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Wasserman RD, Abel W, Monkemuller K, Yeaton P, Kesar V, Kesar V. Non-variceal Upper Gastrointestinal Bleeding and Its Endoscopic Management. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:599-608. [PMID: 39150279 PMCID: PMC11363156 DOI: 10.5152/tjg.2024.23507] [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: 11/12/2023] [Accepted: 03/17/2024] [Indexed: 08/17/2024]
Abstract
Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality. Clinical symptoms that patients may present with include: hematemesis, coffee-ground emesis, melena, and hematochezia. Clinical signs can range from tachycardia to shock. The anatomical landmark that differentiates upper gastrointestinal (GI) bleeds from lower bleeds is the ligament of Treitz. The first steps of treating a patient who presents with signs of UGIB are resuscitation with appropriate fluids and blood products as necessary. The consideration of endoscopy and the urgency at which it should be performed is also vital during initial resuscitation. Endoscopic therapy should ideally be performed within 24 hours of presentation after initial stabilization with crystalloids and blood products. Intravenous proton pump inhibitors are the mainstay in the initial management of upper GI bleeding from a non-variceal etiology, and they should be administered in the acute setting to decrease the probability of high-risk stigmata seen during endoscopy. Pro-kinetic agents can be given 30 minutes to an hour before endoscopy and may aid in the diagnosis of UGIB. There are 3 broad categories of endoscopic management for UGIB: injection, thermal, and mechanical. Each endoscopic method can be used alone or in combination with others; however, the injection technique with epinephrine should always be used in conjunction with another method to increase the success of achieving hemostasis. In this review article, we will review the steps of triage and initial resuscitation in UGIB, causes of UGIB and their respective management, several endoscopic techniques and their effectiveness, and prognosis with a primary focus limited to non-variceal bleeding.
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Affiliation(s)
- Reid D. Wasserman
- Department of Internal Medicine, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - William Abel
- Department of Internal Medicine, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Klaus Monkemuller
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Paul Yeaton
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Vivek Kesar
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
| | - Varun Kesar
- Department of Gastroenterology, Institute of Carilion Clinic, Riverside Circle, Roanoke, Virginia, United States
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Syed AS, Vaughan AR, McCarthy JG, Laczek JT. Bleeding Gastrointestinal Stromal Tumor (GIST) Results in a Sticky Situation: The Good and Bad of Hemostatic Spray. Cureus 2023; 15:e46691. [PMID: 37942371 PMCID: PMC10629834 DOI: 10.7759/cureus.46691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
A 50-year-old female presented with symptomatic anemia and hematemesis due to a 3.3 cm gastric gastrointestinal stromal tumor (GIST), which was located in the fundus. Adequate endoscopic views were only achieved in the retroflexed position and attempts at hemostasis via endoscopic clips were unsuccessful. Subsequently, TC-325 hemostatic powder was sprayed on the bleeding lesion and given retroflexed positioning, the powder also coated the esophagogastroduodenoscopy (EGD) scope where it abutted the gastroesophageal junction (GEJ). Hemostasis was successful, but the scope was unable to be withdrawn due to adherence to the surrounding mucosa. With torque maneuvering and a moderate amount of withdrawal force, the scope was successfully freed. The patient was started on imatinib mesylate and did not experience further bleeding episodes. This case highlights the challenge of achieving hemostasis in a bleeding GIST, the beneficial role of hemostatic powder spray, and the need for caution when utilizing it in a retroflexed manner.
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Affiliation(s)
- Azfar S Syed
- Gastroenterology, Walter Reed National Military Medical Center, Bethesda, USA
| | | | - John G McCarthy
- Gastroenterology, Walter Reed National Military Medical Center, Bethesda, USA
| | - Jeffrey T Laczek
- Gastroenterology, Walter Reed National Military Medical Center, Bethesda, USA
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Tanner S, Al Kazzi E, Aslam R, Isenberg G, Cooper G. A Case of Upper Gastrointestinal Bleeding Due to Metastatic High-Grade B-Cell Lymphoma Successfully Treated With Chemotherapy. Cureus 2022; 14:e24738. [PMID: 35676981 PMCID: PMC9166593 DOI: 10.7759/cureus.24738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 12/02/2022] Open
Abstract
Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening condition. Metastatic disease is an exceedingly rare cause of UGIB. We report the case of a 73-year-old man with high-grade B-cell lymphoma (HGBL) who presented for the initiation of chemotherapy and was found to be acutely anemic due to UGIB. An esophagogastroduodenoscopy (EGD) revealed multiple large, discrete, ulcerated, non-circumferential, and friable masses in the stomach. Biopsies were consistent with HGBL. The patient was urgently initiated on chemotherapy with the resolution of lesions on subsequent EGD. The rate of prevalence of gastric metastases is unknown, but it should be considered in patients with active malignancy who present with signs of UGIB.
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Cha B, Lee D, Shin J, Park JS, Kwon GS, Kim H. Hemostatic efficacy and safety of the hemostatic powder UI-EWD in patients with lower gastrointestinal bleeding. BMC Gastroenterol 2022; 22:170. [PMID: 35392821 PMCID: PMC8991611 DOI: 10.1186/s12876-022-02247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background and aims Acute lower gastrointestinal bleeding (LGIB) is a common cause of emergency hospitalization and may require readmission for re-bleeding. Recently, a novel endoscopic hemostatic powder (UI-EWD/Nexpowder™, Nextbiomedical, Incheon, South Korea) was developed and applied for the control of LGIB. The aim of this study was to evaluate the hemostatic efficacy and long-term safety of UI-EWD in LGIB. Patients and methods We conducted a retrospective cohort study of LGIB at a single tertiary center in south Korea. One hundred and sixty-seven consecutive patients with LGIB who were initially successful in endoscopic hemostasis were included and divided into the conventional treatment group (n = 112) and the UI-EWD therapy group (n = 55; 38 patients with conventional treatment and 17 patients with UI-EWD alone). The success rate of hemostasis, adverse events related to UI-EWD, and re-bleeding rate were evaluated. Results The incidence of endoscopic hemostasis applied to the hepatic flexure (7.3% vs. 0%, p = 0.011) and larger than 4 cm (25.5% vs. 8.0%, p = 0.002) were significantly higher in the UI-EWD group than in the conventional therapy group. The cumulative rebleeding rate within 28 days in the UI-EWD group was 5.5% (3/55), which was significantly lower than that in the conventional treatment group (17.0% [19/112]; p = 0.039). No UI-EWD-related adverse events were recorded. Conclusion Based on our results, application of UI-EWD in LGIB showed promising results for the prevention of re-bleeding, especially in locations where it is difficult to approach or cases with more bleeding. There were no significant complications, such as perforation or embolism. In particular, UI-EWD should be considered first for anatomical or technical impediments to endoscopic access in LGIB.
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Affiliation(s)
- Boram Cha
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Donghyun Lee
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Jongbeom Shin
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea.
| | - Jin-Seok Park
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Gye-Suk Kwon
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
| | - Hyungkil Kim
- Digestive Disease Center, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, South Korea
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Minhem MA, Nakshabandi A, Mirza R, Alsamman MA, Mattar MC. Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence, predictors, and interventions. World J Gastrointest Endosc 2021; 13:391-406. [PMID: 34630889 PMCID: PMC8474699 DOI: 10.4253/wjge.v13.i9.391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/27/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal hemorrhage (GIH) is a common complication with gastrointestinal cancers (GIC). There is no comprehensive research that examines GIH in different types of GIC.
AIM To study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC.
METHODS This is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients (≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality.
RESULTS Out of a total of 18173885 inpatients, 321622 (1.77%) cases had a diagnosis of GIC. Within GIC patients, 30507 (9.5%) inpatients had GIH, which was significantly (P < 0.001) more than the prevalence of GIH in patients without GIC (3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer (15.7%), liver cancer (13.0%), small bowel cancer (12.7%), esophageal cancer (9.1%), colorectal cancer (9.1%), pancreatic cancer (7.2%), bile duct cancer (6.0%), and gallbladder cancer (5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate (15.6%) than jejunal (11.1%) and ileal cancers (5.7%). Within esophageal cancers, lower third cancers had higher GIH (10.7%) than the middle third (8.0%) or upper third cancers (6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances (Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis (P < 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios (OR) = 0.74 (0.72-0.77), P < 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267 (53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42 (0.38-0.46), P < 0.001].
CONCLUSION The prevalence of GIH in patients with GIC varies significantly based on the tumor’s anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.
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Affiliation(s)
- Mohamad A Minhem
- Internal Medicine, Loyola University Medical Center, Maywood, IL 60153, United States
| | - Ahmad Nakshabandi
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Rabia Mirza
- School of Medicine, Georgetown University, Washington, DC 20007, United States
| | - Mohd Amer Alsamman
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Mark C Mattar
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
- School of Medicine, Georgetown University, Washington, DC 20007, United States
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Thongtan T, Deb A, Islam S, Nugent K. Upper gastrointestinal bleeding as the initial manifestation of gastroenteropancreatic neuroendocrine tumors. Proc AMIA Symp 2021; 34:618-619. [PMID: 34456491 DOI: 10.1080/08998280.2021.1913372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
A 78-year-old man presented with upper gastrointestinal bleeding, which was biopsy proven to be from a gastric neuroendocrine tumor. By the time of diagnosis, he developed liver metastasis and died 2 months later. Upper gastrointestinal bleeding is an uncommon feature in gastroenteropancreatic neuroendocrine tumor.
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Affiliation(s)
- Thanita Thongtan
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Anasua Deb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Sameer Islam
- Division of Gastroenterology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Then EO, Nutakki S, Ofosu A, Saleem S, Gayam V, Sunkara T, Gaduputi V. An Unlikely Culprit: Gastric Metastasis from Primary Prostatic Adenocarcinoma. J Gastrointest Cancer 2021; 51:1081-1083. [PMID: 32424673 DOI: 10.1007/s12029-020-00410-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eric Omar Then
- Division of Gastroenterology and Hepatology, SBH Health System, 4422 Third Avenue, Bronx, NY, 10457, USA.
| | - Spoorthi Nutakki
- Division of Gastroenterology and Hepatology, SBH Health System, 4422 Third Avenue, Bronx, NY, 10457, USA
| | - Andrew Ofosu
- Division of Gastroenterology and Hepatology, Clinical Affiliate of The Mount Sinai Hospital, The Brooklyn Hospital Center, 121 Dekalb Ave, Brooklyn, NY, 11201, USA
| | - Saad Saleem
- Department of Internal Medicine, Mercy Saint Vincent Medical Center, 2213 Cherry St, Toledo, OH, 43608, USA
| | - Vijay Gayam
- Department of Internal Medicine, Interfaith Medical Center, 1545 Atlantic Ave, Brooklyn, NY, 11213, USA
| | - Tagore Sunkara
- Division of Gastroenterology and Hepatology, Mercy Medical Center, 1111 Sixth Ave, Des Moine, IA, 50314, USA
| | - Vinaya Gaduputi
- Division of Gastroenterology and Hepatology, SBH Health System, 4422 Third Avenue, Bronx, NY, 10457, USA
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Bilal S, Saeed SM, Siddique MZ, Saqib M, Mehmood S, Yusuf MA. Salvage therapy of bleeding esophageal tumor by fully covered self-expandable metallic stent: A case report. SAGE Open Med Case Rep 2021; 9:2050313X21997198. [PMID: 33717487 PMCID: PMC7925943 DOI: 10.1177/2050313x21997198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 01/21/2023] Open
Abstract
The role of self-expandable metallic stents is gradually evolving for a diverse group of benign and malignant gastrointestinal tract problems, with luminal obstruction being by far the most common. Although its role in refractory variceal bleeding is well established, it has rarely been tried for tumor-related bleeding, with only a few case reports in this regard. We share our experience of successfully controlling esophageal tumor–related bleeding with the use of a fully covered self-expandable metallic stent. A 58-year-old woman with irresectable distal esophageal cancer, presented with hematemesis. Esophago-gastro-duodenoscopy revealed an obstructing esophageal tumor with diffuse oozing of blood. This was unamenable to local injection of adrenaline and hemospray; therefore, a temporary self-expandable metallic stent was parked to create a tamponade effect. This successfully stopped bleeding and the patient remained asymptomatic till discharge. However, she was lost to follow-up, and therefore, the stent was removed after a period of 5 months instead of 2 weeks.
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Affiliation(s)
- Sundus Bilal
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Saad Muhammad Saeed
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Zeeshan Siddique
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammad Saqib
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Shafqat Mehmood
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammed Aasim Yusuf
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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Shin J, Cha B, Park JS, Ko W, Kwon KS, Lee JW, Kim HK, Shin YW. Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding. BMC Gastroenterol 2021; 21:40. [PMID: 33509102 PMCID: PMC7842074 DOI: 10.1186/s12876-021-01611-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/13/2021] [Indexed: 01/06/2023] Open
Abstract
Background Gastrointestinal tumor bleeding remains a clinical challenge because it is difficult to treat with conventional endoscopic hemostatic options. Recently, an endoscopic hemostatic powder (UI-EWD) was developed and reported to provide effective control of upper gastrointestinal bleeding. The aim of current study was to evaluate the feasibility and efficacy of this novel hemostatic powder in tumor bleeding.
Methods A total of 41 consecutive patients with upper gastrointestinal tumor bleeding were included. UI-EWD was applied in all patients as an auxiliary hemostatic method as a salvage therapy or monotherapy during endoscopic treatment. Hemostasis success rates, adverse event related to UI-EWD, and rates of re-bleeding were evaluated. Results In all cases, UI-EWD application was successful at tumor bleeding sites. Immediate hemostasis occurred in 40/41 (97.5%) patients, and re-bleeding within 28 days occurred in 10 of 40 (22.5%) patients that achieved initial hemostasis. The success rate of immediate hemostasis for UI-EWD monotherapy was 100% (23/23). The re-bleeding rate at 28 days after UI-EWD monotherapy was 26.1% (6/23). No adverse events associated with UI-EWD application were encountered. Conclusions The success rate of UI-EWD for immediate hemostasis in cases of GI tumor bleeding was excellent and UI-EWD produced promising results with respect to the prevention of re-bleeding. Based on these results, we suggest that UI-EWD be considered an effective salvage therapy or even monotherapy for GI tumor bleeding.
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Affiliation(s)
- Jongbeom Shin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
| | - Boram Cha
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
| | - Jin-Seok Park
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.
| | - Weonjin Ko
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
| | - Kye Sook Kwon
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
| | - Hyung Kil Kim
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
| | - Yong Woon Shin
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea
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Kim M, Truong VG, Kim S, Kim H, Hasenberg T, Kang HW. In Vivo Investigation of Noncontact Rapid Photothermal Hemostasis on Venous and Arterial Bleeding. IEEE Trans Biomed Eng 2021; 68:2689-2697. [PMID: 33406035 DOI: 10.1109/tbme.2021.3049483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Endoscopic surgical procedures rigorously underscore the significance of rapid hemostasis for unavoidable intraoperative bleeding, requiring advancement of the immediate hemostatic interventions for favorable clinical outcomes. Here, we report the efficacy of a new optical treatment with dual-wavelengths to develop an endoscopic hemostasis method. METHODS we combine visible (20-W 532 nm at 1.1 kW/cm2) and near-infrared (40-W 980 nm at 2.2 kW/cm2) wavelengths for facilitating noncontact thermal hemostasis on venous and arterial bleeders in in vivo leporine models. RESULTS Simultaneous irradiation of 60-W dual-wavelengths allows for an increased irradiance of 3.3 kW/cm2, involving both rapid light absorption by hemoglobin and deep thermal penetration. The collective thermal effects from the combined wavelengths contribute to a significant reduction in coagulation time and a high success rate of complete hemostasis for both venous and arterial bleeders. The enhanced hemostatic potential of the dual-wavelengths treatment accompanies minimal hemorrhage, reduces inflammatory responses, and facilitates re-epithelialization. CONCLUSION The proposed dual-wavelengths method can achieve rapid and complete hemostasis for endoscopic procedures. SIGNIFICANCE We present the high-irradiance photothermal treatment using the dual-wavelengths as a novel method to regulate venous and arterial bleeding and potentially as a rapid noncontact hemostasis option to mitigate the risk associated with significant blood loss.
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Jiang L, Ling-Hu EQ, Chai NL, Li W, Cai FC, Li MY, Guo X, Meng JY, Wang XD, Tang P, Zhu J, Du H, Wang HB. Novel endoscopic papillectomy for reducing postoperative adverse events (with videos). World J Gastroenterol 2020; 26:6250-6259. [PMID: 33177797 PMCID: PMC7596639 DOI: 10.3748/wjg.v26.i40.6250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/04/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic adenoma can potentially transform into adenocarcinoma, so it is recommended to be resected surgically or endoscopically. Endoscopic papillectomy is one of the main treatments for papillary adenoma, and bleeding, perforation, and pancreatitis are the most frequent and critical adverse events that restrict its wider use. There is no standard procedure for endoscopic papillectomy yet. The procedure is relevant to postoperative adverse events.
AIM To reduce the postoperative adverse event rates and improve patients’ postoperative condition, we developed a standard novel procedure for endoscopic papillectomy.
METHODS The novel endoscopic papillectomy had two main modifications based on the conventional method: The isolation of bile from pancreatic juice with a bile duct stent and wound surface protection with metal clips and fibrin glue. We performed a single-center retrospective comparison study on the novel and conventional methods to examine the feasibility of the novel method for reducing postoperative adverse events.
RESULTS A total of 76 patients, of whom 23 underwent the novel procedure and 53 underwent the conventional procedure, were retrospectively evaluated in this study. The postoperative bleeding and pancreatitis rates of the novel method were significantly lower than those of the conventional method (0 vs 20.75%, P = 0.028, and 17.4% vs 41.5%, P = 0.042, respectively). After applying the novel method, the most critical adverse event, perforation, was entirely prevented, compared to a prevalence of 5.66% with the conventional method. Several postoperative symptoms, including fever, rapid pulse, and decrease in hemoglobin level, were significantly less frequent in the novel group (P = 0.042, 0.049, and 0.014, respectively). Overall, the total adverse event rate of the novel method was lower (0 vs 24.5%, P = 0.007) than that of the conventional method.
CONCLUSION Patients who underwent the novel procedure had lower postoperative adverse event rates. This study demonstrates the potential efficacy and safety of the novel endoscopic papillectomy in reducing postoperative adverse events.
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Affiliation(s)
- Lei Jiang
- School of Medicine, Nankai University, Tianjin 300071, China
| | - En-Qiang Ling-Hu
- School of Medicine, Nankai University, Tianjin 300071, China
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- School of Medicine, Nankai University, Tianjin 300071, China
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Wen Li
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Feng-Chun Cai
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ming-Yang Li
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xu Guo
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Jiang-Yun Meng
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xiang-Dong Wang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Jing Zhu
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong Du
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hong-Bin Wang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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