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Moughal S, Islim FI, Nejadhamzeeigilani H, Saleem N, Goddard T, Patankar T. A large UK single-centre experience in the long-term safety and efficacy of Woven Endobridge in the treatment of wide-neck intracranial aneurysms and risk factors associated with re-bleeding and re-treatment. Interv Neuroradiol 2024:15910199241236818. [PMID: 38613373 DOI: 10.1177/15910199241236818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Endovascular treatment of wide neck aneurysms remains complicated with a determined and continuous technological effort towards treatment options that can offer safer and efficacious outcomes. The Woven Endobridge device was introduced in 2010 and has become a mainstay endovascular treatment for wide neck and large intracranial aneurysms. A recent review of the Woven Endobridge Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) and WEBCAST2 trials and the five-year follow-up of patients was published. Our aim is to demonstrate real-life experience of aneurysms and patients treated with Woven Endobridge from a large high-volume specialist centre. METHODS A retrospective review was performed of patients treated with Woven Endobridge from March 2013 to March 2018. Primary efficacy outcomes were defined as per Raymond-Roy Occlusion Criteria (RROC) resulting in long-term complete occlusion (RROC1) and adequate occlusion (RROC1 and RROC2). Primary Safety outcomes were defined as procedure-related morbidity, rate of re-bleeding and rate of re-treatment. RESULTS Seventy-nine aneurysms were treated during the five-year period. Adequate aneurysm occlusion (RROC1 and RROC2) achieved was 81%. Retreatment was required in 18% of patients (14/79). Greater retreatment rate was demonstrated in partially thrombosed aneurysms, aneurysms with larger neck and dome diameter and dome heights. CONCLUSION Woven Endobridge treatment of wide-neck intracranial aneurysms offers a safe and efficacious outcome. This large UK single-centre experience demonstrates congruity with recent five-year outcomes of WEBCAST and WEBCAST2 trials.
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Affiliation(s)
- Saad Moughal
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Fathallah Ismail Islim
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | | | - Nayyar Saleem
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Tony Goddard
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Tufail Patankar
- Department of Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Rathore SS, Wint ZS, Goyal A, Jeswani BM, Farrukh AM, Nieto-Salazar MA, Thugu TR, Erva S, Mehmood R, Toro-Velandia AC, Aneis H, Ratnani S, Al Shyyab IMY. Prevalence and outcomes of upper gastrointestinal bleeding in COVID-19: A systematic review and meta-analysis. Rev Med Virol 2024; 34:e2509. [PMID: 38282392 DOI: 10.1002/rmv.2509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/02/2023] [Accepted: 12/17/2023] [Indexed: 01/30/2024]
Abstract
Upper gastrointestinal bleeding (UGIB) in COVID-19 presents challenges in patient management. Existing studies lack comprehensive review due to varied designs, samples, and demographics. A meta-analysis can provide valuable insights into the incidence, features, and outcomes of UGIB in COVID-19. A comprehensive literature search was carried out using several databases. We considered all appropriate observational studies from all over the world. Mantel-Haenszel odds ratios and associated 95% confidence intervals (CIs) were produced to report the overall effect size using random effect models. Besides, Random effects models were used to calculate the overall pooled prevalence. Funnel plots, Egger regression tests, and Begg-Mazumdar's rank correlation test were used to appraise publication bias. Data from 21 articles consisting of 26,933 COVID-19 patients were considered. The pooled estimate of UGIB prevalence in patients admitted with COVID-19 across studies was 2.10% (95% CI, 1.23-3.13). Similarly, the overall pooled estimate for severity, mortality, and rebleeding in COVID-19 patients with UGIB was 55% (95% CI, 37.01-72.68), 29% (95% CI, 19.26-40.20) and 12.7% (95% CI, 7.88-18.42) respectively. Further, UGIB in COVID-19 patients was associated with increased odds of severity (OR = 3.52, 95% CI 1.80-6.88, P = 0.001) and mortality (OR = 2.16, 95% CI 1.33-3.51, P = 0.002) compared with patients without UGIB. No significant publication bias was evident in the meta-analysis. The results of our study indicate that UGIB in individuals with COVID-19 is linked to negative outcomes such as severe illness, higher mortality rates, and an increased risk of re-bleeding. These findings highlight the significance of identifying UGIB as a significant complication in COVID-19 cases and emphasise the importance of timely clinical assessment and proper treatment.
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Affiliation(s)
| | - Zario Shai Wint
- All American Institute of Medical Sciences, Black River, Jamaica
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
| | | | | | | | | | - Snigdha Erva
- MNR Medical College and Hospital, Sangareddy, India
| | - Raafay Mehmood
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Hamam Aneis
- Department of Internal Medicine, UPMC, Mckeesport, Pennsylvania, USA
| | - Sunny Ratnani
- Saint James School of Medicine, The Quarter, Anguilla
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Iqbal Janjua F, Ahmad M, Javed S, Zia MQ, Abbas G, Aslam N, Farooq K, Shafqat MN. Endoscopic Therapy of Gastric Varices: Safety and Efficacy of N-Butyl-2-Cyanoacrylate Injection. Cureus 2023; 15:e49539. [PMID: 38156146 PMCID: PMC10753266 DOI: 10.7759/cureus.49539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Upper gastrointestinal bleeding (UGIB) is a common medical emergency that results in significant morbidity, mortality, and socioeconomic burden. Both types of cardio-fundal varices, gastro-esophageal varix 2 (GOV2) and isolated gastric varices type 1 (IGV1), can cause massive bleeding and often are difficult to treat compared to the other types of gastric varices. Endoscopic variceal band ligation (EVBL) is a less effective treatment modality for gastric varices than esophageal varices and is associated with high re-bleeding rates. N-butyl-2-cyanoacrylate (Histoacryl) injection is an effective and potential treatment option for fundal varices. This study aims to evaluate the safety and efficacy of n-butyl-2-cyanoacrylate injection therapy in cardio-fundal varices. Objective To assess the efficacy and safety of n-butyl-2-cyanoacrylate injection therapy for fundal varices. Methods This retrospective observational cohort study was conducted at the Department of Gastroenterology, Allied Teaching Hospital, Gujranwala, over one year. All patients, irrespective of age and gender, presenting with UGIB and in whom fundal varices were diagnosed on gastroscopy followed by n-butyl 2-cyanoacrylate injection therapy were included in this study. The efficacy and safety of Histoacryl therapy were assessed by analyzing successful hemostasis, frequency of re-bleeding, obliteration, and regression of fundal varices on repeat endoscopy. Adverse events such as re-bleeding and mortality related to fundal variceal treatment were documented. Results A total of 60 patients were included in the study. Of these, 70% had IGV1, while the remaining 30% had GOV2. Hemostasis was achieved in 100% of patients following n-butyl-2-cyanoacrylate injection. Successful obliteration with regression of varices was observed in 91.3% of patients. Various adverse events were observed, with abdominal pain being the most common observed complication in 18.3% of participants. However, only 8.3% of participants developed re-bleeding due to ulcer formation at the injection site, and no death occurred directly due to fundal variceal treatment. Conclusion N-butyl-2-cyanoacrylate injection therapy is a lifesaving, effective, and safe intervention for controlling bleeding from cardio-fundal varices, leading to improved health status and a consequent decrease in episodes of recurrent bleeding. Its side effects are few and infrequent. However, larger-scale studies are needed to further evaluate the safety and effectiveness of n-butyl-2-cyanoacrylate injection therapy. These studies will be crucial in establishing comprehensive guidelines for the management of fundal varices.
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Affiliation(s)
- Fawad Iqbal Janjua
- Department of Gastroenterology and Hepatology, Allied Teaching Hospital, Gujranwala, Gujranwala, PAK
| | - Mahmood Ahmad
- Department of Gastroenterology and Hepatology, Amna Inayat Medical College, Lahore, PAK
| | - Salman Javed
- Department of Gastroenterology and Hepatology, Services Institute of Medical Sciences, Lahore, PAK
| | - Muhammad Qasim Zia
- Department of Gastroenterology and Hepatology, Khawaja Muhammad Safdar Medical College, Sialkot, PAK
| | - Ghulam Abbas
- Department of Gastroenterology and Hepatology, Allama Iqbal Medical College, Lahore, PAK
| | - Naveed Aslam
- Department of Gastroenterology and Hepatology, Allied Teaching Hospital, Gujranwala, Gujranwala, PAK
| | - Kamran Farooq
- Department of Gastroenterology and Hepatology, Sheikh Khalifa Medical City, Abu Dhabi, ARE
| | - Muhammad Nabeel Shafqat
- Department of Gastroenterology and Hepatology, Allied Teaching Hospital, Gujranwala, Gujranwala, PAK
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Matsuhashi T, Fukuda S, Abe Y, Mikami T, Tatsuta T, Hikichi T, Nakamura J, Onozato Y, Hatta W, Masamune A, Ohyauchi M, Ito H, Hanabata N, Araki Y, Yanagita T, Imamura H, Tsuji T, Sugawara K, Horikawa Y, Ohara S, Kondo Y, Dohmen T, Iijima K. Nature and treatment outcomes of bleeding post-bulbar duodenal ulcers. Dig Endosc 2022; 34:984-993. [PMID: 34609030 DOI: 10.1111/den.14160] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although post-bulbar duodenal ulcers (PBDUs) could become a source of upper gastrointestinal bleeding, the whole picture of the disease is unknown. We compared the characteristic features and treatment outcomes after endoscopic hemostasis between PBDUs and bulbar duodenal ulcers (BDUs). METHODS Data on duodenal ulcers with evidence of endoscopically-active bleeding were extracted from the data that were retrospectively collected from 12 institutes in Japan between 2011 and 2018. Rebleeding and in-hospital mortality were compared between patients with PBDUs and those with BDUs by logistic regression analyses. RESULTS Among 468 consecutive patients with bleeding duodenal ulcers, 96 (20.5%) had endoscopically-confirmed PBDUs. PBDUs were more frequently observed in patients with a poor general condition in comparison to BDUs. The rates of rebleeding and in-hospital mortality in patients with PBDUs were approximately three times higher than those in patients with BDUs (PBDU vs. BDU: 29.2% vs. 10.2% [P < 0.0001] and 14.6% vs. 5.1% [P = 0.0029], respectively). Although the high in-hospital mortality in PBDUs could be explained, to a lesser extent, by the likelihood of rebleeding, and, to a greater extent, by the patients' poor general condition, the presence of a PBDU itself was largely responsible for the high rebleeding rates in PBDUs. CONCLUSION This is the first study focusing on the nature and treatment outcomes of bleeding PBDUs. PBDUs were associated with much higher rebleeding and mortality rates in comparison to BDUs, and the likelihood of rebleeding may be derived from their unique anatomic location.
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Affiliation(s)
- Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Sho Fukuda
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yasuhiko Abe
- Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan
| | - Tetsuya Tatsuta
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yusuke Onozato
- Department of Gastroenterology, Faculty of Medicine, Yamagata University Hospital, Yamagata, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Motoki Ohyauchi
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Hirotaka Ito
- Department of Gastroenterology, Osaki Citizen Hospital, Miyagi, Japan
| | - Norihiro Hanabata
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Yasumitsu Araki
- Department of Gastroenterology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Takumi Yanagita
- Department of Gastroenterology, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Hidemichi Imamura
- Department of Gastroenterology, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Tsuyotoshi Tsuji
- Department of Gastroenterology, Akita City Hospital, Akita, Japan
| | - Kae Sugawara
- Department of Gastroenterology, Akita City Hospital, Akita, Japan
| | - Youhei Horikawa
- Department of Gastroenterology, Hiraka General Hospital, Akita, Japan
| | - Shuichi Ohara
- Department of Gastroenterology, Tohoku Rosai Hospital, Miyagi, Japan
| | - Yutaka Kondo
- Department of Gastroenterology, Tohoku Rosai Hospital, Miyagi, Japan
| | - Takahiro Dohmen
- Department of Gastroenterology, Yuri Kumiai General Hospital, Akita, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
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Uysal E, Ayhan Acar Y. Features of patients with upper gastrointestinal bleeding and factors affecting the re-bleeding risk. ULUS TRAVMA ACIL CER 2022; 28:147-154. [PMID: 35099025 PMCID: PMC10443140 DOI: 10.14744/tjtes.2021.00670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The risk of re-bleeding in upper gastrointestinal bleeding (UGIB) is a major complication that can be mortal. In this study, we aimed to determine the factors that can predict the risk of re-bleeding in UGIB patients. METHODS We retrospectively screened UGIB patients admitted in adult intensive care. Along with age and gender, complaints of admission, vital signs, comorbidities, laboratory findings, medications, endoscopy status, and re-bleeding status were recorded. According to these findings, Glasgow-Blatchford and AIMS65 scores of the patients were calculated. All statistical tests were performed with the Predictive Analytics Software (PASW®, version 18, SPSS Inc., Chicago, IL). RESULTS A total of 241 patients were included in the study. Mean age of patients was 57.58±19.31, years and 176 (73.0%) of them were male. A total of 117 (48.5%) patients were Helicobacter pylori positive and re-bleeding occurred in 77 (32.0%) patients. Sclerotherapy was applied in 103 (42.7%) patients, while 5 (2.1%) underwent electrocoagulation, and 4 (1.7%) underwent hemoclips. There was a significant difference between patients with and without endoscopic intervention for re-bleeding (p<0.001). Hematocrit, urea values, Glasgow-Blatchford, and AIMS65 scores were statistically significant different between the groups with and without re-bleeding (p=<0.001, <0.001, <0.001, and 0.008, respectively). In the ROC analysis of Glasgow-Blatchford and AIMS65 scoring systems area, under the curve values were 0.700 (p=<0.001, 95% CI: 0.626-0.775), and 0.557 (p=0.194, CI 95%: 0.469-0.645), respectively. Mortality rate was 2.1% (n=5) among study population. CONCLUSION Hematocrit and urea values seem beneficial among studied laboratory values, however, Glasgow-Blatchford scoring system performed better than AIMS65 in the prediction of re-bleeding risk in UGIB. The authors concluded that more specific predictive markers may be useful for clinicians.
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Affiliation(s)
- Emin Uysal
- Department of Emergency Medicine, University of Health Sciences, Bağcılar Training and Research Hospital, İstanbul-Turkey
| | - Yahya Ayhan Acar
- Department of Emergency Medicine, University of Health Sciences Gulhane Faculty of Medicine, Ankara-Turkey
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Hashash JG, Aoun R, El-Majzoub N, Khamis A, Rockey D, Akl EA, Barada K. Resuming aspirin in patients with non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34:344-353. [PMID: 33948059 PMCID: PMC8079865 DOI: 10.20524/aog.2021.0617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background Our primary and secondary aims were to analyze the evidence surrounding mortality and re-bleeding risks in patients on aspirin with non-variceal upper gastrointestinal bleeding (NVUGIB) as a function of whether or not aspirin was resumed after the bleeding episode, and to determine whether aspirin intake upon admission affected the outcomes. Methods A search for randomized controlled trials (RCTs) and prospective observational studies was performed. Data extraction and risk of bias assessment were done. Generic inverse variance and random-effects model were employed. Heterogeneity across studies was assessed using the I2 test. Certainty of evidence was assessed using the GRADE approach for each comparison and outcome, and an evidence profile was created. Results Evidence from 1 RCT and 4 observational studies suggests that early aspirin resumption reduced mortality (hazard ratio [HR] 0.20, 95% confidence interval [CI] 0.06-0.63) while increasing re-bleeding risk (HR 1.90, 95%CI 0.60-6.00); moderate certainty of evidence. The observational evidence was inconsistent for both mortality (HR 0.84, 95%CI 0.54-1.33) and re-bleeding (HR 0.85, 95%CI 0.47-1.55); very low certainty of evidence. Nine observational studies addressed our secondary aim: 6 provided inconsistent results regarding mortality (pooled odds ratio [OR] 1.1, 95%CI 0.80-1.50) and 4 provided inconsistent results regarding re-bleeding risk (pooled OR 0.92, 95%CI 0.53-1.59); very low certainty of evidence for both outcomes. Conclusion Evidence supporting a protective effect of aspirin resumption soon after NVUGIB is of low-to-moderate certainty, and is not informative as to the optimal timing of aspirin resumption.
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Affiliation(s)
- Jana G Hashash
- Division of Gastroenterology, American University of Beirut, Riad El Solh, Beirut, Lebanon (Jana G. Hashash, Roni Aoun, Kassem Barada)
| | - Roni Aoun
- Division of Gastroenterology, American University of Beirut, Riad El Solh, Beirut, Lebanon (Jana G. Hashash, Roni Aoun, Kassem Barada)
| | - Nadim El-Majzoub
- American University of Beirut, Riad El Solh, Beirut, Lebanon (Nadim El-Majzoub)
| | - Assem Khamis
- Clinical Research Institute, American University of Beirut, Riad El Solh, Beirut, Lebanon (Assem Khamis, Elie A. Akl)
| | - Don Rockey
- Division of Gastroenterology, Medical University of South Carolina, USA (Don Rockey)
| | - Elie A Akl
- Clinical Research Institute, American University of Beirut, Riad El Solh, Beirut, Lebanon (Assem Khamis, Elie A. Akl)
| | - Kassem Barada
- Division of Gastroenterology, American University of Beirut, Riad El Solh, Beirut, Lebanon (Jana G. Hashash, Roni Aoun, Kassem Barada)
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Abstract
OBJECTIVE To determine the incidence of diverticular bleeding (DB) and examine the time trend of the incidence. Furthermore to study prognosis with regard to therapy and rebleeding. METHODS A retrospective, population-based study of patients with DB in a National University Hospital from 2006 to 2016. Patients were identified in an electronically stored colonoscopy database. Definite diverticular bleeding was defined as active bleeding, a nonbleeding visible vessel or adherent clot. Presumptive diverticular bleeding was defined as acute painless rectal bleeding leading to hospitalization with visible diverticula but no evidence of bleeding and no other colonic lesions or bleeding sites identified on endoscopy. A 30-day re-bleeding was determined after discharge. RESULTS A total of 3683 colonoscopy reports were reviewed, including 345 patients (males 51%) with presumptive 95% (n = 327) or definitive 5% (n = 18) diverticular bleeding. Overall 96% were treated conservatively, 3% endoscopically and 0.3% surgically. Only 5.8% of patients had a 30-day rebleed. After exclusion, 315 patients were included in the incidence calculations. The mean cumulative incidence of diverticular bleeding was 14/100,000 inhabitants per year. A time trend analysis of the incidence of DB revealed no significant change in incidence during the study period. CONCLUSIONS The mean incidence of colonic diverticular bleeding was found to be approximately 14 cases per 100,000 inhabitants and year. The incidence does not seem to have changed in the past decade. The vast majority of patients with diverticular bleeding did not require endoscopic therapy and could be managed with conservative treatment.
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Affiliation(s)
- G D Olafsson
- a Faculty of Medicine , University of Iceland , Reykjavik , Iceland
| | - J P Hreinsson
- b Division of Gastroenterology and Hepatology, Department of Internal Medicine , The National University Hospital of Iceland , Reykjavik , Iceland
| | - E S Björnsson
- a Faculty of Medicine , University of Iceland , Reykjavik , Iceland.,b Division of Gastroenterology and Hepatology, Department of Internal Medicine , The National University Hospital of Iceland , Reykjavik , Iceland
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Li Y, Guo X, Bai Z, Shao X, Wang R, Li H, Qi X. Banana may be forbidden after endoscopic variceal ligation: a case report. Transl Gastroenterol Hepatol 2019; 4:13. [PMID: 30976716 PMCID: PMC6414354 DOI: 10.21037/tgh.2019.01.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/27/2019] [Indexed: 02/05/2023] Open
Abstract
Acute variceal hemorrhage (AVH) is a devastating complication of liver cirrhosis. Endoscopic variceal ligation (EVL) is a useful endoscopic treatment for AVH with few complications. However, the issue regarding management of early re-bleeding after EVL still needs to be concerned. Furthermore, the dietary principle after EVL is unclear. There is no consensus regarding what food should be eaten after EVL. In this paper, we reported a patient who ate a banana after an EVL and then developed early re-bleeding episodes.
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Affiliation(s)
- Yingying Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
- Postgraduate College, Jinzhou Medical University, Jinzhou 121001, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
| | - Zhaohui Bai
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110840, China
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
| | - Ran Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), Shenyang 110840, China
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Rosenqvist K, Sheikhi R, Nyman R, Rorsman F, Sangfelt P, Ebeling Barbier C. Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population. Scand J Gastroenterol 2018; 53:70-75. [PMID: 28990812 DOI: 10.1080/00365521.2017.1386795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting. MATERIALS AND METHODS Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016. RESULTS Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE. CONCLUSIONS TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.
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Affiliation(s)
- K Rosenqvist
- a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden
| | - R Sheikhi
- b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden
| | - R Nyman
- a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden
| | - F Rorsman
- b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden
| | - P Sangfelt
- b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden
| | - C Ebeling Barbier
- a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden
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Lee SJ, Kim SU, Kim MD, Kim YH, Kim GM, Park SI, Won JY, Lee DY, Lee KH. Comparison of treatment outcomes between balloon-occluded retrograde transvenous obliteration and transjugular intrahepatic portosystemic shunt for gastric variceal bleeding hemostasis. J Gastroenterol Hepatol 2017; 32:1487-1494. [PMID: 28085232 DOI: 10.1111/jgh.13729] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/29/2016] [Accepted: 01/04/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Both balloon-occluded retrograde transvenous obliteration (BRTO) and transjugular intrahepatic portosystemic shunt (TIPS) are considered effective treatments for gastric variceal bleeding (GVB). In this study, outcomes of these two procedures were compared in managing patients with GVB. METHODS A total of 142 patients undergoing BRTO (n = 95) or TIPS (n = 47) between 2005 and 2012 at two tertiary centers were selected for retrospective review. RESULTS Mean patient age (male, 115; female, 27) was 58.1 years. Alcoholic liver cirrhosis was the most common underlying cause (n = 63, 44.4%), followed by hepatitis B (n = 60, 42.3%) and hepatitis C (n = 7, 4.9%) viral infections. Concurrent hepatocellular carcinoma (HCC) was identified in 64 (45.1%) patients. During the follow-up period (mean, 28.2 months), 27 patients (19%) experienced re-bleeding. Cumulative re-bleeding rates after BRTO (8.6% at 1 year; 22.7% at 3 years) were significantly lower than those after TIPS (19.8% at 1 year; 48.2% at 3 years; P = 0.006, log-rank test). In multivariate analysis, TIPS (vs BRTO) was found independently predictive of re-bleeding (hazard ratio [HR] = 2.174; P = 0.048), in addition to concurrent HCC and poor baseline Child-Pugh score (both P < 0.05). Although BRTO surpassed TIPS (P = 0.026, log-rank test) in terms of overall postprocedural survival, independent factors predictive of poor overall survival after hemostasis were concurrent HCC (HR = 3.106), high Child-Pugh score (HR = 1.886 per 1-point increase), and postprocedural hepatic encephalopathy (HR = 3.014; all P < 0.05). CONCLUSION Balloon-occluded retrograde transvenous obliteration proved more effective than TIPS in hemostasis of GVB, associated with significantly less risk of re-bleeding.
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Affiliation(s)
- Shin Jae Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Man-Deuk Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hwan Kim
- Department of Radiology, Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Gyoung Min Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Il Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Yun Won
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yun Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hun Lee
- Department of Radiology, Gangam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Katsinelos P, Kountouras J, Chatzimavroudis G, Lazaraki G, Terzoudis S, Gatopoulou A, Mimidis K, Maris T, Paroutoglou G, Anastasiadou K, Georgakis N. Factors predicting a positive capsule endoscopy in past overt obscure gastrointestinal bleeding: a multicenter retrospective study. Hippokratia 2016; 20:127-132. [PMID: 28416909 PMCID: PMC5388513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Capsule endoscopy (CE) remains the examination of choice for the investigation of obscure gastrointestinal bleeding. Although the factors predicting positive CE findings in the overall obscure gastrointestinal bleeding have been investigated, the clinical characteristics that predict a positive CE in patients with past overt obscure gastrointestinal bleeding (OOGIB) have not been systematically studied. METHODS Between September 2004 and December 2013, 262 patients underwent CE for evaluation of past OOGIB after negative upper and lower endoscopy, and other diagnostic modalities. Patients' records were retrospectively reviewed to assess the factors that could possibly predict positive CE findings. RESULTS Two hundred and twenty four patients with a median age of 70 years (range: 17-87) were enrolled in the final analysis and were divided into two groups; those who had positive (group A: 118 patients) and those who had negative CE findings (group B: 106 patients). The overall diagnostic yield of CE was 52.68 %. Multivariate analysis demonstrated that age >65 years, anticoagulant use, antiplatelet use, and non-steroidal anti-inflammatory drugs use were independent predictive factors for positive findings on CE. Of the 118 patients with positive CE, therapeutic interventions were performed in 56 patients (47.46 %). Recurrence of bleeding presented in nine patients of group B compared with 39 patients of group A (p <0.001). CONCLUSIONS Certain clinical characteristics predict a positive CE in patients with past OOGIB. Patients with OOGIB and negative CE had a considerably lower rebleeding rate, and further invasive investigational procedures may be adjourned or may not be required, though such recommendation warrants further validation. Hippokratia 2016, 20(2): 127-132.
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Affiliation(s)
- P Katsinelos
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - J Kountouras
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - G Chatzimavroudis
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - G Lazaraki
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - S Terzoudis
- Department of Endoscopy and Motility Unit, G.Gennimatas General Hospital, Athens, Greece
| | - A Gatopoulou
- 2 Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, Greece
| | - K Mimidis
- 1 Department of Internal Medicine, University Hospital of Alexandroupoli, Democritus University of Thrace, Greece
| | - T Maris
- Department of Gastroenterology, G.Papanikolaou General Hospital, Thessaloniki, Greece
| | - G Paroutoglou
- Department of Gastroenterology, University Hospital of Thessaly, Larissa, Greece
| | - K Anastasiadou
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N Georgakis
- 2 Department of Internal Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Matsumura T, Arai M, Saito K, Okimoto K, Saito M, Minemura S, Oyamada A, Maruoka D, Nakagawa T, Watabe H, Katsuno T, Yokosuka O. Predictive factor of re-bleeding after negative capsule endoscopy for obscure gastrointestinal bleeding: over 1-year follow-up study. Dig Endosc 2014; 26:650-8. [PMID: 24628735 DOI: 10.1111/den.12257] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Capsule endoscopy (CE) is now widely accepted as a first-line diagnostic modality for obscure gastrointestinal bleeding (OGIB), with a high diagnostic yield compared to other modalities. However, even after negative CE examination, re-bleeding is often known to occur. The aim of the present study was to identify predictive factors of re-bleeding after negative CE, and to clarify the clinical utility of double-balloon enteroscopy (DBE) after negative CE for OGIB. METHODS Two hundred and sixty patients who underwent CE for OGIB between October 2007 and September 2012 were included, and followed up for at least 1 year after CE examination. Demographic and clinical parameters associated with re-bleeding after negative CE were investigated. RESULTS A total of 154 patients (59.2%) had negative findings. Thirteen of those patients (8.4%) had one or more re-bleeding episodes during the follow-up period. In comparing patients with and without re-bleeding, Cox hazard regression analysis revealed that advanced age was a predictive factor for re-bleeding after negative CE (hazard ratio 1.05 [1.01-1.10], P = 0.03). Subsequent DBE for reasons other than re-bleeding was carried out in 51 patients (33.1%). Mucosal lesions (ulcer or multiple erosions) were subsequently detected in seven patients (13.7%), and endoscopic therapies were carried out in two patients (3.9%). CONCLUSIONS In patients of advanced age, more extensive follow up is needed, even if the CE result is negative. In addition, DBE subsequent to negative CE may be useful to detect lesions that were overlooked on CE.
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Affiliation(s)
- Tomoaki Matsumura
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Abstract
AAUs should develop and review protocols and local guidelines for the multidisciplinary team management of upper GI bleeding, for example with respect to: Early and appropriate resuscitation. Use of the tools for assessing severity. Timing of endoscopy, including recognising low-risk patients who could be discharged for outpatient investigation. Postendoscopy drug treatment, including appropriate and limited use of iv PPIs and Helicobacter pylori eradication therapy. Follow up, including referral for repeat endoscopy and/or urea breath testing. Regular review and audit of local guidance of the management of UGIB should become an integral part of an acute trust's clinical governance programme.
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Affiliation(s)
- Lotte Dinesen
- Department of Gastroenterology, Chelsea and Westminster Hospital, London.
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Hockel K, Trabold R, Schöller K, Török E, Plesnila N. Impact of anesthesia on pathophysiology and mortality following subarachnoid hemorrhage in rats. Exp Transl Stroke Med 2012; 4:5. [PMID: 22414527 PMCID: PMC3338388 DOI: 10.1186/2040-7378-4-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/13/2012] [Indexed: 05/10/2023]
Abstract
BACKGROUND Anesthesia is indispensable for in vivo research but has the intrinsic potential to alter study results. The aim of the current study was to investigate the impact of three common anesthesia protocols on physiological parameters and outcome following the most common experimental model for subarachnoid hemorrhage (SAH), endovascular perforation. METHODS Sprague-Dawley rats (n = 38) were randomly assigned to (1) chloral hydrate, (2) isoflurane or (3) midazolam/medetomidine/fentanyl (MMF) anesthesia. Arterial blood gases, intracranial pressure (ICP), mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), and regional cerebral blood flow (rCBF) were monitored before and for 3 hours after SAH. Brain water content, mortality and rate of secondary bleeding were also evaluated. RESULTS Under baseline conditions isoflurane anesthesia resulted in deterioration of respiratory parameters (arterial pCO2 and pO2) and increased brain water content. After SAH, isoflurane and chloral hydrate were associated with reduced MAP, incomplete recovery of post-hemorrhagic rCBF (23 ± 13% and 87 ± 18% of baseline, respectively) and a high anesthesia-related mortality (17 and 50%, respectively). Anesthesia with MMF provided stable hemodynamics (MAP between 100-110 mmHg), high post-hemorrhagic rCBF values, and a high rate of re-bleedings (> 50%), a phenomenon often observed after SAH in humans. CONCLUSION Based on these findings we recommend anesthesia with MMF for the endovascular perforation model of SAH.
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Affiliation(s)
- Konstantin Hockel
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
| | - Raimund Trabold
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
- Department of Neurosurgery, Munich, Germany
| | - Karsten Schöller
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
- Department of Neurosurgery, Munich, Germany
| | - Elisabeth Török
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
| | - Nikolaus Plesnila
- Laboratory of Experimental Neurosurgery, Institute for Surgical Research, Munich, Germany
- Department of Neurosurgery, Munich, Germany
- Institute for Stroke and Dementia Research, University of Munich Medical Center - Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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