内镜干预及联合普萘洛尔预防食管静脉曲张破裂再出血的疗效

Endoscopic treatment of esophagogastric varices: Problems and thoughts

Esophagogastric variceal bleeding (EVB) is a common digestive emergency, and it is usually severe and is associated with a high mortality. The American Association of Liver Diseases guidelines recommend endoscopic treatment as the first choice for acute EVB. Studies have shown that emergency endoscopic hemostasis can achieve a success rate of > 90% and thus reduce the incidence of early rebleeding and the mortality rate of patients. Endoscopic treatment mainly includes endoscopic variceal ligation, endoscopic injection sclerotherapy, tissue adhesive injection, and endoscopic therapy combined with other treatments. However, the therapeutic effect of endoscopic treatment is related to the operator's skill, portal pressure, collateral circulation, esophageal varices, and other factors. Therefore, endoscopic treatment is not indicated for all cases. In addition, endoscopic treatment may cause serious complications. Here we describe the problems and thoughts on endoscopic treatment of esophagogastric varices.

Efficacy and safety of endoscopic concurrent therapy in patients with esophagogastric varices

AIM

To evaluate the efficacy and safety of endoscopic concurrent therapy in patients with esophagogastric varices.

METHODS

From June 2015 to July 2016, 60 patients with esophagogastric varices were divided into a control group (n = 30) and an observation group (n = 30) according to the treatment regimen used. The control group was treated by sequential therapy, and the observation group was treated by endoscopic concurrent therapy. The clinical effects, complication rate, hospitalization rate and mortality rate were compared.

RESULTS

The effective rate was 93.33% in the observation group and 73.33% in the control group, and there was a significant difference between them (P < 0.05). The rates of complications, hospitalization, rebleeding and mortality in the observation group were 20.00%, 23.33%, 6.67% and 10.00%, respectively, all of which were significantly lower than those in the control group (26.67%, 30.00%, 10.00% and 23.33%, respectively; P < 0.05).

CONCLUSION

Endoscopic concurrent therapy for esophagogastric varices is effective and safe.

Mechanism underlying the protective effect of Compound Danshen Injection against gastric mucosal lesion in rats with portal hypertensive gastropathy

AIM: To explore the protective effect of Compound Danshen Injection against gastric mucosal lesion in rats with portal hypertensive gastropathy and to explore possible mechanism involved.

METHODS: Portal hypertension was induced in Wistar rats by partial portal vein ligation. Seventy male rats were randomly divided into three groups: model control group (n = 30), Compound Danshen Injection group (n = 30) and normal control group (n = 10). Rats were killed 5, 10, 15, 20, 30 and 45 days after model creation to observe gastric histopathological changes and detect the expression levels of iNOS, ET-1, SOD, Bcl-2 and Bax in gastric tissue.

RESULTS: Compared to the normal control group, the expression of iNOS, ET-1 and Bax in gastric tissue in the model control group was significantly up-regulated on day 5, peaked on day 15, and was maintained thereafter, while that of Bcl-2 and SOD was significantly down-regulated on day 5, reached the lowest level on day 15, and was maintained thereafter. Compared to the model control group, treatment with Compound Danshen Injection reduced gastric injury, increased the activity of SOD, up-regulated the expression of Bcl-2, and down-regulated that of iNOS, ET-1 and Bax (all P < 0.05).

CONCLUSION: Compound Danshen Injection exerts a protective effect against gastric mucosal lesion in rats with portal hypertensive gastropathy possibly via a mechanism associated with antioxidation and inhibition of apoptosis.