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Yao L, Ni L, Wu X. Does the Use of Gastric-Acid Suppressants Increase the Risk of Peritonitis in Patients Undergoing Peritoneal Dialysis? A Meta-Analysis. Semin Dial 2024. [PMID: 39182173 DOI: 10.1111/sdi.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 07/21/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024]
Abstract
Gastric-acid suppressants (GASs) are commonly prescribed to patients undergoing peritoneal dialysis for various gastrointestinal disorders. However, long-term GAS use has been linked with the risk of enteric peritonitis in this patient population. To assess the association between the enteric peritonitis risk and GAS use in patients undergoing peritoneal dialysis for end-stage renal disease, we conducted a systematic search for relevant articles published until December 2023 in PubMed, Embase, and the Cochrane Library databases. We included 11 articles on the association between GAS use and enteric peritonitis risk in patients undergoing peritoneal dialysis. We calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed and random-effects models to obtain overall effect estimates. We also explored potential sources of heterogeneity through subgroup analyses. We qualitatively analyzed data from 11 studies (n = 1993 participants), out of which, nine studies were included in meta-analysis. The overall results revealed a significant association between the enteric peritonitis risk and the use of GASs (OR, 1.61; 95% CI, 1.26-2.05; p < 0.00001). The analysis of study design subgroups showed a significant association in retrospective cohort studies (OR, 1.70; 95% CI, 1.42-2.03; p < 0.00001) but not in case-control studies. Histamine-2 receptor antagonist (H2RA) use was significantly associated with enteric peritonitis (OR, 1.49; 95% CI, 1.05-2.11, p = 0.03), whereas proton pump inhibitor use was not (OR, 1.13; 95% CI, 0.72-1.77, p = 0.28). Our findings suggest a significant association between the development of enteric peritonitis and GAS use in patients undergoing peritoneal dialysis. However, the observed heterogeneity in study characteristics warrants caution in interpreting the results.
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Affiliation(s)
- Lili Yao
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China
| | - Linfeng Ni
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China
| | - Xu Wu
- Department of Nephrology, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Huzhou, Zhejiang, China
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Piplani S, Jelic V, Johnson A, Shah U, Kolli S, Kong S, Tanasijevic N, Bejugam VR, Goguri SR, Mogga P, Kasire SP, Chaturvedi S, Jain P. Prevalence, Causes and Outcomes of Acute Gastrointestinal Bleeding in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis. Mediterr J Rheumatol 2024; 35:210-219. [PMID: 39211013 PMCID: PMC11350423 DOI: 10.31138/mjr.230324.pca] [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] [Received: 03/23/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 09/04/2024] Open
Abstract
Aim The present study aims to investigate the prevalence, causes and outcomes of acute gastrointestinal (GI) bleeding in Rheumatoid arthritis (RA). Methods A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 14th November 2023. All statistical analyses were conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in prevalence and their corresponding 95% confidence interval (CI). Other outcomes were assessed using qualitative analysis. Results A total of eight studies (six observational studies and 2 trials were used to conduct this systematic review and meta-analysis. A total population of 138,041 patients was used. Pooled analysis showed a statistically significant risk of GI bleeding in RA patients receiving NSAIDs (prevalence = 2% (1%, 3%); P < 0.00001; I2 = 98%). Qualitatively, causes and outcomes were discussed. Conclusion Our study showed that 2% RA patients were subjected to GI bleeding, when they used NSAIDs. Other causes of GI bleeding were age-related factors, cardiovascular events, history of GI complications, and peptic ulcers. Outcome varied by the use of specific NSAIDs and the presence of comorbidities. Recent guidelines for the management of RA may mention GI bleeding as a potential complication, but the level of emphasis placed on this issue varies. Some guidelines provide comprehensive recommendations for its prevention and management, while others offer limited guidance.
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Affiliation(s)
- Shobhit Piplani
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Vladimir Jelic
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Adejoke Johnson
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Usman Shah
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Shiny Kolli
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Steve Kong
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Nikola Tanasijevic
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Vishal Reddy Bejugam
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Sumaja Reddy Goguri
- Frank H. Netter MD School of Medicine/St. Vincent’s Medical Centre, Connecticut, United States
| | - Phanidhar Mogga
- Frank H. Netter MD School of Medicine/St. Vincent’s Medical Centre, Connecticut, United States
| | - Sripada Preetham Kasire
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
| | - Salil Chaturvedi
- Jacobi Medical Centre/North Central Bronx, Albert Einstein College of Medicine, NYC Health and Hospitals, New York, New York, United States
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Heunis CM, Wang Z, de Vente G, Misra S, Venkiteswaran VK. A Magnetic Bio-Inspired Soft Carrier as a Temperature-Controlled Gastrointestinal Drug Delivery System. Macromol Biosci 2023; 23:e2200559. [PMID: 36945731 DOI: 10.1002/mabi.202200559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/14/2023] [Indexed: 03/23/2023]
Abstract
Currently, gastrointestinal bleeding in the colon wall and the small bowel is diagnosed and treated with endoscopes. However, the locations of this condition are often problematic to treat using traditional flexible and tethered tools. New studies commonly consider untethered devices for solving this problem. However, there still exists a gap in the extant literature, and more research is needed to diagnose and deliver drugs in the lower gastrointestinal tract using soft robotic carriers. This paper discusses the development of an untethered, magnetically-responsive bio-inspired soft carrier. A molding process is utilized to produce prototypes from Diisopropylidene-1,6-diphenyl-1,6-hexanediol-based Polymer with Ethylene Glycol Dimethacrylate (DiAPLEX) MP-3510 - a shape memory polymer with a low transition temperature to enable the fabrication of these carriers. The soft carrier design is validated through simulation results of deformation caused by magnetic elements embedded in the carrier in response to an external field. The thermal responsiveness of the fabricated prototype carriers is assessed ex vivo and in a phantom. The results indicate a feasible design capable of administering drugs to a target inside a phantom of a large intestine. The soft carrier introduces a method for the controlled release of drugs by utilizing the rubbery modulus of the polymer and increasing the recovery force through magnetic actuation.
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Affiliation(s)
- Christoff M Heunis
- Surgical Robotics Laboratory, Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Zhuoyue Wang
- Department of Biomedical Engineering, University of Groningen and University Medical Centre Groningen, Groningen, 9713 GZ, The Netherlands
| | - Gerko de Vente
- Surgical Robotics Laboratory, Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
| | - Sarthak Misra
- Surgical Robotics Laboratory, Department of Biomechanical Engineering, University of Twente, Enschede, 7500 AE, The Netherlands
- Department of Biomedical Engineering, University of Groningen and University Medical Centre Groningen, Groningen, 9713 GZ, The Netherlands
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Boullier M, Fohlen A, Viennot S, Alves A. Gastrointestinal bleeding of undetermined origin: What diagnostic strategy to propose? J Visc Surg 2023:S1878-7886(23)00089-9. [PMID: 37344277 DOI: 10.1016/j.jviscsurg.2023.05.006] [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: 06/23/2023]
Abstract
Gastrointestinal bleeding of undetermined origin (GBUO) is defined as gastrointestinal bleeding without an identified cause or location despite an endoscopic assessment including an esogastroduodenal endoscopy (EOGD) and a total colonoscopy. A distinction is made between exteriorized GBUO and non-exteriorized occult GBUO. The causes in the majority of cases (vascular, inflammatory and tumoral) are located in the small intestine. The diagnostic strategy aiming to locate the origin of the GBUO is a real challenge. Innovation in endoscopic and imaging techniques has enabled minimally invasive exploration of the small intestine. In Europe, there is a strong consensus to recommend a video-capsule endoscopy (VCE) as the first-intention study. If there is reason to suspect intestinal obstruction, VCE is contraindicated and a CT-enteroscopy is then performed as first intention. Enteroscopy is performed as a second-line treatment, either for therapeutic purposes after a positive VCE or CT-enteroclysis, or for diagnostic purposes after a negative VCE. Finally, intraoperative enteroscopy (IOE) coupled with surgical exploration should be reserved either for therapeutic purposes in the event of impossibility or failure of preoperative enteroscopy, or for diagnostic purposes in the event of recurrent GBUO after failure of all other studies and explorations of the small intestine.
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Affiliation(s)
- Mathilde Boullier
- Digestive surgery department, university hospital center, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - Audrey Fohlen
- Uro-digestive imaging and interventional radiology department, university hospital center, 14000 Caen, France; Équipe CERVOxy, ISTCT UMR 6030-CNRS, CEA, Caen Normandie University, GIP Cycéron, 14074 Caen cedex, France
| | - Stéphanie Viennot
- Gastroenterology department, university hospital center, 14000 Caen, France
| | - Arnaud Alves
- Digestive surgery department, university hospital center, avenue de la Côte-de-Nacre, 14000 Caen, France; Inserm 1086 "ANTICIPE" Unit, Centre François-Baclesse "Cancers & Préventions", 14076 Caen cedex, France
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Kim JH, Nam SJ. Prediction models for recurrence in patients with small bowel bleeding. World J Clin Cases 2023; 11:3949-3957. [PMID: 37388787 PMCID: PMC10303624 DOI: 10.12998/wjcc.v11.i17.3949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Obscure gastrointestinal bleeding (OGIB) has traditionally been defined as gastrointestinal bleeding whose source remains unidentified after bidirectional endoscopy. OGIB can present as overt bleeding or occult bleeding, and small bowel lesions are the most common causes. The small bowel can be evaluated using capsule endoscopy, device-assisted enteroscopy, computed tomography enterography, or magnetic resonance enterography. Once the cause of small-bowel bleeding is identified and targeted therapeutic intervention is completed, the patient can be managed with routine visits. However, diagnostic tests may produce negative results, and some patients with small bowel bleeding, regardless of diagnostic findings, may experience rebleeding. Predicting those at risk of rebleeding can help clinicians form individualized surveillance plans. Several studies have identified different factors associated with rebleeding, and a limited number of studies have attempted to create prediction models for recurrence. This article describes prediction models developed so far for identifying patients with OGIB who are at greater risk of rebleeding. These models may aid clinicians in forming tailored patient management and surveillance.
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Affiliation(s)
- Ji Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
| | - Seung-Joo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24341, South Korea
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Agarwal A, Kumar KP, Madhusudhan KS. Utility of dual energy CT angiography in the evaluation of acute non-variceal gastrointestinal hemorrhage: comparison with digital subtraction angiography. Abdom Radiol (NY) 2023; 48:1880-1890. [PMID: 36939912 DOI: 10.1007/s00261-023-03864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To evaluate the utility of dual energy CT angiography (DECTA) in acute non-variceal gastrointestinal hemorrhage (ANVGIH) compared to digital subtraction angiography (DSA) as gold standard. MATERIALS AND METHODS 111 Patients (mean age: 39.2 years; 94 males) of ANVGIH who underwent both DECTA and DSA between January 2016 and September 2021 were included. Virtual monochromatic (VM) images at 10 keV increments from 40 to 70 keV and blended (120kVp equivalent) images of arterial phase of DECTA were evaluated independently by two readers blinded to DSA information. Quantitative analysis included measurement of attenuation in the major arteries (abdominal aorta, celiac artery, superior mesenteric artery), suspected vascular lesion, and lesion feeding artery to calculate contrast-to-noise ratios (CNRs) and signal-to-noise ratios (SNRs). Qualitative analysis assessed the image quality of each data set using a 3-point Likert scale. Findings on DSA were evaluated by a third reader and both DECTA and DSA were compared. RESULTS On linear blended images, vascular lesion was identified by reader 1 in 88 (79.3%) and by reader 2 in 87 (78.4%) patients and DSA showed lesion in 92 (82.9%) patients. The sensitivity and specificity of blended images and VM images of DECTA for lesion detection were not significantly different from each other. The CNR and SNR of arteries, vascular lesion and feeding artery were significantly higher at 70 keV (p < 0.005) compared to blended and other VM images. Although subjective scores for image quality were higher for 60 keV images by both readers, the difference was not statistically significant (p = 0.3). The interobserver agreement was mostly good. CONCLUSION In the assessment of ANVGIH, the 60 keV and 70 keV VM images improved the image quality and contrast, respectively, but there was no increase in diagnostic accuracy of VM image datasets compared to linearly blended images. Hence, the diagnostic utility of DECTA in ANVGIH is still uncertain.
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Affiliation(s)
- Ayushi Agarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Korukanti Pradeep Kumar
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Newman C, Nandurkar R, Holcdorf D, Gerstenmaier J, Tagkalidis P, Clements W. Role of CT angiography and therapeutic anticoagulation in patients presenting to the emergency department with acute gastrointestinal bleeding. J Med Imaging Radiat Oncol 2023; 67:37-44. [PMID: 35394116 DOI: 10.1111/1754-9485.13410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 02/24/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute gastrointestinal bleeding (GIB) is associated with morbidity and mortality. There can be a low threshold for practitioners to assess for active GIB and computed tomography angiography (CTA) examinations are performed frequently, even for stable patients and those who are therapeutically anticoagulated. We aimed to assess the predictive value of CTA for acute GIB and the influence of CTA on treatment. METHODS Retrospective single-centre study over a 2-year period. RESULTS A total of 227 patients with mean age 67.7 years (SD 17.86), 58.6% male. 84.4% were for lower GIB. 49 patients were on therapeutic anticoagulation (21.6%). 45 CTAs were positive (19.8%). 22 patients received embolisation, and 15 received acute endoscopic treatment. CTA sensitivity was 68.6% and specificity 89.1%. The PPV was 53.3% and NPV 93.9%. The odds ratio of a positive CTA requiring treatment for patients on therapeutic anticoagulation was 1.1 (P = 0.932) compared with the odds of patients not taking therapeutic anticoagulation 21.5 (P < 0.001). The risk ratio for requiring treatment if not taking anticoagulation was 6.2. A total of 19 patients (9.1%) met the definition of CI-AKI as a result of the CTA. A pre-existing eGFR of less than 20 was associated with significantly increased odds of developing CI-AKI (OR 3.95, P = 0.031, 95%CI 1.135-13.782). CONCLUSIONS The presence of anticoagulation has a significant impact on the decision not to perform interventional treatments on patients with acute GIB when CTA is positive. Anticoagulant reversal and volume resuscitation are important front-line measures, and CTA may have a role for those anticoagulated who are haemodynamically unstable after resuscitation.
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Affiliation(s)
- Chris Newman
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Rohan Nandurkar
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - David Holcdorf
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jan Gerstenmaier
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Tagkalidis
- Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Warren Clements
- Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University Central Clinical School, Melbourne, Victoria, Australia.,National Trauma Research Institute, Melbourne, Victoria, Australia
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Boortalary T, Erwin R, Dong M, Shinn B, Infantolino A, Tofani C. RHEMITT Score Predicts Rebleed After Capsule Endoscopy: First Validation at a U.S. Tertiary Care Center. Dig Dis Sci 2023; 68:187-192. [PMID: 35543830 DOI: 10.1007/s10620-022-07527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with obscure gastrointestinal bleeding undergo small bowel capsule endoscopy (SBCE), but often return for recurrent bleeding or anemia. The RHEMITT score evaluates patients based on 7 variables (heart failure, chronic kidney disease, Saurin P1/P2 lesions, major bleeding, incomplete SBCE, smoking status, and endoscopic treatment) and seeks to predict the risk of rebleeding. AIMS This study aims to perform an external validation of the RHEMITT score in the United States. METHODS SBCEs performed to evaluate anemia or GI bleeding from a tertiary-care center's PillCam database between 1/22/2018 and 7/21/2020 were reviewed. Variables based on the RHEMITT score were collected. The primary outcome was rebleeding, defined as (1) melena or hematochezia or (2) hemoglobin drop of 2 g/dL. Patient were categorized into low, intermediate, and high-risk categories based on RHEMITT score. The accuracy of the RHEMITT score for predicting rebleeding was assessed. RESULTS A total of 361 SBCEs were included in the study. Age, indication for SBCE, endoscopic treatment, antiplatelet use, cirrhosis, heart failure, chronic kidney disease, and major bleeding were significantly associated with risk of rebleed (p < 0.05). Each increasing risk category for the RHEMITT score predicted increased probability of this study's primary outcome, rebleeding (p < 0.001). There was a significant association between RHEMITT risk category and rebleeding-free survival (log-rank p < 0.001). An area under the receiver operating characteristic curve for the RHEMITT score was 0.790 (p < 0.001). CONCLUSION Our findings validate the RHEMITT score and confirm acceptable performance for predicting rebleeding at a tertiary referral center in the United States.
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Affiliation(s)
- Tina Boortalary
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA
| | - Ryan Erwin
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA
| | - Michael Dong
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA
| | - Brianna Shinn
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA
| | - Anthony Infantolino
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA
| | - Christina Tofani
- Department of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, 132 S. 10th St. Main Building, Suite 480, Philadelphia, PA, 19107, USA.
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Ephraim Joseph K, Devane AM, Abrams GA. Patient and endoscopic characteristics and clinical outcomes in subjects with non-variceal GI bleeding referred for transarterial embolization: a single-center experience. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3883-3891. [PMID: 36031627 DOI: 10.1007/s00261-022-03650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Management of massive non-variceal upper gastrointestinal bleeding (NV-UGIB) can be challenging. Transarterial Embolization (TAE) is often the first therapeutic approach when endoscopic therapy fails before surgery. The purpose of this study is to analyze the technical success, and outcome for our patients with an NV-UGIB referred for TAE. METHOD This retrospective analysis included 74 consecutive patients with an NV-UGIB in whom TAE was performed after endoscopic treatment between February 2016 to May 2019 at Prisma Health-Upstate Greenville Memorial Hospital. RESULTS TAE was 98.7% technically successful, with a failure due to severe celiac stenosis, and 85.1% clinically successful. Most TAEs were performed empirically due to lack of extravasation yet were clinically as effective as targeted TAE. We noted a 30-day rebleeding rate and mortality rate of 14.8% and 13.5%, respectively. No complications were reported during the angiographic procedure. Subjects with coagulopathy had more rebleeding (45.5% vs. 17.5%, p = 0.040), and mortality (30% vs 7.4%, p = 0.012). Mortality was also associated with the number of transfused packed blood cells (13.6 ± 8.4 vs. 6.1 ± 5.4, p = 0.020) units and hypotension on admission (27.8% vs. 8.9%, p = 0.043). Interestingly, subjects that underwent left gastric artery (LGA) compared to non-LGA embolization had a higher rebleeding rate of (37.5% vs. 8.6%, p = 0.004) and a greater mortality rate of (37.5% vs. 6.9%, p = 0.002). CONCLUSION TAE is clinically effective in the presence or absence of contrast extravasation to treat uncontrolled or high-risk NV-UGIB. Less effective clinical outcomes regarding TAE targeting the LGA warrant further investigation.
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Affiliation(s)
- Kripalini Ephraim Joseph
- Department of Medicine, Gastroenterology & Liver Center, Prisma Health- Upstate, Greenville, SC, 29605, USA.
| | - Aron M Devane
- Department of Diagnostic and Interventional Radiology, University of South Carolina SOM - Greenville, Prisma Health -Upstate, Greenville, SC, 29605, USA
| | - Gary A Abrams
- Department of Medicine, Gastroenterology & Liver Center, University of South Carolina SOM - Greenville, Prisma Health- Upstate, Greenville, SC, 29605, USA
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Dixit VK, Sahu MK, Venkatesh V, Bhargav VY, Kumar V, Pateriya MB, Venkataraman J. Gastrointestinal Emergencies and the Role of Endoscopy. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1755303] [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: 02/07/2023] Open
Abstract
AbstractMany gastrointestinal (GI) disorders present to the emergency room with acute clinical presentations, some even life threatening. Common emergencies encountered that require urgent endoscopic interventions include GI hemorrhage (variceal and nonvariceal), foreign body ingestion, obstructive jaundice, postprocedure-related complications such as postpolypectomy bleed or perforation, etc. A major advantage of emergency endoscopy is that it is cost effective and, on many occasions, can be life-saving. The present review will highlight a practical approach on various endoscopic modalities and their use in the GI emergencies.
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Affiliation(s)
- Vinod Kumar Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Manoj Kumar Sahu
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Vybhav Venkatesh
- Department of Gastroenterology and Hepatobiliary Sciences, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (SOA) University, Bhubaneswar, Odisha, India
| | - Varanasi Yugandhar Bhargav
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Vinod Kumar
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mayank Bhushan Pateriya
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jayanthi Venkataraman
- Department of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Alzubaidi AS, Basilim AF. Comparison of intermittent and continuous proton pump inhibitor infusions in patients with non-variceal upper gastrointestinal bleeding at King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A retrospective study. Saudi Med J 2022; 43:941-945. [PMID: 35964952 PMCID: PMC9749666 DOI: 10.15537/smj.2022.43.8.20220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the effectiveness of intermittent and continuous proton pump inhibitors (PPIs) infusion on the outcomes of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). METHODS The study was a single-centred retrospective study in adult patients with active upper gastrointestinal bleeding who received intermittent or continuous PPI infusion at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2013 to October 2019. The outcomes assessed were rebleeding, length of hospital stays and mortality within 30 days of admission, and were compared between the treatment groups. A statistically significant p-value was set at 0.05. RESULTS The study involved 97 patients with NVUGIB treated with intermittent (n=56) and continuous (n=41) PPI infusions, with mean (±SD) ages of 66.0±16.1 and 58.0±19.5 years, respectively. The baseline and clinical characteristics between the 2 treatment groups; age (p=0.116), gender (p=0.345) and comorbidities (p=0.401), were comparable. There were no significant differences in rebleeding rates within 30 days (5 [8.9%] versus 1 [2.4%], p=0.396), length of hospital stays (4 vs 5, p=0.067), and mortality rate (1 [1.7%] vs 3 [7.3%], p=0.308) between the 2 groups. CONCLUSION The management of NVUGIB with intermittent and continuous PPI infusions demonstrated comparable outcomes in reducing rebleeding rate, length of hospital stays, and mortality rate among patients attending the university hospital in Saudi Arabia.
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Affiliation(s)
- Abeer S. Alzubaidi
- From the Pharmacy Department (Alzubaidi), and from the Department of Pharmacy Practice (Basilim), Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Dr. Abeer S. Alzubaidi, Pharmacy Department, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid/org/0000-0003-0505-1360
| | - Ahmed F. Basilim
- From the Pharmacy Department (Alzubaidi), and from the Department of Pharmacy Practice (Basilim), Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Sasaki Y, Abe T, Kawamura N, Keitoku T, Shibata I, Ohno S, Ono K, Makishima M. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study. BMC Gastroenterol 2022; 22:337. [PMID: 35820868 PMCID: PMC9277905 DOI: 10.1186/s12876-022-02413-8] [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: 05/18/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Gastrointestinal bleeding is one of the major gastrointestinal diseases. In this study, our objective was to compare Glasgow-Blatchford score (GBS), AIMS65 score, MAP score, Modified GBS, and Iino score as outcome measures for upper gastrointestinal bleeding. In addition, we extracted factors associated with hemostatic procedures including endoscopy, and proposed a new robust score model. Methods From January 2015 to December 2019, 675 patients with symptoms such as hematemesis who visited the National Hospital Organization Disaster Medical Center and underwent urgent upper endoscopy with diagnosis of suspected non-variceal upper gastrointestinal bleeding were retrospectively reviewed. We evaluated the GBS, AIMS65 score, MAP score, Modified GBS, and Iino score, and assessed the outcomes of patients requiring hemostatic treatments at the subsequent emergency endoscopy. We performed logistic regression analysis of factors related to endoscopic hemostasis and upper gastrointestinal bleeding, created a new score model, and evaluated the prediction of hemostatic treatment and mortality in the new score and the existing scores. Results The factors associated with endoscopic treatment were hematemesis, heart rate, HB (hemoglobin), blood pressure, blood urea nitrogen (BUN). Based on these predictors and the partial regression coefficients, a new score named H3B2 (using the initial letters of hematemesis, heart rate, HB, blood pressure, and BUN) was generated. H3B2 score was slightly more discriminatory compared to GBS and Modified GBS (area under the receiver operating characteristic curves (AUROC): 0.73 versus 0.721 and 0.7128, respectively) in predicting hemostatic treatment in emergency endoscopy. The H3B2 score also showed satisfactory prediction accuracy for subsequent deaths (AUROC: 0.6857. P < 0.001). Conclusions We proposed a new score, the H3B2 score, consisting of simple and objective indices in cases of suspected upper gastrointestinal bleeding. The H3B2 score is useful in identifying high-risk patients with suspected upper gastrointestinal bleeding who require urgent hemostatic treatment including emergency endoscopy.
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Affiliation(s)
- Yoshihiro Sasaki
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan. .,Division of Biochemistry, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Tomoko Abe
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan
| | - Norio Kawamura
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan
| | - Taisei Keitoku
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan
| | - Isamu Shibata
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan
| | - Shino Ohno
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan
| | - Keiichi Ono
- Department of Gastroenterology, National Disaster Medical Center, 3256 Midoricho, Tachikawa-shi, Tokyo, 190-0014, Japan
| | - Makoto Makishima
- Division of Biochemistry, Department of Biomedical Sciences, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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13
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Kusano C. Can we find a precise timing for endoscopic intervention in gastrointestinal bleeding? Dig Endosc 2022; 34:750-752. [PMID: 35199391 DOI: 10.1111/den.14265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Chika Kusano
- Division of Gastroenterology and Hepatology, Department of Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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14
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Kate V, Sureshkumar S, Gurushankari B, Kalayarasan R. Acute Upper Non-variceal and Lower Gastrointestinal Bleeding. J Gastrointest Surg 2022; 26:932-949. [PMID: 35083723 DOI: 10.1007/s11605-022-05258-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 01/31/2023]
Abstract
Acute gastrointestinal (GI) bleeding is a common surgical emergency requiring hospital admission and associated with high morbidity and mortality. Appropriate decision-making is essential to make a prompt diagnosis, accurate risk assessment, and proper resuscitation of patients with gastrointestinal bleeding. Despite multiple randomized trials and meta-analyses, there is still controversy on various management issues like appropriate risk stratification, the timing of endoscopy, choosing an appropriate endoscopic, and radiological intervention in these groups of patients. As the usage of nonsteroidal anti-inflammatory drugs, antiplatelet, and antithrombotic agents is common in patients with gastrointestinal bleeding, the physician is challenged with proper management of these drugs. The present review summarizes the current strategies for risk stratification, localization of bleeding source, endoscopic and radiological intervention in patients with acute nonvariceal upper GI, middle GI, and lower GI bleeding.
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Affiliation(s)
- Vikram Kate
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India.
| | - Sathasivam Sureshkumar
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Balakrishnan Gurushankari
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
| | - Raja Kalayarasan
- Department of Surgery and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605006, India
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15
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Kan SW, Huang TY, Ma HP, Tay MZ, Tam KW, Tsai TY. Early versus delayed feeding after therapeutic endoscopic procedures: Meta-analysis of randomized controlled trials. Dig Endosc 2022; 34:451-458. [PMID: 34536972 DOI: 10.1111/den.14140] [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: 07/08/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Early feeding was previously considered to increase the risk of postprocedural bleeding. However, many trials have demonstrated the benefits of early feeding after therapeutic endoscopic procedures. We conducted a meta-analysis of randomized controlled trials to evaluate the safety and outcomes between early feeding and delayed feeding after therapeutic endoscopic procedures. METHODS Medline (PubMed), Embase, Google Scholar, the Cochrane Library, and clinicaltrials.gov were searched to identify randomized controlled trials that met our inclusion criteria. The pooled data for the mortality rate, postprocedural bleeding rate, and length of hospital stay were analyzed. RESULTS A total of seven trials consisting of 717 patients were reviewed. These seven trials examined various therapeutic endoscopic procedures. Three trials included patients undergoing endoscopic hemostasis for upper gastrointestinal bleeding, two included patients undergoing esophageal variceal ligation, and two included patients with gastric neoplasm treated with endoscopic submucosal dissection. Although no significant differences were observed in the postprocedural bleeding rate or the mortality rate between patients who received early feeding and those who received delayed feeding, early feeding resulted in shorter hospital stays (weighted mean difference -1.04, 95% confidence interval -1.45 to 0.63). CONCLUSION Early feeding appears to be a safe management method for patients undergoing therapeutic endoscopic procedures. Therefore, we recommend early feeding for these patients.
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Affiliation(s)
- Sheau Wen Kan
- Division of Emergency Medicine, Department of Emergency and Critical Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Ting-Yun Huang
- Division of Emergency Medicine, Department of Emergency and Critical Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
| | - Hon-Ping Ma
- Division of Emergency Medicine, Department of Emergency and Critical Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, New Taipei City, Taiwan
| | - Ming Zhe Tay
- Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Tung-Yao Tsai
- Division of Emergency Medicine, Department of Emergency and Critical Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan
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16
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Predictive Role of Admission Venous Lactate Level in Patients with Upper Gastrointestinal Bleeding: A Prospective Observational Study. J Clin Med 2022; 11:jcm11020335. [PMID: 35054029 PMCID: PMC8780414 DOI: 10.3390/jcm11020335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 02/01/2023] Open
Abstract
Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies. Risk stratification is essential in patients with this potentially life-threatening condition. The aim of this prospective study was to evaluate the usefulness of the admission venous lactate level in predicting clinical outcomes in patients with UGIB. All consecutive adult patients hospitalized due to UGIB were included in the study. The clinical data included the demographic characteristics of the observed population, etiology of UGIB, need for surgical intervention and intensive care, bleeding recurrence, and mortality rates. Venous lactate was measured in all patients on admission. Logistic regression analyses were used to calculate the odds ratios (OR) of lactate levels for all outcomes. The receiver operating characteristic (ROC) curve was used to determine the accuracy of lactate levels in measuring clinical outcomes, while Youden index was used to calculate the best cut-off points. A total of 221 patients were included in the study (151M; 70F). There were 24 cases of UGIB recurrence (10.8%), 19 patients (8.6%) required surgery, and 37 individuals (16.7%) required intensive care. Mortality rate was 11.3% (25 cases). The logistic regression analysis showed statistically significant association between admission venous lactate and all clinical outcomes: mortality (OR = 1.39, 95%CI: 1.22–1.58, p < 0.001), recurrence of bleeding (OR = 1.16, 95%CI: 1.06; 1.28, p = 0.002), surgical intervention (OR = 1.17, 95%CI: 1.06–1.3, p = 0.002) and intensive care (OR = 1.33, 95%CI: 1.19–1.5, p < 0.001). The ROC curve analysis showed a high predictive value of lactate levels for all outcomes, especially mortality: cut-off point 4.3 (AUC = 0.82, 95%CI: 0.72–0.92, p < 0.001) and intensive care: cut-off point 4.2 (AUC = 0.76, 95%CI: 0.66–0.85, p < 0.001). Admission venous lactate level may be a useful predictive factor of clinical outcomes in patients with UGIB.
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Bardakcı O, Sıddıkoğlu D, Akdur G, Şimşek G, Atalay Ü, Das M, Akdur O, Beyazit Y. Prediction of adverse outcomes using non-endoscopic scoring systems in patients over 80 years of age who present with the upper gastrointestinal bleeding in the emergency department. ULUS TRAVMA ACIL CER 2022; 28:39-47. [PMID: 34967427 PMCID: PMC10443161 DOI: 10.14744/tjtes.2020.27810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The emergency department (ED) admission rate for elderly patients with non-variceal upper gastrointestinal bleeding (UGIB) is increasing. The AIMS65 and Glasgow-Blatchford score (GBS) are two distinct scoring systems proposed to predict in-hospital and post-discharge mortality, length of stay (LOS), and health-related costs in these patients. The objective of the present study is to evaluate the accuracy of these scoring systems, in conjunction with the Charlson comorbidity index (CCI), to predict 30-day mortality and LOS in UGIB patients who are 80 years of age or older METHODS: A retrospective analysis was undertaken of 182 patients with non-variceal UGIB who were admitted to the ED of Canakkale Onsekiz Mart University Hospital. The AIMS65, GBS, and CCI scores were calculated and adverse patient outcomes were assessed. RESULTS The mean age of patients was 85.59±4.33 years, and 90 (49.5%) of the patients were males. The AIMS65 was superior to the GBS (area under the receiver operating characteristic curve [AUROC] 0.877 vs. 0.695, respectively) and CCI (AUROC 0.877 vs. 0.526, respectively) in predicting the 30-day mortality. All three scores performed poorly in predicting the LOS in hospital. The cutoff threshold that maximized sensitivity and specificity for mortality was three for the AIMS65 score (sensitivity, 0.87; specificity, 0.80; negative predictive values [NPV], 0.977; positive predictive values [PPV], 0.392), 14 for GBS (sensitivity, 0.83; specificity, 0.51; NPV, 0.923; PPV, 0.367), and 5 for CCI (sensitivity, 0.91; specificity, 0.22; NPV, 0.946; PPV, 0.145). CONCLUSION The AIMS65 is a simple, accurate, and non-endoscopic scoring system that can be performed easily in ED settings. It is superior to GBS and CCI in predicting 30-day mortality in elderly patients with UGIB.
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Affiliation(s)
- Okan Bardakcı
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Duygu Sıddıkoğlu
- Department of Biostatistics, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Gökhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Güven Şimşek
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Ünzile Atalay
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Murat Das
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Okhan Akdur
- Department of Emergency Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
| | - Yavuz Beyazit
- Department of Internal Medicine, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale-Turkey
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18
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A Case Report on Life-Threatening Lower Gastrointestinal Bleeding: A Rare Presentation of Mucinous Adenocarcinoma of the Appendix. Case Rep Surg 2021; 2021:2349737. [PMID: 34603811 PMCID: PMC8481042 DOI: 10.1155/2021/2349737] [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] [Received: 04/16/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction A life-threatening lower gastrointestinal bleeding from mucinous adenocarcinoma of the appendix is a rare occurrence. Diagnosing and management of such a condition are challenging. Case Presentation. A 73-year-old male with a history of type 2 diabetes mellitus and hypertension presented with intermittent per rectal bleeding for two weeks, which progressed to the passage of a large number of blood clots and fresh blood. He had features of class III shock on admission. An endoscopic evaluation followed initial resuscitation to locate the source of bleeding. Colonoscopy revealed a large blood clot at the opening of the appendicular orifice with no active bleeding. Oesophagoduodenoscopy, contrast-enhanced CT abdomen, and CT angiogram findings were unremarkable. Due to repeated episodes of rebleeding leading to haemodynamic instability, an exploratory laparotomy was performed. A retrocaecal appendix was noticed with a macroscopically suspicious-looking dilated tip adhered to the posterior caecal wall. Right hemicolectomy was performed as the lesion was suspicious and to stop bleeding from the site. Ileocolic side-to-side hand-sewn anastomosis was performed using 3/0 polyglactin. Postoperatively, per rectal bleeding was settled. Microscopy revealed appendiceal mucinous adenocarcinoma with AJCC staging of pT3NoMx. The patient was discharged on postoperative day seven and referred to oncological management. He was offered six cycles of chemotherapy with capecitabine and oxaliplatin. At the six-month follow-up visit, the patient had no features of recurrence clinically. Conclusion Mucinous adenocarcinoma of the appendix can rarely present as life-threatening lower GI bleeding. Prompt resuscitation, endoscopic evaluation, and operative management with right hemicolectomy and chemotherapy provided a good outcome.
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Birda CL, Kumar A, Samanta J. Endotherapy for Nonvariceal Upper Gastrointestinal Hemorrhage. JOURNAL OF DIGESTIVE ENDOSCOPY 2021. [DOI: 10.1055/s-0041-1731962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AbstractNonvariceal upper gastrointestinal hemorrhage (NVUGIH) is a common GI emergency with significant morbidity and mortality. Triaging cases on the basis of patient-related factors, restrictive blood transfusion strategy, and hemodynamic stabilization are key initial steps for the management of patients with NVUGIH. Endoscopy remains a vital step for both diagnosis and definitive management. Multiple studies and guidelines have now defined the optimum timing for performing the endoscopy after hospitalization, to better the outcome. Conventional methods for achieving endoscopic hemostasis, such as injection therapy, contact, and noncontact thermal therapy, and mechanical therapy, such as through-the-scope clips, have reported to have 76 to 90% efficacy for primary hemostasis. Newer modalities to enhance hemostasis rates have come in vogue. Many of these modalities, such as cap-mounted clips, coagulation forceps, and hemostatic powders have proved to be efficacious in multiple studies. Thus, the newer modalities are recommended not only for management of persistent bleed and recurrent bleed after failed initial hemostasis, using conventional modalities but also now being advocated for primary hemostasis. Failure of endotherapy would warrant radiological or surgical intervention. Some newer tools to optimize endotherapy, such as endoscopic Doppler probes, for determining flow in visible or underlying vessels in ulcer bleed are now being evaluated. This review is focused on the technical aspects and efficacy of various endoscopic modalities, both conventional and new. A synopsis of the various studies describing and comparing the modalities have been outlined. Postendoscopic management including Helicobacter pylori therapy and starting of anticoagulants and antiplatelets have also been outlined.
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Affiliation(s)
- Chhagan L. Birda
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Antriksh Kumar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Cañamares-Orbís P, Lanas Arbeloa Á. New Trends and Advances in Non-Variceal Gastrointestinal Bleeding-Series II. J Clin Med 2021; 10:3045. [PMID: 34300211 PMCID: PMC8303152 DOI: 10.3390/jcm10143045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
The gastrointestinal tract is a long tubular structure wherein any point in the mucosa along its entire length could be the source of a hemorrhage. Upper (esophagel and gastroduodenal) and lower (jejunum, ileum, and colon) gastrointestinal bleeding are common. Gastroduodenal and colonic bleeding are more frequent than bleeding from the small bowel, but nowadays the entire gastrointestinal tract can be explored endoscopically and bleeding lesions can be locally treated successfully to stop or prevent further bleeding. The extensive use of antiplatelet and anticoagulants drugs in cardiovascular patients is, at least in part, the cause of the increasing number of patients suffering from gastrointestinal bleeding. Patients with these conditions are usually older and more fragile because of their comorbidities. The correct management of antithrombotic drugs in cases of gastrointestinal bleeding is essential for a successful outcome for patients. The influence of the microbiome in the pathogenesis of small bowel bleeding is an example of the new data that are emerging as potential therapeutic target for bleeding prevention. This text summarizes the latest research and advances in all forms of acute gastrointestinal bleeding (i.e., upper, small bowel and lower). Diagnosis is approached, and medical, endoscopic or antithrombotic management are discussed in the text in an accessible and comprehensible way.
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Affiliation(s)
- Pablo Cañamares-Orbís
- Gastroenterology, Hepatology and Nutrition Unit, San Jorge University Hospital, 22004 Huesca, Spain
| | - Ángel Lanas Arbeloa
- IIS Aragón, CIBERehd, 50009 Zaragoza, Spain;
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, 50009 Zaragoza, Spain
- University of Zaragoza, 500009 Zaragoza, Spain
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21
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Safety and Efficacy of the Noncessation Method of Antithrombotic Agents after Emergency Endoscopic Hemostasis in Patients with Nonvariceal Upper Gastrointestinal Bleeding: A Multicenter Pilot Study. Can J Gastroenterol Hepatol 2021; 2021:6672440. [PMID: 34095017 PMCID: PMC8164533 DOI: 10.1155/2021/6672440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS The present study aimed to clarify the safety and efficacy of the noncessation method of antithrombotic agents after emergency endoscopic hemostasis in patients with nonvariceal upper gastrointestinal bleeding (UGIB). METHODS In this multicenter, prospective, pilot study, we performed emergency endoscopic hemostasis for nonvariceal UGIB in patients taking antithrombotic agents and resumed the medications without a cessation period (group A). The clinical characteristics, types of antithrombotic agents, UGIB etiology, treatment outcome, and adverse events were evaluated. We used propensity score matching to compare treatment outcomes and adverse events with our previous cohort (group B) in whom antithrombotic agents were transiently discontinued after emergency endoscopic hemostasis. RESULTS Forty-three consecutive patients were prospectively enrolled. The main antithrombotic agents were low-dose aspirin and direct oral anticoagulants; 11 patients (25.6%) were taking multiple antithrombotics. Peptic ulcers were the main cause of bleeding (95.4%). Endoscopic hemostasis was successful in all patients and the incidence of rebleeding within a month was 7.0%. Propensity score matching created 40 matched pairs. Endoscopic hemostasis was performed by soft coagulation significantly more frequently in group A than in group B (97.5% versus 60.0%, P < 0.001). Neither the rebleeding rate within a month nor thromboembolic event rate was different between the two groups. However, the mean duration of hospitalization was significantly shorter in group A than in group B (8.6 ± 5.2 d versus 14.4 ± 7.1 d, P < 0.001). CONCLUSIONS Antithrombotic agents possibly can be continued after successful emergency endoscopic hemostasis for nonvariceal UGIB.
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Song Y, Feng Y, Sun LH, Zhang BJ, Yao HJ, Qiao JG, Zhang SF, Zhang P, Liu B. Role of argon plasma coagulation in treatment of esophageal varices. World J Clin Cases 2021; 9:521-527. [PMID: 33553390 PMCID: PMC7829739 DOI: 10.12998/wjcc.v9.i3.521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/02/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
With the development of endoscopic therapy, argon plasma coagulation (APC) has been widely used by endoscopists. It has many advantages, such as simple to operate, low cost, and minimal invasiveness. Because of its capability of lesion ablation and hemostasis, APC has several indications in the gastrointestinal tract. One of them is esophageal varices. The aim of this review is to summarize the research on APC in this field to provide a reference for clinical practice.
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Affiliation(s)
- Ying Song
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Yuan Feng
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Li-Hui Sun
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Bo-Jiang Zhang
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Hong-Juan Yao
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Jing-Gui Qiao
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Shu-Fen Zhang
- Department of Gastroenterology, Xi’an Gaoxin Hospital, Xi'an 710032, Shaanxi Province, China
| | - Ping Zhang
- Department of Clinical Medical Affair, Erbe China Ltd., Shanghai 200336, China
| | - Bin Liu
- Department of Clinical Medical Affair, Erbe China Ltd., Shanghai 200336, China
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Alatawi A, Aljohani WS, Aljayani RT, Alblowi Y, Yousuf M, Almutairi H. Findings of Esophagogastroduodenoscopy in Patients Suspected of Upper Gastrointestinal Bleeding Referred to the Main Endoscopy Unit at King Fahad Specialist Hospital. Cureus 2020; 12:e11862. [PMID: 33409096 PMCID: PMC7781575 DOI: 10.7759/cureus.11862] [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] [Indexed: 11/23/2022] Open
Abstract
Introduction Upper gastrointestinal bleeding (UGIB) is defined as any blood loss originating from the esophagus, stomach or the proximal duodenum above the ligament of Treitz. Ethnic trends regarding the causes of UGIB have been reported. The aim of this study was to identify the most common causes of UGIB among patients residing in Tabuk city, Saudi Arabia. Methods We have conducted a retrospective descriptive cohort study at King Fahad Specialist Hospital (KFSH), Tabuk, Saudi Arabia. All adult patients above the age of 18 years who were suspected of UGIB and referred for esophagogastroduodenoscopy (EGD) were included. The collected data included age, sex, nationality, complaint, EGD, and histopathologic findings. Results Between January 1, 2017 and December 31, 2019, 73 patients were included. 83.6% were Saudi, and 64.4% were males. Hematemesis was the main complaint (65.8%). Esophagogastroduodenoscopy was normal in 6.84% of cases; however, it showed UGIB due to esophageal and gastric varices (9.57%) as well as non-variceal causes (83.56%). The most frequent non-variceal findings which represent about two-thirds of the cases were duodenal ulcer (20.53%), antral gastropathy (13.68%), gastric ulcer (12.32%), antral gastritis (10.94%), and duodenal/gastric mass (9.57%), whereas much less frequent findings representing a total of 16.39% of cases included Cameron gastropathy, gastropathy/duodenopathy, esophagitis/gastritis, gastritis/duodenitis, gastroesophageal reflux disease (GERD), and Mallory-Weiss tear. Conclusion Non-variceal causes showed higher prevalence as causes of UGIB than variceal causes in the Tabuk area. Furthermore, chronic duodenal and gastric ulcers were the most common culprits of bleeding, whereas duodenitis, gastritis, esophagitis, and Mallory-Weiss syndrome were the least common non-variceal causes.
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