very few and transient complications were observed. POL foam injection followed by laser pulses is safe and efficient for vein treatment in dark-skinned patients.
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Soweid AM, Yaghi SR, Jamali FR, Kobeissy AA, Mallat ME, Hussein R, Ayoub CM. Posterior lingual lidocaine: A novel method to improve tolerance in upper gastrointestinal endoscopy. World J Gastroenterol 2011; 17:5191-6. [PMID: 22215944 PMCID: PMC3243886 DOI: 10.3748/wjg.v17.i47.5191] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of posterior lingual lidocaine swab on patient tolerance to esophagogastroduodenoscopy, the ease of performance of the procedure, and to determine if such use will reduce the need for intravenous sedation.
METHODS: Eighty patients undergoing diagnostic esophagogastroduodenoscopy in a tertiary care medical center were randomized to either lidocaine swab or spray. Intravenous meperidine and midazolam were given as needed during the procedure.
RESULTS: Patients in the lidocaine swab group (SWG) tolerated the procedure better than those in the spray group (SPG) with a median tolerability score of 2 (1, 4) compared to 4 (2, 5) (P < 0.01). The endoscopists encountered less difficulty performing the procedures in the SWG with lower median difficulty scores of 1 (1, 5) compared to 4 (1, 5) in the SPG (P < 0.01). In addition, the need for intravenous sedation was also lower in the SWG compared to the SPG with fewer patients requiring intravenous sedation (13/40 patients vs 38/40 patients, respectively, P < 0.01). The patients in the SWG were more satisfied with the mode of local anesthesia they received as compared to the SPG. In addition, the endoscopists were happier with the use of lidocaine swab.
CONCLUSION: The use of a posterior lingual lidocaine swab in esophagogastroduodenoscopy improves patient comfort and tolerance and endoscopist satisfaction and decreases the need for intravenous sedation.
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Manguso F, Riccio E, de Nucci G, Aiezza ML, Amato G, Degl’Innocenti L, Piccirillo MM, De Dominicis G, Santoro T, Trimarco E, Balzano A. Helicobacter pylori infection in bleeding peptic ulcer patients after non-steroidal antiinflammatory drug consumption. World J Gastroenterol 2011; 17:4509-16. [PMID: 22110282 PMCID: PMC3218142 DOI: 10.3748/wjg.v17.i40.4509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 06/09/2011] [Accepted: 06/16/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish the prevalence of Helicobacter pylori (H. pylori) infection in patients with a bleeding peptic ulcer after consumption of non-steroidal antiinflammatory drugs (NSAIDs).
METHODS: A very early upper endoscopy was performed to find the source of upper gastrointestinal bleeding and to take biopsy specimens for analysis of H. pylori infection by the rapid urease (CLO) test, histological examination, and bacterial culture. IgG anti-CagA were also sought. The gold standard for identifying H. pylori infection was positive culture of biopsy specimens or contemporary positivity of the CLO test and the presence of H. pylori on tissue sections.
RESULTS: Eighty patients, 61 males (76.3%), mean age 61.2 ± 15.9 years, were consecutively enrolled. Forty-seven (58.8%) patients occasionally consumed NSAIDs, while 33 (41.3%) were on chronic treatment with low-dose aspirin (LD ASA). Forty-four (55.0%) patients were considered infected by H. pylori. The infection rate was not different between patients who occasionally or chronically consumed NSAIDs. The culture of biopsy specimens had a sensitivity of 86.4% and a specificity of 100%; corresponding figures for histological analysis were 65.9% and 77.8%, for the CLO test were 68.2% and 75%, for the combined use of histology and the CLO test were 56.8% and 100%, and for IgG anti-CagA were 90% and 98%. The highest accuracy (92.5%) was obtained with the culture of biopsy specimens.
CONCLUSION: Patients with a bleeding peptic ulcer after NSAID/LD ASA consumption frequently have H. pylori infection. Biopsy specimen culture after an early upper gastrointestinal tract endoscopy seems the most efficient test to detect this infection.
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Abstract
Gastrointestinal bleeding is a common complaint encountered in the emergency department and frequent cause of hospitalization. Important diagnostic factors that increase morbidity and mortality include advanced age, serious comorbid conditions, hemodynamic instability, esophageal varices, significant hematemesis or melena, and marked anemia. Because gastrointestinal bleeding carries a 10% overall mortality rate, emergency physicians must perform timely diagnosis, aggressive resuscitation, risk stratification, and early consultation for these patients.
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Affiliation(s)
- Ritu Kumar
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Ground Ravdin, Philadelphia, PA 19104, USA
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Schenker MP, Majdalany BS, Funaki BS, Yucel EK, Baum RA, Burke CT, Foley WD, Koss SA, Lorenz JM, Mansour MA, Millward SF, Nemcek AA, Ray CE. ACR Appropriateness Criteria® on Upper Gastrointestinal Bleeding. J Am Coll Radiol 2010; 7:845-53. [DOI: 10.1016/j.jacr.2010.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 05/25/2010] [Indexed: 12/14/2022]
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Havanond C, Havanond P. WITHDRAWN: Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. Cochrane Database Syst Rev 2009; 2009:CD003791. [PMID: 19821313 PMCID: PMC10680414 DOI: 10.1002/14651858.cd003791.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Endoscopic treatment is recommended for initial hemostasis in non-variceal upper gastrointestinal bleeding. Many endoscopic hemostatic devices are used. Argon Plasma Coagulation (APC) is an alternative. OBJECTIVES This study reviews all available literature to access the efficacy of APC compared to other endoscopic therapies in the control of acute non-variceal upper GI hemorrhage. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4 2003), MEDLINE 1966 to December 2003, EMBASE 1980 to December 2003, Web of Science for SCISEARCH (1980 to December 2003), BIOSIS (1985 to December 2003), and the National Research Register Issue 4 2003. We also handsearched abstracts from conference proceedings of the United European Gastroenterology Week and Digestive Disease Week. SELECTION CRITERIA Randomized, controlled trials of APC compared with other endoscopic hemostasis interventions in the treatment of non-variceal upper gastrointestinal bleeding. DATA COLLECTION AND ANALYSIS Two reviewers assessed trial quality and independently extracted data. MAIN RESULTS Two trials involving 121 people were included. There was no common intervention to pool. One trial compared APC to heat probe, another trial compared APC to injection sclerotherapy. There was no significant difference between groups in either of these trials. AUTHORS' CONCLUSIONS On the basis of the two randomised controlled trials identified in this review, there is no evidence to suggest that APC is superior to other endoscopic therapies. Further randomised controlled trials are needed.
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Affiliation(s)
- Chittinad Havanond
- Medical science, Faculty of Medicine, Thammasat University, Paholyothin Road, Pathumthani, Thailand, 12120
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ANNAMALAI G, MASSON N, ROBERTSON I. Acute gastrointestinal haemorrhage: investigation and treatment. IMAGING 2009. [DOI: 10.1259/imaging/29199389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Outcome of esophageal carcinoma in the veteran affairs population: a comparative analysis from the Veteran Affairs Central Cancer Registry. Am J Clin Oncol 2009; 32:286-90. [PMID: 19433959 DOI: 10.1097/coc.0b013e31818af0d8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Reports indicate that esophageal carcinoma is changing with a shift from squamous cell carcinoma (SCC) to adenocarcinoma (AC) along with worse survival in black patients. However, data on esophageal carcinoma in the Veteran Affairs (VA) population is lacking. We set to describe site-specific and histology-specific characteristics of esophageal cancer in the VA population over the past decades. METHODS We queried the VA Central Cancer Registry database for esophageal cancer cases between 1995 and 2005. Patient characteristics and treatment methods were obtained and overall survival was estimated using the Kaplan-Meier method. RESULTS There were 7929 patients included in the study. The median survival in the period 1995 to 1999 was 7.53 months and 2000 to 2005 was 8.33 months. The median survival in AC was 8.93 months; SCC was 7.30 months. Cox-regression multivariate model revealed that location, age, histology, stage, and treatment were independent predictors of survival. Blacks were less likely to undergo surgery and more likely to undergo radiation. CONCLUSIONS In nonmetastatic esophageal cancer at the VA, SCC has worse outcome as compared with AC. Blacks with AC have worse outcome than whites. Despite equal access to health care blacks are less likely to undergo surgery, which may contribute to their worse outcome. We recommend further studies to determine factors leading to selection of treatment modalities in minority patients.
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Zouhairi ME, Venner A, Charabaty A, Pishvaian MJ. Small bowel adenocarcinoma. Curr Treat Options Oncol 2009; 9:388-99. [PMID: 19365735 DOI: 10.1007/s11864-009-0098-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 03/23/2009] [Indexed: 12/31/2022]
Abstract
Small bowel cancers are rare, accounting for only about 6000 cases/year in the United States, approximately 25% of which are small bowel adenocarcinomas. Small bowel adenocarcinomas have traditionally been considered to be highly fatal due to their nonspecific presentation at the time of diagnosis, and to the lack of responsiveness to older chemotherapy regimens. However, that paradigm may be changing. Newer diagnostic techniques such as video capsule and double balloon enteroscopy may facilitate earlier diagnosis. In addition, modern chemotherapy regimens have produced improved response rates and survival rates, when compared to historical controls. Still, there remains great need for multi-institutional, cooperative group studies to define the optimal treatment of small bowel adenocarcinoma, both in the adjuvant and advanced/metastatic setting.
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Affiliation(s)
- Majed El Zouhairi
- Lombardi Comprehensive Cancer Center, Georgetown University, 3800 Reservoir Road, NW, Washington, DC 20007, USA
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Manguso F, Riccio E, Bennato R, Picascia S, Martino R, De Nucci G, Fiorito R, Balzano A. In-hospital mortality in non-variceal upper gastrointestinal bleeding Forrest 1 patients. Scand J Gastroenterol 2009; 43:1432-41. [PMID: 18759153 DOI: 10.1080/00365520802307989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Non-variceal upper gastrointestinal bleeding (NVUGIB) is recognized world-wide as a common cause of emergency hospitalization, and it often represents a life-threatening event. The purpose of this prospective study was to assess in-hospital mortality in NVUGIB Forrest 1 patients admitted to the emergency unit owing to active bleeding. MATERIAL AND METHODS We enrolled all patients consecutively admitted to the emergency unit for NVUGIB, acutely bleeding at endoscopy (spurting or oozing). Demographic characteristics, clinical and biochemical parameters, endoscopic findings and treatments were evaluated. RESULTS Of a total of 142 patients (98 M (69%), mean age+/-SD=66+/-14 years), spurting (16 (11.3%)) and oozing (126 (88.7%)) were identified. All patients received endoscopic treatment within 6 h of admission and were managed according to the guidelines. Seventeen (12%) patients suffered rebleeding, 4 patients (2.8%) required surgery to stop the bleeding, and 8 (5.6%) died during hospitalization (4 within 5 days and the remainder within 24 days of admission) - 3 as a consequence of bleeding (2.1%) and 5 of non-surgical complications (3.5%). Cox regression analysis showed that the lesions in more than one segment of the esophagogastroduodenal tract (p=0.008, hazard ratio (95% CI)=7.623 (1.680-34.600)) and the number of blood units transfused during the first 48 h of hospitalization (p=0.038, 2.075 (1.041-4.135)) were predictive of in-hospital death. CONCLUSIONS In Forrest 1 patients given rapid endoscopic treatment, in-hospital mortality seems to be related to the contemporaneous presence of bleeding and non-bleeding lesions in more than one segment of the esophagogastroduodenal tract and the number of blood units transfused during the first 48 h of hospitalization.
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Edwards MR, Biswas S, Siddiqui MN. Our experience of vascular malformations masquerading as gastric stromal tumours. Int J Surg 2008; 6:456-8. [PMID: 18815082 DOI: 10.1016/j.ijsu.2008.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 08/07/2008] [Indexed: 11/26/2022]
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Madan AK, Tichansky DS, Isom J, Minard G, Bee TK. Monitored anesthesia care with propofol versus surgeon-monitored sedation with benzodiazepines and narcotics for preoperative endoscopy in the morbidly obese. Obes Surg 2008; 18:545-8. [PMID: 18386111 DOI: 10.1007/s11695-007-9338-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 10/29/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although still controversial, upper endoscopy is frequently performed before bariatric surgery. This study investigated the hypothesis that morbidly obese patients would prefer anesthesiologist-monitored sedation (AMS) compared to surgeon-monitored sedation (SMS) during preoperative endoscopy. METHODS All patients who underwent endoscopy before their bariatric surgery were given a post-procedure survey regarding their experience with the preoperative endoscopy. The survey inquired about issues during and after the procedure. We compared patients who had AMS with IV propofol versus SMS IV narcotics and benzodiazepines. RESULTS There were 100 patients (SMS=49 and AMS=51). Few patients complained of pain in the abdomen or throat during the procedure (AMS vs. SMS=2 vs. 8% and 2 vs. 10%, respectively; p=NS). More patients complained about throat pain after the procedure (AMS vs. SMS=37 vs. 45%; p=NS). More patients in the SMS group remembered the scope being placed in the mouth versus AMS (33 vs. 10%; p<0.02). More patients remembered gagging during the procedure in the SMS group versus the AMS group, but this did not reach statistical significance (24 vs. 10%; p=0.06). There was a trend that more patients in the AMS group felt they recovered in less than 1 h (53%) compared to the SMS group (37%; p=0.1). CONCLUSION Patients who undergo upper endoscopy with either AMS or SMS seem to tolerate the procedure well. The preliminary benefits seen with AMS need to be further explored. AMS should be considered for patients undergoing preoperative upper endoscopy before bariatric surgery.
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Affiliation(s)
- Atul K Madan
- Division of Laparoendoscopic and Bariatric Surgery, Department of Surgery, University of Miami, 1475 N.W. 12th Avenue Room 4017, Miami, FL 33136, USA.
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Glasgow RE, Rollins MD. Stomach and Duodenum. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Anthony S, Milburn S, Uberoi R. Multi-detector CT: review of its use in acute GI haemorrhage. Clin Radiol 2007; 62:938-49. [PMID: 17765458 DOI: 10.1016/j.crad.2007.02.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 02/20/2007] [Accepted: 02/28/2007] [Indexed: 10/23/2022]
Abstract
The advent of multi-section computed tomography (CT) technology allows the non-invasive assessment of the arterial tree. Using current software, it is now possible to produce high-quality, angiographic-like images that can be used to plan and guide therapeutic procedures. One such clinical situation is the assessment of patients with acute gastrointestinal (GI) haemorrhage. Multi-section CT has a number of advantages over conventional angiography in this situation. The simplicity and non-invasive nature of the technique compared with conventional angiography make CT angiography possible in situations where conventional angiography is not available. Movement artefact from respiration and peristalsis is a common problem in the interpretation of conventional angiography; this is essentially abolished with rapid acquisition times and the use of multi-planar images to remove overlying bowel loops. Cross-sectional imaging with the ability for multi-planar reconstruction allows the accurate anatomical localization of the bleeding site, as well as an assessment of the underlying pathology: this can be used to plan therapy (embolization or surgery). The aim of this paper is to review the current use of CT in the investigation of patients with GI haemorrhage, illustrated with images from our Institution. For patients in whom GI endoscopy has failed to establish a diagnosis, we propose multi-section CT angiography as the initial imaging investigation in acute GI haemorrhage.
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Affiliation(s)
- S Anthony
- Department of Radiology, John Radcliffe Hospital, Oxford, UK
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Ayoub C, Skoury A, Abdul-Baki H, Nasr V, Soweid A. Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy. Gastrointest Endosc 2007; 66:786-93. [PMID: 17905023 DOI: 10.1016/j.gie.2007.03.1086] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Accepted: 03/29/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND Conscious sedation is usually achieved during EGD by a combination of intravenous benzodiazepines and opiates; however, these have potential serious adverse effects. The addition of topical oropharyngeal anesthetics such as lidocaine may be useful. Recent data suggest that the administration of topical lidocaine by means of a lollipop is effective for endotracheal intubation and bronchoscopy. OBJECTIVE Our purpose was to evaluate the safety and efficacy of a lidocaine lollipop as single-agent anesthesia for EGD and to determine whether its use reduces the need for intravenous sedatives and analgesics. DESIGN Single-blinded, randomized, prospective study. SETTING University hospital. PATIENTS 50 patients undergoing diagnostic EGD. INTERVENTIONS Patients were randomized to either lidocaine lollipop or lidocaine spray. Intravenous meperidine and midazolam were administered during the procedure as needed. MAIN OUTCOME MEASUREMENTS The success and safety of local anesthesia by lidocaine lollipop in addition to the need for intravenous sedation. RESULTS Patients were equally randomized between the lollipop and the spray groups. The lollipop group had less gag reflex, accommodated scope introduction more, and tolerated the procedure better. Thirty-two percent of patients receiving the lollipop required sedation compared with 96% of patients in the spray group (P < .001). The majority in the lollipop group were satisfied with their mode of anesthesia compared with the spray group. CONCLUSIONS Lidocaine lollipop is a promising form of local oropharyngeal anesthesia for EGD. Its use resulted in sparing the use of intravenous sedation. It is well tolerated and safe and may be particularly important in the elderly, patients with comorbidities, and office-based endoscopy.
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Affiliation(s)
- Chakib Ayoub
- Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon
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21
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Rubio-Tapia A, Murray JA. Novel endoscopic methods for the evaluation of the small-bowel mucosa. Gastrointest Endosc 2007; 66:382-6. [PMID: 17643718 DOI: 10.1016/j.gie.2007.03.1056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 03/21/2007] [Indexed: 02/08/2023]
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Abstract
Failure to identify and diagnose the site and cause of obscure bleeding or some other gastrointestinal disorder may be an indication for push enteroscopy. During this procedure, a long, narrow, flexible gastrointestinal endoscope, known as a push enteroscope, is advanced into the upper gastrointestinal tract to examine and evaluate the proximal section (first one third) of the small bowel. Because of limited funding and inadequate instrument availability, some gastrointestinal endoscopy units may perform this procedure using a colonoscope instead of a push enteroscope. Although not specifically designed for push enteroscopy, colonoscopes are less expensive than push enteroscopes and readily available for clinical use in virtually every gastrointestinal endoscopy unit. The use of a colonoscope or other lower gastrointestinal endoscope to perform push enteroscopy or another upper gastrointestinal procedure (or the use of an upper gastrointestinal endoscope to perform a lower gastrointestinal procedure) is defined in this article as endoscopic shuffling. Although it is arguably efficient and cost effective (and in some instances may improve clinical outcomes), endoscopic shuffling raises a number of economic, legal, medical, and ethical questions and concerns, several of which are discussed in this article, with a particular focus on infection control.
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Affiliation(s)
- Lawrence F Muscarella
- Research and Development, Custom Ultrasonics, Inc., Ivyland, Pennsylvania 18974, USA.
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23
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Anthony S, Uberoi R. The current status of imaging in acute gastrointestinal haemorrhage. IMAGING 2006. [DOI: 10.1259/imaging/78162316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schlansky B, Dimarino AJ, Loren D, Infantolino A, Kowalski T, Cohen S. A survey of oesophageal cancer: pathology, stage and clinical presentation. Aliment Pharmacol Ther 2006; 23:587-93. [PMID: 16480397 DOI: 10.1111/j.1365-2036.2006.02782.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Oesophageal adenocarcinoma is the sixth leading cause of cancer-related mortality worldwide. Previously, oesophageal cancer was mainly squamous cell, presenting late with dysphagia and weight loss. AIMS To examine the distribution of oesophageal cancer histopathology at a large, urban hospital; to determine the tumour stage and symptoms at presentation; and to evaluate the impact of endoscopic surveillance in Barrett's oesophagus. METHODS From 1999 to 2004, all patients diagnosed with oesophageal cancer were evaluated retrospectively for demographics and tumour stage at presentation using endoscopic ultrasonography and computerized tomography. RESULTS A total of 131 patients were included. 81% of tumours were adenocarcinomas; most localized to the distal oesophagus (97%). Patients presented with dysphagia (56%), pain (30%) and/or weight loss (16%). Irrespective of histology, locally advanced lesions accounted for most cases. Thirteen patients had lesions detected in Barrett's surveillance; these were early or intermediate stage in nine patients, but late stage in four patients. CONCLUSIONS Adenocarcinoma has become the dominant histologic subtype, comprising 81% of proven malignancies. Despite a change in histopathology, most cancers are diagnosed at an advanced stage, presenting with dysphagia, pain and/or weight loss. Endoscopic surveillance of Barrett's oesophagus allows earlier diagnosis of cancer in most, but not all, patients.
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Affiliation(s)
- B Schlansky
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA, USA
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25
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Havanond C, Havanond P. Argon plasma coagulation therapy for acute non-variceal upper gastrointestinal bleeding. Cochrane Database Syst Rev 2005:CD003791. [PMID: 15846682 DOI: 10.1002/14651858.cd003791.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Endoscopic treatment is recommended for initial hemostasis in non-variceal upper gastrointestinal bleeding. Many endoscopic hemostatic devices are used. Argon Plasma Coagulation (APC) is an alternative. OBJECTIVES This study reviews all available literature to access the efficacy of APC compared to other endoscopic therapies in the control of acute non-variceal upper GI hemorrhage. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4 2003), MEDLINE 1966 to December 2003, EMBASE 1980 to December 2003, Web of Science for SCISEARCH (1980 to December 2003), BIOSIS (1985 to December 2003), and the National Research Register Issue 4 2003. We also handsearched abstracts from conference proceedings of the United European Gastroenterology Week and Digestive Disease Week. SELECTION CRITERIA Randomized, controlled trials of APC compared with other endoscopic hemostasis interventions in the treatment of non-variceal upper gastrointestinal bleeding. DATA COLLECTION AND ANALYSIS Two reviewers assessed trial quality and independently extracted data. MAIN RESULTS Two trials involving 121 people were included. There was no common intervention to pool. One trial compared APC to heat probe, another trial compared APC to injection sclerotherapy. There was no significant difference between groups in either of these trials. AUTHORS' CONCLUSIONS On the basis of the two randomised controlled trials identified in this review, there is no evidence to suggest that APC is superior to other endoscopic therapies. Further randomised controlled trials are needed.
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Affiliation(s)
- C Havanond
- Surgery, Faculty of Medicine, Thammasat University, Thammasat Hospital, Pahon Yothin Rd., Klong Luang, Prathumtani, Thailand, 12120.
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26
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Lin CC, Lee YC, Lee H, Lin JT, Ho WC, Chen TH, Wang HP. Bedside colonoscopy for critically ill patients with acute lower gastrointestinal bleeding. Intensive Care Med 2005; 31:743-6. [PMID: 15803300 DOI: 10.1007/s00134-005-2604-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Accepted: 03/01/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the clinical impact of bedside colonoscopy for critically ill patients with acute lower gastrointestinal (GI) bleeding. DESIGN AND SETTING A 3-year retrospective analysis (chart review). Medical intensive care unit (ICU) of a 1,312-bed tertiary-care center in Taiwan. PATIENTS AND PARTICIPANTS Fifty-five people undergoing bedside colonoscopy for lower GI bleeding that developed while in the ICU. INTERVENTIONS Bedside colonoscopy. MEASUREMENTS AND RESULTS Colonoscopy was successful in diagnosing the source of bleeding in 37 patients. Among them, colitis (15 patients, including ischemic, pseudomembranous, or radiation-induced) and acute hemorrhagic rectal ulcer (nine patients) were the most frequent confirmed causes. In seven patients, fresh blood was noticed above the colonoscopically accessible area and considered to originate from the small bowel. No adverse event was associated with colonoscopy. Spontaneous cessation of bleeding was noted in 29 (29/55, 53%) patients, whereas 16 (16/55, 29%) achieved endoscopic hemostasis. Ten (10/55, 18%) patients failed primary hemostasis or localization. Overall in-hospital mortality was 53% (29/55); however, hemorrhage-related death occurred in only two patients. CONCLUSIONS ICU patients with acute lower GI bleeding have distinctive causes. Bedside colonoscopy is effective for diagnosis in two-thirds of patients, but only a minority of them needs endoscopic hemostasis.
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Affiliation(s)
- Chun-Che Lin
- Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Chien Kuo N. Rd., 402 Taichung, Taiwan
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27
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Abstract
Since the introduction of flexible fiberoptic endoscopy in the early 1970s, esophagogastro-duodenoscopy and colonoscopy have become established procedures for the diagnosis, evaluation and treatment of gastrointestinal tract disease in the pediatric population. The development of safe fiberoptic endoscopes specially designed for neonates has allowed visualization of lesions occurring in the first days of life. Despite an increased understanding of neonatal digestive disorders deriving from this new diagnostic modality, there is little consensus on the appropriate use of endoscopic procedures in routine care of neonates. It is the feeling of the authors that widening the indications of endoscopy in the neonatal period might lead to diagnosis of discrete clinical abnormalities, which might improve the care of neonates. The techniques for performing neonatal endoscopies, the appropriate indications, the common normal and pathologic findings and the complications of these procedures are reviewed.
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Affiliation(s)
- Christophe Dupont
- Department of Pediatrics-Neonatology, Hôpital Cochin-Saint Vincent de Paul, Université Paris V, Faculté de Médecine Cochin, Paris, France.
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28
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Abstract
Gastrointestinal endoscopy is the primary diagnostic and therapeutic modality in the management of gastrointestinal bleeding. Esophagogastroduodenoscopy, small bowel enteroscopy, and colonoscopy are well-established standards for initial evaluation of gastrointestinal bleeding, and have been used effectively for diagnosis, prognosis, and therapy. Although thermal, injection, and mechanical methods have been the mainstay of endoscopic therapy, promising new technologies such as endoscopic ultrasound and wireless capsule endoscopy will further advance our ability to improve morbidity and mortality from severe gastrointestinal hemorrhage. Herein we review current standards and recent advances in the endoscopic management of upper, lower, and obscure gastrointestinal bleeding.
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Affiliation(s)
- Joseph K Lim
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
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29
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Annamalai G, Robertson I. Acute gastrointestinal haemorrhage: investigation and treatment. IMAGING 2004. [DOI: 10.1259/imaging/41646236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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30
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Saeian K. Unsedated transnasal endoscopy (the Shaker technique): an alternative for assessment of supraesophageal complications of gastroesophageal reflux. Am J Med 2003; 115 Suppl 3A:144S-149S. [PMID: 12928091 DOI: 10.1016/s0002-9343(03)00213-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews problems associated with sedated endoscopy, and describes the rationale for unsedated endoscopy as an alternative. Costs, tolerability, potential for complications, and general patient and physician acceptance for unsedated endoscopy are reviewed. A new technique, the transnasal esophagogastroduodenoscopy (the Shaker technique), is described.
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Affiliation(s)
- Kia Saeian
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee 53226, USA
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31
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Van Kouwen MCA, Drenth JPH, Verhoeven HMJM, Bos LP, Engels LGJB. Upper gastrointestinal endoscopy in patients aged 85 years or more. Results of a feasibility study in a district general hospital. Arch Gerontol Geriatr 2003; 37:45-50. [PMID: 12849072 DOI: 10.1016/s0167-4943(03)00004-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We performed a cross sectional analysis of the feasibility and yield of upper gastrointestinal endoscopy (UGE) in a cohort of patients aged 85 years or more. The study involved 218 patients who underwent diagnostic upper gastrointestinal endoscopy in a district general hospital between 1994 and 1998. Indication, use of sedation, endoscopic findings and treatment after endoscopy were evaluated. Indications for gastroscopy were suspicious of upper gastrointestinal bleeding (UGI) bleeding (41%), anemia (15%), and presence of dyspeptic- (31%), alarm- (9%) and/or reflux symptoms (3%). Serious UGI disease (cancer, peptic ulcer, reflux oesofagitis and/or erosive gastritis/duodenitis) was detected in 97 patients (44%). With respect to clinical presentation, serious UGI disease was present in 61% with bleeding, in 57% with reflux symptoms, in 42% with alarm symptoms, in 33% with anemia and in 28% with dyspepsia. Carcinoma was detected in eight patients (3.8%), all of them were treated with supportive care. In very old people gastroscopy is generally performed on sound indications reveals serious UGI disease in almost one out of two patients, markedly influences medical treatment, and reveals low malignancy rates (3.8%). In these patients, UGE is worthwhile and should not be omitted because of age considerations.
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Affiliation(s)
- Mariëtte C A Van Kouwen
- Department of Gastroenterology and Hepatology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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32
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Fitzgerald JF, Fox VL, Gilger MA, Kay M, Liacouras CA. Research agenda for pediatric gastroenterology, hepatology and nutrition: endoscopy. Report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition for the Children's Digestive Health and Nutrition Foundation. J Pediatr Gastroenterol Nutr 2003; 35 Suppl 3:S254-7. [PMID: 12394361 DOI: 10.1097/00005176-200210003-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Joseph F Fitzgerald
- Children's Digestive Health and Nutrition Foundation, PO Box 6, Flourtown, PA 19031, USA.
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Siu WT, Chau CH, Law BKB, Tang CN, Li MKW. Laparoscopic repair of iatrogenic endoscopic perforated peptic ulcer. J Laparoendosc Adv Surg Tech A 2003; 13:51-3. [PMID: 12676023 DOI: 10.1089/109264203321235485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Iatrogenic perforation is an uncommon but inevitable complication of endoscopy. Laparotomy has been the standard treatment for pyloroduodenal perforations caused by endoscopy. Laparoscopic repair is a well-documented treatment modality for spontaneously perforated peptic ulcer. We report our successful laparoscopic suture repair of perforations sustained during upper gastrointestinal endoscopy in two high-risk elderly patients.
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Affiliation(s)
- Wing Tai Siu
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, SAR, China
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34
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Predicción clínica de los signos endoscópicos de hemorragia digestiva alta activa o reciente. Med Clin (Barc) 2003. [DOI: 10.1016/s0025-7753(03)73786-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Gary C Vitale
- Director of Interventional Endoscopy of the Center for Advanced Surgical Technologies, Norton Hospital Surgical Director, Digestive Disease Center, University of Louisville, Louisville, Kentucky, USA
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36
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Aschl G, Kirchgatterer A, Allinger S, Hinterreiter M, Stadler B, Knoflach P. [Indications and results of endoscopic examinations in intensive care units]. ACTA MEDICA AUSTRIACA 2002; 29:48-51. [PMID: 12050945 DOI: 10.1046/j.1563-2571.2002.02003.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the study was to analyze retrospectively all endoscopies performed on 3 intensive care units in a tertiary referral center with more than thousand beds during a period of ten years. The study evaluates all endoscopies with regard to indication and findings. In the years 1989-1998 a total of 326 endoscopic examinations was performed, most of them were done as an upper gastrointestinal endoscopy (88%). In more than 87% the indication was a suspected gastrointestinal bleeding. The most frequent findings consisted in ulcers of the stomach or duodenum and esophageal varices, then followed by Mallory-Weiss-lesions, esophagitis and erosive gastritis. The etiology of gastrointestinal bleeding was similar to that of non intensive care patients. Specific causes of bleeding such as esophagitis caused by nasogastric tubes were only found in 3% of all bleedings. The numbers of endoscopies on the 3 intensive care units were increasing during the ten year period, however the numbers of the patients treated on the intensive care units were also increasing, but the increase of endoscopies was not always parallel to the rising number of intensive care patients.
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Affiliation(s)
- G Aschl
- I. Interne Abteilung/Gastroenterologie, Allgemeines Krankenhaus der Barmherzigen Schwestern vom heiligen Kreuz, Grieskirchner Strasse 42, A-4600 Wels.
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37
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Conrad SA. Acute upper gastrointestinal bleeding in critically ill patients: causes and treatment modalities. Crit Care Med 2002; 30:S365-8. [PMID: 12072663 DOI: 10.1097/00003246-200206001-00006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Upper gastrointestinal bleeding from peptic ulcers or other nonvariceal causes generally stops spontaneously; if it fails to do so, aggressive management is required. Such measures also are necessary for patients at high risk for rebleeding. Endoscopic therapy achieves hemostasis in >90% of bleeding patients and reduces mortality. After successful hemostasis of the initial bleeding episode, the primary concern becomes the prevention of rebleeding, which occurs in up to 20% of patients. Acid suppression with histamine-2-receptor antagonists has been widely used for many years to prevent recurrent bleeding. However, in acutely bleeding patients, these agents have not been shown to reduce the number of episodes of further bleeding or rebleeding or to reduce the need for transfusions or surgery. Omeprazole, an intravenous proton pump inhibitor, significantly reduced the rate of rebleeding in a recent placebo-controlled trial in which only patients with endoscopic confirmation of successful hemostasis were enrolled. Although this drug does not seem to reduce the need for surgical intervention or to decrease mortality, the trial does indicate the promise of intravenous proton pump inhibitors in reducing upper gastrointestinal bleeding. Evidence from additional well-controlled trials is needed to confirm this finding. The use of proton pump inhibitors in this setting also may have a positive economic impact, and a decrease in the percentage of patients who experience rebleeding will eliminate the cost of further management strategies in those cases.
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Affiliation(s)
- Steven A Conrad
- Department of Medicine and Emergency Medicine, LSU Health Sciences Center, Shreveport, LA 71130-3932, USA.
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Abstract
Upper endoscopy is an integral component in the management of upper gastrointestinal disorders, but it is underutilized because of its high cost and potential complications. Unsedated transnasal endoscopy (T-EGD) is a relatively new technique using an ultrathin endoscope. Because it is better tolerated than standard upper endoscopy, it is performed with the patient unsedated, thus avoiding the associated costs and complications of conscious sedation. In this review, the technique of T-EGD and its current experience are discussed. In addition, potential future applications, special considerations, and potential pitfalls are reviewed.
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Affiliation(s)
- Kia Saeian
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Alfa MJ, Olson N, DeGagne P, Jackson M. A survey of reprocessing methods, residual viable bioburden, and soil levels in patient-ready endoscopic retrograde choliangiopancreatography duodenoscopes used in Canadian centers. Infect Control Hosp Epidemiol 2002; 23:198-206. [PMID: 12002234 DOI: 10.1086/502035] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). DESIGN Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the duodenoscope. SETTING Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible duodenoscopes for ERCP procedures. METHODS The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. RESULTS Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. CONCLUSIONS Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.
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Affiliation(s)
- Michefle J Alfa
- Microbiology Department, St Boniface General Hospital, Winnipeg, Manitoba, Canada
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40
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Abstract
Gastrointestinal bleeding in elderly individuals is a frequent cause of consultation with a physician and of hospital admissions. Co-morbidity and greater medication use in this steadily growing patient group influence the clinical course and adversely affect outcome. Clinical presentation is often predictable and guides subsequent patient management. Due to a surprising lack of prospective controlled data in the area of gastrointestinal bleeding, the selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithmic approach. Advances in endoscopic, medical, radiological and surgical treatment modalities offer promising new diagnostic and therapeutic tools, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. This chapter will address clinical presentation, aetiology, diagnosis and treatment of both upper and lower gastrointestinal bleeding in the elderly.
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Affiliation(s)
- T Lingenfelser
- Klinik für Gastroenterologie, Universitätsklinik Magdeburg, Leipziger Strasse 44, D-39120 Magdeburg, Germany
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41
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Abstract
Gastroesophageal reflux disease (GERD) affects more than one third of the population. It is generally a chronic condition and has the potential to be serious. Some patients with GERD experience persistent daytime or nighttime heartburn and some sustain severe damage, including ulceration, stricture, and Barrett's esophagus, which can predispose to development of adenocarcinoma. Extraesophageal manifestations of GERD can include otolaryngologic, respiratory, and cardiac problems. Severe GERD responds best to agents that suppress gastric acid secretion. Of these, proton pump inhibitors (PPIs) provide the most effective control of gastric acidity and are, therefore, the medical treatment of choice. In fact, nonresponse to a PPI should raise the suspicion that the diagnosis is not GERD. Proton pump inhibitors are quickly becoming the treatment of choice for GERD, especially for severe or refractory cases. For patients whose GERD is refractory even to PPIs or who are unwilling to face years of PPI therapy, antireflux surgery remains an option.
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Affiliation(s)
- J A DiPalma
- Division of Gastroenterology, University of South Alabama College of Medicine, Mobile 36693, USA.
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42
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Wassef W, O'keefe S. Interventional procedures. Curr Opin Gastroenterol 2000; 16:508-15. [PMID: 17031129 DOI: 10.1097/00001574-200011000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
During the past year, numerous articles were published on interventional procedures of the stomach, focusing on upper gastrointestinal tract bleeding, gastric cancer, gastric outlet obstruction, and benign disease. In the area of upper gastrointestinal tract bleeding, early endoscopy is warranted for early therapeutic intervention and for triage. In patients with bleeding related to peptic ulcer disease, combination therapy (epinephrine injection in conjunction with electrocoagulation therapy) remains the standard of care. Hemoclipping is a new technique that may be helpful in cases in which conventional therapy fails. Repeat endoscopy should always be considered in patients in whom the first attempt at endoscopic therapy fails. In patients with bleeding related to portal hypertension, prophylactic antibiotics may decrease the risk of infections. Banding remains the therapy of choice for this group of patients. There is no documented benefit for combination therapy (banding and sclerotherapy). Transjugular intrahepatic portosystemic shunts may be helpful in the treatment of hypertensive portal gastropathy but not gastric vascular ectasias. In the area of gastric cancer, management revolves around staging. This can be accomplished best through the use of CT scan and endoscopic ultrasound. In patients with early limited disease, attempt at endoscopic mucosal resection should be considered. This technique can be performed in a variety of ways: the most common method seems to be through the use of a saline injection, to separate the mucosa-submucosal layer, followed by a cap-assisted snare resection with suction. The safety, efficacy, and outcome of this technique are reviewed. Gastric outlet obstruction remains a difficult problem to treat endoscopically. However, there is some evidence that endoscopic therapy may be successful in benign disease and should be considered prior to surgical intervention.
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Affiliation(s)
- W Wassef
- Division of Digestive Diseases and Nutrition, University of Massachusetts Medical School, Worchester, Massachusetts 01655, USA.
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43
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Abstract
Endoscopy is extremely valuable in the evaluation of disorders of the luminal gastrointestinal tract, pancreas, and biliary system. Endoscopy as a medical discipline continues to evolve and is becoming increasingly therapeutic in nature. Minimally invasive endoscopic intervention now is effective in a wide variety of disorders, including gastrointestinal hemorrhage, obstructive diseases of the intestinal or biliary tree, and early detection or prevention of neoplastic disease of the colon and esophagus. The development of EUS technology has expanded greatly the potential utility of endoscopy as a diagnostic and a therapeutic modality, and further technologic advances are anticipated.
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Affiliation(s)
- S Mallery
- Division of Gastroenterology, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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44
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Abstract
Acute gastrointestinal bleeding is a significant worldwide medical problem. Despite modern measures for diagnosis and treatment, morbidity and mortality rates associated with gastrointestinal bleeding remain largely unchanged. Aggressive medical resuscitation while initiating an evaluation to localize the site of blood loss remains the key to successful management of acute gastrointestinal bleeding. A multidisciplinary approach with early involvement of a gastroenterologist, surgeon, and radiologist can be extremely helpful in the management of these patients. With the logical and direct approach to the evaluation of patients with gastrointestinal bleeding described in this article, most episodes can be managed successfully.
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Affiliation(s)
- M A Fallah
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
A review of the recent literature reveals an increasing published opinion in favour of unsedated endoscopy. However, recent studies show that the majority of US patients are unwilling or unable to tolerate this. In order for there to be a shift towards unsedated endoscopy, physicians will have to change patients' expectations. The indications for diagnostic and therapeutic endoscopic procedures continue to expand, involving increasingly complex techniques that require a high degree of patient cooperation. There is still a need to refine the sedative regimen for these cases.
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Affiliation(s)
- R C Hutchinson
- University Department of Anaesthesia, Royal Infirmary, Glasgow, UK
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