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Wang DX, Wu XJ, Yu JZ, Zhan JY, Xing FF, Liu W, Chen JM, Liu P, Liu CH, Mu YP. Visualizing global progress and challenges in esophagogastric variceal bleeding. World J Gastrointest Surg 2025; 17:102020. [PMID: 40291887 PMCID: PMC12019055 DOI: 10.4240/wjgs.v17.i4.102020] [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: 10/05/2024] [Revised: 01/20/2025] [Accepted: 02/13/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension, most commonly caused by cirrhosis of various etiologies. Although a considerable body of research has been conducted in this area, the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings, insufficient information, and a lack of systematic investigation. Bibliometric analysis can help clarify research trends, identify core topics, and reveal potential future directions. Therefore, this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field, with the expectation of providing new insights for both clinical practice and scientific research. AIM To evaluate research trends and advancements in esophagogastric variceal bleeding (EGVB) over the past twenty years. METHODS Relevant publications on EGVB were retrieved from the Web of Science Core Collection. VOSviewer, Pajek, CiteSpace, and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume, countries, institutions, journals, authors, keywords, and citation counts. RESULTS The analysis focused on original research articles and review papers. From 2004 to 2023, a total of 2097 records on EGVB were retrieved. The number of relevant publications has increased significantly over the past two decades, especially in China and the United States. The leading contributors in this field, in terms of countries, institutions, authors, and journals, were China, Assistance Publique-Hôpitaux de Paris, Bosch Jaime, and World Journal of Gastroenterology, respectively. Core keywords in this field include portal hypertension, management, liver cirrhosis, risk, prevention, and diagnosis. Future research directions may focus on optimizing diagnostic methods, personalized treatment, and multidisciplinary collaboration. CONCLUSION Using bibliometric methods, this study reveals the developmental trajectory and trends in research on EGVB, underscoring risk assessment and diagnostic optimization as the core areas of current focus. The study provides an innovative and systematic perspective for this field, indicating that future research could center on multidisciplinary collaboration, personalized treatment approaches, and the development of new diagnostic tools. Moreover, this work offers practical research directions for both the academic community and clinical practice, driving continued advancement in this domain.
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Affiliation(s)
- De-Xin Wang
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Xue-Jie Wu
- Heilongjiang University of Chinese Medicine, Harbin 150040, Heilongjiang Province, China
| | - Jin-Zhong Yu
- Department of Gastroenterology Endoscopy, Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine, Shanghai 201203, China
| | - Jun-Yi Zhan
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Fei-Fei Xing
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Wei Liu
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Jia-Mei Chen
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Ping Liu
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Cheng-Hai Liu
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
| | - Yong-Ping Mu
- Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
- Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai 201203, China
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Martyak M, Soult A, Britt LD. Diagnosis and management of gastrointestinal hemorrhage: What you need to know. J Trauma Acute Care Surg 2025:01586154-990000000-00961. [PMID: 40205645 DOI: 10.1097/ta.0000000000004599] [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: 04/11/2025]
Abstract
ABSTRACT Acute gastrointestinal (GI) hemorrhage is a common cause for hospital admission that requires prompt diagnosis and multidisciplinary management to optimize clinical outcomes. Acute gastrointestinal bleeding (GIB) includes both upper and lower GI tract sources with an extensive list of differential pathologies. This review provides a systematic approach to both upper and lower GIB management, emphasizing initial resuscitation, stabilization, diagnostic evaluation to identify the source, and treatment modalities. Endoscopy remains the cornerstone for diagnostic and interventional purposes, significantly reducing the need for surgical procedures. However, lower GIB and severe or refractory cases may necessitate additional imaging and interventions, including surgical management. Integrating clinical guidelines, evidence-based strategies, and individualized care, this review delineates what you need to know to diagnose and manage acute GI hemorrhage. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Michael Martyak
- From the Surgery Department, Eastern Virginia Medical School, Old Dominion University, Norfolk, Virginia
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Yi K, Ma Y, Zhang P, He H, Lin Y, Sun D. Environmental and Clinical Factors Concerning Gastrointestinal Bleeding: An Umbrella Review of Meta-Analyses. J Am Med Dir Assoc 2025; 26:105412. [PMID: 39818418 DOI: 10.1016/j.jamda.2024.105412] [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: 07/25/2024] [Revised: 11/05/2024] [Accepted: 11/05/2024] [Indexed: 01/18/2025]
Abstract
OBJECTIVES Gastrointestinal bleeding, an emergency and critical disease, is affected by multiple factors. This study aims to systematically summarize and appraise various factors associated with gastrointestinal bleeding. DESIGN Umbrella review. SETTING AND PARTICIPANTS Meta-analyses that evaluated environmental and clinical factors concerning gastrointestinal bleeding. METHODS We conducted a systematic search to identify eligible meta-analyses. For each included study, the risk estimates, heterogeneity estimates, small-study effects, excess significance tests, and publication biases were recalculated and appraised. Furthermore, we considered the methodologic quality and classified the evidence. RESULTS In this study, 51 beneficial and 44 harmful associations were found. This study found that preemptive transjugular intrahepatic portosystemic shunt was the most reliable treatment to reduce gastroesophageal variceal bleeding and mortality risk, followed by antibiotics. For gastroduodenal ulcer bleeding, Yunnan Baiyao and proton pump inhibitors (PPIs) were relatively dependable treatment drugs, and the comparatively reliable prophylactic drugs comprised PPIs and H2-receptor antagonists. Patients with hemodynamic instability and larger ulcers had a higher risk of rebleeding. Both weekend admissions and the combination of selective serotonin reuptake inhibitors and nonsteroidal anti-inflammatory drugs were high-risk factors for upper gastrointestinal bleeding and mortality. We also found that tranexamic acid was a credible drug for overall gastrointestinal bleeding. Meanwhile, aspirin, warfarin, diabetes, and renal failure were all high-risk factors. CONCLUSIONS AND IMPLICATIONS Altogether, many factors can substantially influence gastrointestinal bleeding. Therefore, in daily life and clinical practice, we should not only remain cautious in prescribing and taking some drugs but also pay attention to the management of lifestyle and underlying diseases. If necessary, protective drugs should be properly supplemented.
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Affiliation(s)
- Keqian Yi
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Yu Ma
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Pengcheng Zhang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
| | - Haiyu He
- Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China.
| | - Yueying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China.
| | - Dali Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, China
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Ni Y, Ali K, Tang P, Hayat K, Cheng Z, Xu B, Qin Z, Zhang W. Over-the-scope clips for Nonvariceal upper gastrointestinal bleeding: a systematic review and meta-analysis of randomized studies. Postgrad Med J 2025; 101:351-359. [PMID: 39500365 DOI: 10.1093/postmj/qgae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Indexed: 03/18/2025]
Abstract
BACKGROUND & AIMS Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common and potentially life-threatening condition. Over-the-scope clips (OTSCs) have emerged as a promising endoscopic treatment option for NVUGIB. We aimed to analyze the efficacy and safety of OTSCs compared to standard endoscopic treatments (ST) in patients with NVUGIB. METHODS We conducted a comprehensive search of PubMed, Embase, Scopus, and Cochrane Library databases from inception to June 2024 for randomized controlled trials (RCTs) comparing OTSCs with ST for NVUGIB. The primary outcomes were initial hemostasis and persistent bleeding. Secondary outcomes included rebleeding rates, mortality, hospital stays and others. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random/fixed-effects models. RESULTS Six RCTs involving 621 patients were included in the meta-analysis. OTSCs demonstrated significantly higher initial hemostasis (OR 4.80, 95% CI 1.78-12.96; P = 0.002) and lower persistent bleeding rates (OR 0.17, 95% CI 0.05-0.56; P = 0.003) compared to ST group. The rebleeding rate was significantly lower in the OTSC group 7-days re-bleeding (OR 0.27, 95% CI 0.14-0.53; P = 0.001); 30-days rebleeding (OR 0.40, 95%CI 0.22, 0.70; P = 0.002). No significant differences were observed in mortality (OR 0.65, 95% CI 0.31-1.33; P = 0.38) and hospital stay (mean difference 0.79 days 95%CI -0.57, 2.15) between the two groups. CONCLUSIONS OTSCs are more effective than ST for achieving hemostasis and preventing rebleeding in patients with NVUGIB, without increasing mortality. Key message What is Already Known Previous studies have shown that nonvariceal upper gastrointestinal bleeding (NVUGIB) is a serious medical condition that needs effective endoscopic interventions. The success rates of standard treatments for achieving hemostasis and preventing rebleeding are not consistent. What This Study Adds According to this study, over-the-scope clips (OTSCs) have the same mortality rate as standard endoscopic treatments, but they significantly improve initial hemostasis and lower rebleeding rates. Impact on Research, Practice, or Policy The findings support the use of OTSCs as a preferred intervention for NVUGIB, which could affect clinical guidelines and encourage additional research focused on improving endoscopic techniques and patient outcomes in the management of gastrointestinal bleeding.
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Affiliation(s)
- Yuanzhi Ni
- Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Dongxin Road. No. 848, Gongshu District, 310000, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, Yuhangtang Road. No. 866, Xihu District, 310000, Hangzhou, Zhejiang, China
| | - Kamran Ali
- Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, 322000, No. 1, Shangcheng Avenue, Yiwu, Zhejiang, China
| | - Penghao Tang
- The Second Affiliated Hospital of Zhejiang Chinese Medical University, Chaowang Road, No. 318, Gongshu District, 310000, Hangzhou, Zhejiang, China
| | - Khizar Hayat
- Department of Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, 322000, No. 1, Shangcheng Avenue, Yiwu, Zhejiang, China
| | - Zhiwen Cheng
- Zhejiang University School of Medicine, Hangzhou, Yuhangtang Road. No. 866, Xihu District, 310000, Hangzhou, Zhejiang, China
| | - Benfeng Xu
- Graduate School of Zhejiang Chinese Medical University, Bingwen Road, No. 548, Bingjiang District, 310000 Hangzhou, Zhejiang, China
| | - Zhiwen Qin
- Graduate School of Zhejiang Chinese Medical University, Bingwen Road, No. 548, Bingjiang District, 310000 Hangzhou, Zhejiang, China
| | - Wu Zhang
- Department of Hepatobiliary Pancreatic Surgery, Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University, Shulan International Medical College, Dongxin Road. No. 848, Gongshu District, 310000, Hangzhou, Zhejiang, China
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Xie W, Yin Q, Fang H, Yang KY, Xue HB, Zheng H, Li P. Diagnosis of nasopharyngeal disease during upper GI endoscopy. Gut 2025:gutjnl-2024-334528. [PMID: 40015950 DOI: 10.1136/gutjnl-2024-334528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 02/09/2025] [Indexed: 03/01/2025]
Affiliation(s)
- Wei Xie
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qian Yin
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hong Fang
- Department of Otorhinolaryngology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kai-Yan Yang
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hai-Bo Xue
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huimin Zheng
- Central Laboratory of the Medical Research Center, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Pan Li
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, Sydney, New South Wales, Australia
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Miao Y, Gu A, Yu G, Tang B. Technological integration in timing of endoscopy: Predictive modeling for acute upper gastrointestinal bleeding outcomes. Technol Health Care 2025:9287329251316050. [PMID: 40007413 DOI: 10.1177/09287329251316050] [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: 02/27/2025]
Abstract
BACKGROUND Technological advancements have revolutionized the management of acute upper gastrointestinal bleeding (AUGIB). However, the impact of endoscopic timing on treatment outcomes remains a critical area of exploration. OBJECTIVE This study evaluated the role of endoscopic timing in improving treatment outcomes for AUGIB and introduces a predictive model incorporating clinical and technological insights. METHODS A retrospective analysis of AUGIB patients treated between December 2020 and December 2023 was conducted. Logistic regression identified significant predictors of outcomes, and receiver operating characteristic (ROC) analysis evaluated their predictive value. A predictive model was developed based on these findings. RESULTS Among 145 patients, 35 (24.1%) experienced rebleeding. Key predictors included endoscopic timing, active bleeding, shock on admission, and bleeding volume (p < 0.05). The predictive model demonstrated robust performance (C-index: 0.885, 95% CI: 0.810-0.956), emphasizing the clinical relevance of precise timing in endoscopic intervention. CONCLUSION This study underscores the importance of integrating technology with clinical practice to optimize endoscopic timing and improve AUGIB outcomes. The predictive model offers a valuable tool for risk stratification and clinical decision-making in modern healthcare settings.
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Affiliation(s)
- Yangde Miao
- Department of Gastroenterology, Taizhou Municipal Hospital of Zhejiang Province, Taizhou, China
| | - Ajun Gu
- Department of Gastroenterology, Taizhou Municipal Hospital of Zhejiang Province, Taizhou, China
| | - Guang Yu
- Department of Gastroenterology, Taizhou Municipal Hospital of Zhejiang Province, Taizhou, China
| | - Binbin Tang
- Department of Gastroenterology, Taizhou Municipal Hospital of Zhejiang Province, Taizhou, China
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Liu A, Huang Z, Cui S, Xiao Y, Guo X, Pan G, Song L, Deng J, Xu T, Fan Y, Wang R. Ionically assembled hemostatic powders with rapid self-gelation, strong acid resistance, and on-demand removability for upper gastrointestinal bleeding. MATERIALS HORIZONS 2024; 11:5983-5996. [PMID: 39422136 DOI: 10.1039/d4mh00837e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Upper gastrointestinal bleeding (UGIB) is bleeding in the upper part of the gastrointestinal tract with an acidic and dynamic environment that limits the application of conventional hemostatic materials. This study focuses on the development of N-[(2-hydroxy-3-trimethylammonium) propyl] chitosan chloride/phytic acid (HTCC/PA, HP) powders with fast hemostatic capability and strong acid resistance, for potential applications in managing UGIB. Upon contact with liquids within 5 seconds, HP powders rapidly transform into hydrogels, forming ionic networks through electrostatic interactions. The ionic crosslinking process facilitates the HP powders with high blood absorption (3.4 times of self-weight), sufficient tissue adhesion (5.2 and 6.1 kPa on porcine skin and stomach, respectively), and hemostasis (within 15 seconds for in vitro clotting). Interestingly, the PA imparts the HP powders with strong acid resistance (69.8% mass remaining after 10 days of incubation at pH 1) and on-demand removable sealing while HTCC contributes to fast hemostasis and good wet adhesion. Moreover, the HP powders show good biocompatibility and promote wound healing. Therefore, these characteristics highlight the promising clinical potential of HP powders for effectively managing UGIB.
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Affiliation(s)
- Ashuang Liu
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, 325035, P. R. China
| | - Zhimao Huang
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
| | - Shengyong Cui
- Department of Burn Surgery, Ningbo No. 2 Hospital, Ningbo, 315010, P. R. China
| | - Ying Xiao
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
| | - Xiangshu Guo
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
| | - Gaoke Pan
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
| | - Lei Song
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
| | - Junjie Deng
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, 325035, P. R. China
| | - Ting Xu
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
| | - Youfen Fan
- Department of Burn Surgery, Ningbo No. 2 Hospital, Ningbo, 315010, P. R. China
| | - Rong Wang
- Laboratory of Advanced Theranostic Materials and Technology, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, P. R. China.
- Zhejiang International Scientific and Technological Cooperative Base of Biomedical Materials and Technology, Ningbo Cixi Institute of Biomedical Engineering, Ningbo, 315300, P. R. China
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Li W, Shao M, Hu S, Xie S, He B. The diagnostic value of endoscopic ultrasound for esophageal subepithelial lesions: A review. Medicine (Baltimore) 2024; 103:e40419. [PMID: 39560558 PMCID: PMC11576025 DOI: 10.1097/md.0000000000040419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 10/18/2024] [Indexed: 11/20/2024] Open
Abstract
Esophageal subepithelial lesions (ESELs) encompass a variety of diseases, including leiomyoma, granular cell tumors, hemangioma, lipoma, stromal tumors, leiomyosarcoma, schwannoma, neuroendocrine tumors and more. These lesions often present asymptomatically, leading to a generally low clinical diagnosis rate. Common imaging techniques for diagnosing ESELs include conventional endoscopy, spiral computed tomography, and endoscopic ultrasound (EUS). Among these, EUS is currently regarded as one of the most accurate methods for diagnosing ESELs. In recent years, EUS has increasingly been combined with advanced technologies such as artificial intelligence, submucosal saline injection, high-frequency impedance measurement, and enhanced imaging to improve diagnostic accuracy and reduce missed diagnoses. This article reviews the application and recent advancements of EUS in diagnosing esophageal submucosal lesions.
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Affiliation(s)
- Wanwen Li
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mengqi Shao
- Department of Thoracic Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shichen Hu
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shenglong Xie
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bin He
- Department of Thoracic Surgery, Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Pacheco MO, Gerzenshtein IK, Stoppel WL, Rinaldi-Ramos CM. Advances in Vascular Diagnostics using Magnetic Particle Imaging (MPI) for Blood Circulation Assessment. Adv Healthc Mater 2024; 13:e2400612. [PMID: 38879782 PMCID: PMC11442126 DOI: 10.1002/adhm.202400612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/11/2024] [Indexed: 06/29/2024]
Abstract
Rapid and accurate assessment of conditions characterized by altered blood flow, cardiac blood pooling, or internal bleeding is crucial for diagnosing and treating various clinical conditions. While widely used imaging modalities such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound offer unique diagnostic advantages, they fall short for specific indications due to limited penetration depth and prolonged acquisition times. Magnetic particle imaging (MPI), an emerging tracer-based technique, holds promise for blood circulation assessments, potentially overcoming existing limitations with reduction in background signals and high temporal and spatial resolution, below the millimeter scale. Successful imaging of blood pooling and impaired flow necessitates tracers with diverse circulation half-lives optimized for MPI signal generation. Recent MPI tracers show potential in imaging cardiovascular complications, vascular perforations, ischemia, and stroke. The impressive temporal resolution and penetration depth also position MPI as an excellent modality for real-time vessel perfusion imaging via functional MPI (fMPI). This review summarizes advancements in optimized MPI tracers for imaging blood circulation and analyzes the current state of pre-clinical applications. This work discusses perspectives on standardization required to transition MPI from a research endeavor to clinical implementation and explore additional clinical indications that may benefit from the unique capabilities of MPI.
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Affiliation(s)
| | | | - Whitney L Stoppel
- Chemical Engineering, University of Florida, Gainesville FL
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville FL
| | - Carlos M Rinaldi-Ramos
- Chemical Engineering, University of Florida, Gainesville FL
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville FL
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Maity R, Dhali A, Biswas J. Importance of risk assessment, endoscopic hemostasis, and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding. World J Clin Cases 2024; 12:5462-5467. [PMID: 39188600 PMCID: PMC11269988 DOI: 10.12998/wjcc.v12.i24.5462] [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: 03/10/2024] [Revised: 04/20/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common medical emergency in clinical practice. While the incidence has significantly reduced, the mortality rates have not undergone a similar reduction in the last few decades, thus presenting a significant challenge. This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis. Since ANUVGIB predominantly affects the elderly population, the impact of comorbidities may be responsible for the poor outcomes. A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly. Early risk stratification plays a crucial role in deciding the line of management and predicting mortality. Emerging scoring systems such as the ABC (age, blood tests, co-morbidities) score show promise in predicting mortality and guiding clinical decisions. While conventional endoscopic therapies remain cornerstone approaches, novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives, particularly in cases refractory to traditional modalities. By integrating validated scoring systems and leveraging novel therapeutic modalities, clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB.
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Affiliation(s)
- Rick Maity
- General Medicine, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India
| | - Arkadeep Dhali
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, United Kingdom
- School of Medicine and Population Health, University of Sheffield, Sheffield S102HQ, United Kingdom
| | - Jyotirmoy Biswas
- General Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India
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Cacioppa LM, Floridi C, Bruno A, Rossini N, Valeri T, Borgheresi A, Inchingolo R, Cortese F, Novelli G, Felicioli A, Torresi M, Boscarato P, Ottaviani L, Giovagnoni A. Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings. World J Radiol 2024; 16:115-127. [PMID: 38845606 PMCID: PMC11151896 DOI: 10.4329/wjr.v16.i5.115] [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: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage. AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings. METHODS In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA. RESULTS Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02). CONCLUSION In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.
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Affiliation(s)
- Laura Maria Cacioppa
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Laura Maria Cacioppa and Chiara Floridi
| | - Chiara Floridi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
- Laura Maria Cacioppa and Chiara Floridi
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Nicolò Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Tommaso Valeri
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | - Francesco Cortese
- Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
| | | | - Alessandro Felicioli
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Mario Torresi
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Pietro Boscarato
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
| | - Letizia Ottaviani
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
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Wang Y, Wu Y, Wang J, Zhang H, Du L, Wang K, Duan H. Predictors of gastrointestinal bleeding in patients with acute coronary syndrome and the optimal duration of dual antiplatelet therapy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:15. [PMID: 38808215 PMCID: PMC11132419 DOI: 10.4103/jrms.jrms_452_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 05/30/2024]
Abstract
Background This study aims to estimate the risk factors of gastrointestinal (GI) bleeding in patients with acute coronary syndrome (ACS) and to evaluate the optimal duration of dual antiplatelet therapy (DAPT). Materials and Methods We enrolled 1266 patients with ACS in a telephone follow-up program to determine whether any of the patients were hospitalized for GI bleeding. We collected baseline data, laboratory tests, electrocardiograms, and echocardiography covering all ACS patients. Multivariable regression was performed to adjust for confounders and predictors of GI bleeding. At the same time, the optimal duration of DAPT for ACS patients was evaluated. Results A total of 1061 ACS patients were included in the study. After 13-68 months, 48 patients (4.5%) were hospitalized for GI bleeding. The risk of GI bleeding was significantly increased in patients treated with DAPT for more than 18 months (hazard ratio 12.792, 5.607-29.185, P < 0.01). Receiver Operating Characteristic curve showed that the duration of DAPT using a cutoff of 14.5 months resulted in a sensitivity of 66.7% and a specificity of 77%. Conclusion In patients with ACS, DAPT time are the main risk factors of GI bleeding. The optimal duration of DAPT is 14.5 months.
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Affiliation(s)
- Yanyu Wang
- Department of Cardiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yingle Wu
- Department of Cardiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Jingqiao Wang
- Henan Key Laboratory of Epigenetics, School of Basic Medical Sciences, Henan University of Science and Technology, Luoyang, China
| | - Hengliang Zhang
- Department of Cardiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Laijing Du
- Department of Cardiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Ke Wang
- Department of Cardiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Hongqiang Duan
- Department of Cardiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Lu T, Shen R, Xv M, Ye Q, Shen J. Successful endoscopic combined with endovascular haemostasis of a ruptured pseudoaneurysm of the duodenal bulb: A case report. J Int Med Res 2024; 52:3000605231222413. [PMID: 38179804 PMCID: PMC10771055 DOI: 10.1177/03000605231222413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
Pseudoaneurysms are uncommon but their rupture and bleeding can lead to serious complications and be fatal. We present here a case of a man in his late 70s who was transferred to our hospital with persistent gastrointestinal bleeding. One month prior to his admission, he had undergone surgery for a fracture to his left knee. Endoscopic examination found pulsating blood vessels on a duodenal ulcer, which suddenly ruptured and caused significant bleeding. Immediate endoscopic haemostasis was administered and the bleeding decreased. Considering the high rate of rebleeding that may occur with a pseudoaneurysm, the patient underwent interventional radiology that culminated in a diagnosis of a pseudoaneurysm originating from gastroduodenal artery (GDA); successful embolization was achieved. Tests showed that the patient had Helicobacter pylori infection. We hypothesised that the H. pylori infection had led to the occurrence of the duodenal bulb ulcer, and the patient's left knee fracture and surgery a month previously had contributed to this predisposition for a pseudoaneurysm.
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Affiliation(s)
- Ting Lu
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Ruiwei Shen
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Minhong Xv
- Department of Endoscopy Center, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Qunqun Ye
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
| | - Jianwei Shen
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo, ZheJiang Province, China
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Xu X, Tang C, Linghu E, Ding H. Guidelines for the Management of Esophagogastric Variceal Bleeding in Cirrhotic Portal Hypertension. J Clin Transl Hepatol 2023; 11:1565-1579. [PMID: 38161497 PMCID: PMC10752807 DOI: 10.14218/jcth.2023.00061] [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: 02/13/2023] [Revised: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 01/03/2024] Open
Abstract
To standardize the diagnosis, treatment, and management of esophagogastric variceal bleeding (EVB) in patients with cirrhotic portal hypertension, the Chinese Society of Hepatology, the Chinese Society of Gastroenterology, and the Chinese Society of Digestive Endoscopy of the Chinese Medical Association brought together relevant experts, reviewed the latest national and international progress in clinical research on EVB in cirrhotic portal hypertension, and followed evidence-based medicine to update the Guidelines on the Management of EVB in Cirrhotic Portal Hypertension. The guidelines provide recommendations for the diagnosis, treatment, and management of EVB in cirrhotic portal hypertension and with the aim to improve the level of clinical treatment of EVB in patients with cirrhotic portal hypertension.
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Affiliation(s)
- Xiaoyuan Xu
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Chengwei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China
| | - Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Digestive Endoscopy, Chinese Medical Association
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
- Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China
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Mohn F, Szwargulski P, Kaul MG, Graeser M, Mummert T, Krishnan KM, Knopp T, Adam G, Salamon J, Riedel C. Real-time multi-contrast magnetic particle imaging for the detection of gastrointestinal bleeding. Sci Rep 2023; 13:22976. [PMID: 38151569 PMCID: PMC10752888 DOI: 10.1038/s41598-023-50041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023] Open
Abstract
Gastrointestinal bleeding, as a potentially life-threatening condition, is typically diagnosed by radiation-based imaging modalities like computed tomography or more invasively catheter-based angiography. Endoscopy enables examination of the upper gastrointestinal tract and the colon but not of the entire small bowel. Magnetic Particle Imaging (MPI) enables non-invasive, volumetric imaging without ionizing radiation. The aim of this study was to evaluate the feasibility of detecting gastrointestinal bleeding by single- and multi-contrast MPI using human-sized organs. A 3D-printed small bowel phantom and porcine small bowel specimens were prepared with a defect within the bowel wall as the source of a bleeding. For multi-contrast MPI, the bowel lumen was filled with an intestinal tracer representing an orally administered tracer. MPI was performed to evaluate the fluid exchange between the vascular compartment of the bowel wall and the lumen while a blood pool tracer was applied. Leakage of the blood pool tracer was observed to the bowel lumen. Multi-contrast MPI enabled co-registration of both tracers at the same location within the bowel lumen indicating gastrointestinal bleeding. Single- and multi-contrast MPI are feasible to visualize gastrointestinal bleeding. Therefore, MPI might emerge as a useful tool for radiation-free detection of bleeding within the entire gastrointestinal tract.
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Affiliation(s)
- Fabian Mohn
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Patryk Szwargulski
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Michael G Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Matthias Graeser
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
- Fraunhofer Research Institution for Individualized and Cell-based Medical Engineering, IMTE, Lübeck, Germany
- Institute of Medical Engineering, University of Lübeck, Lübeck, Germany
| | - Tobias Mummert
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Kannan M Krishnan
- Department of Materials Science and Engineering, University of Washington, Seattle, USA
| | - Tobias Knopp
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Biomedical Imaging, Hamburg University of Technology, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Johannes Salamon
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Christoph Riedel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Zhou ZP, Zhu SY, Ren LL. Relationship between periulcer mucosal inflammatory status and recurrent bleeding after successful treatment of gastric ulcer bleeding and establishment of an early warning model. Shijie Huaren Xiaohua Zazhi 2023; 31:965-972. [DOI: 10.11569/wcjd.v31.i23.965] [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: 10/12/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Gastrointestinal bleeding tends to recur and may cause mortality, and there are multiple risk factors for gastroin-testinal bleeding. Therefore, comprehensive data is urgently needed in clinical practice to predict the adverse prognosis of peptic ulcer bleeding, in order to more accurately manage patients in a hierarchical manner.
AIM To analyze the relationship between periulcer mucosal inflammatory status and recurrent bleeding after successful treatment of gastric ulcer bleeding, and establish an early warning model based on this.
METHODS Three hundred and seven patients with gastric ulcer bleeding admitted to the Second People's Hospital of Lishui City from January 2020 to December 2022 were retrospectively selected. The situation and duration of gastric ulcer rebleeding after successful initial hemostasis were recorded. The differences in clinical indicators, inclu-ding periulcer mucosal inflammatory status, were compared between the recurrent bleeding group and the non-recurrent bleeding group, using a multifactor Cox regression model, to identify the factors that affect rebleeding and establish a nomogram model for predicting rebleeding.
RESULTS Kaplan-Meier curve analysis showed that there was a statistically significant difference in the occurrence of gastric ulcer rebleeding during the follow-up period between groups with different levels of periulcer mucosal inflammation (P < 0.05). Periulcer mucosal inflammatory status, use of non-steroidal anti-inflammatory drugs, alcohol consumption, ulcer size, Helicobacter pylori (H. pylori) infection, and Forrest grade were identified to be factors affecting the recurrence of bleeding after successful treatment of gastric ulcer bleeding (P < 0.05). Multifactor Cox regression analysis showed that periulcer mucosal inflammatory status, use of non-steroidal anti-inflammatory drugs, alcohol consumption, H. pylori infection, and Forrest grade were independent risk factors for recurrent bleeding after successful treatment of gastric ulcer bleeding (P < 0.05). The discriminability and calibration of the nomo-gram developed for the prediction of rebleeding risk were good.
CONCLUSION The more severe the periulcer mucosal inflammation, the higher the risk of rebleeding. The development of the predictive model for the recurrence of gastric ulcer bleeding after successful treatment based on periulcer mucosal inflammatory status can help clinicians identify high-risk patients early.
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Affiliation(s)
- Ze-Ping Zhou
- Department of Geriatrics, The Second People's Hospital of Lishui, Lishui 323000, Zhejiang Province, China
| | - Shu-Yuan Zhu
- Department of Gastroenterology, The Second People's Hospital of Lishui, Lishui 323000, Zhejiang Province, China
| | - Ling-Ling Ren
- Digestive Endoscopy Center, The Second People's Hospital of Lishui, Lishui 323000, Zhejiang Province, China
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Cheng J, Huang K, Mou JL, Lao YJ, Feng JH, Hu F, Lin ML, Maimaitiaishan T, Shang J, Lin J. Prognosis value of serum chloride on 1-year mortality in cirrhotic patients receiving transjugular intrahepatic portosystemic shunt. J Formos Med Assoc 2023; 122:911-921. [PMID: 36878767 DOI: 10.1016/j.jfma.2023.02.009] [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: 11/16/2022] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND AND PURPOSE Emerging researches have regarded serum chloride as a capable predictor of mortality in liver cirrhosis. We aim to investigate the clinical role of admission chloride in cirrhotic patients with esophagogastric varices receiving transjugular intrahepatic portosystemic shunt (TIPS), which is unclear. METHODS We retrospectively analyzed data of cirrhotic patients with esophagogastric varices undergoing TIPS in Zhongnan Hospital of Wuhan University. Mortality outcome was obtained by following up for 1-year after TIPS. Univariate and multivariate Cox regression were used to identify independent predictors of 1-year mortality post-TIPS. The receiver operating characteristic (ROC) curves were adopted to assess the predictive ability of the predictors. In addition, log-rank test and Kaplan-Meier (KM) analyses were employed to evaluate the prognostic value of predictors in the survival probability. RESULTS A total of 182 patients were included ultimately. Age, fever symptom, platelet-to lymphocyte-ratio (PLR), lymphocyte-to-monocyte ratio (LMR), total bilirubin, serum sodium, chloride, and Child-Pugh score were related to 1-year follow-up mortality. In multivariate Cox regression analysis, serum chloride (HR = 0.823, 95%CI = 0.757-0.894, p < 0.001) and Child-Pugh score (HR = 1.401, 95%CI = 1.151-1.704, p = 0.001) were identified as independent predictors of 1-year mortality. Patients with serum chloride <107.35 mmol/L showed worse survival probability than those with serum chloride ≥107.35 mmol/L no matter with or without ascites (p < 0.05). CONCLUSION Admission hypochloremia and increasing Child-Pugh score are independent predictors of 1-year mortality in cirrhotic patients with esophagogastric varices receiving TIPS.
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Affiliation(s)
- Jie Cheng
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Kai Huang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Juan-Li Mou
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Yao-Jia Lao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Jia-Hui Feng
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Fan Hu
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Meng-Lu Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Tangnuer Maimaitiaishan
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Jian Shang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China
| | - Jun Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China; The Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan, 430071, PR China.
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Yang Z, Chen L, Liu J, Zhuang H, Lin W, Li C, Zhao X. Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2301849. [PMID: 36942893 DOI: 10.1002/adma.202301849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2023] [Indexed: 06/18/2023]
Abstract
Short designer self-assembling peptide (dSAP) biomaterials are a new addition to the hemostat group. It may provide a diverse and robust toolbox for surgeons to integrate wound microenvironment with much safer and stronger hemostatic capacity than conventional materials and hemostatic agents. Especially in noncompressible torso hemorrhage (NCTH), diffuse mucosal surface bleeding, and internal medical bleeding (IMB), with respect to the optimal hemostatic formulation, dSAP biomaterials are the ingenious nanofiber alternatives to make bioactive neural scaffold, nasal packing, large mucosal surface coverage in gastrointestinal surgery (esophagus, gastric lesion, duodenum, and lower digestive tract), epicardiac cell-delivery carrier, transparent matrix barrier, and so on. Herein, in multiple surgical specialties, dSAP-biomaterial-based nano-hemostats achieve safe, effective, and immediate hemostasis, facile wound healing, and potentially reduce the risks in delayed bleeding, rebleeding, post-operative bleeding, or related complications. The biosafety in vivo, bleeding indications, tissue-sealing quality, surgical feasibility, and local usability are addressed comprehensively and sequentially and pursued to develop useful surgical techniques with better hemostatic performance. Here, the state of the art and all-round advancements of nano-hemostatic approaches in surgery are provided. Relevant critical insights will inspire exciting investigations on peptide nanotechnology, next-generation biomaterials, and better promising prospects in clinics.
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Affiliation(s)
- Zehong Yang
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
- Institute for Nanobiomedical Technology and Membrane Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lihong Chen
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ji Liu
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hua Zhuang
- Department of Ultrasonography, West China Hospital of Sichuan University, No. 37 Guoxue Road, Wuhou District, Chengdu, Sichuan, 610041, China
| | - Wei Lin
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Women and Children Diseases of the Ministry of Education, Sichuan University, No. 17 People's South Road, Chengdu, Sichuan, 610041, China
| | - Changlong Li
- Department of Biochemistry and Molecular Biology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaojun Zhao
- Institute for Nanobiomedical Technology and Membrane Biology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
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Su DS, Li CK, Gao C, Qi XS. Hemostatic powder for acute upper gastrointestinal bleeding: Recent research advances. Shijie Huaren Xiaohua Zazhi 2023; 31:249-255. [DOI: 10.11569/wcjd.v31.i7.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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Güven İE, Başpınar B, Durak MB, Yüksel İ. Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:178-184. [PMID: 35605821 DOI: 10.1016/j.gastrohep.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/20/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Data regarding early (within 24h) and urgent endoscopy (within 12h) in non-variceal upper gastrointestinal bleeding (NV-UGIB) revealed conflicting results. This study aimed to investigate the impact of endoscopy timing on the outcomes of high-risk patients with NV-UGIB. PATIENTS AND METHODS From February 2020 to February 2021, consecutive high-risk (Glasgow-Blatchford score ≥12) adults admitted to the emergency department with NV-UGIB were analyzed retrospectively. The primary composite outcome was 30-day mortality from any cause, inpatient rebleeding, need for endoscopic re-intervention, need for surgery or angiographic embolization. RESULTS 240 patients were enrolled: 152 (63%) patients underwent urgent endoscopy (<12h) and 88 (37%) patients underwent early endoscopy (12-24h). One or more components of the composite outcome were observed in 53 (22.1%) patients: 30 (12.5%) had 30-day mortality, rebleeding occurred in 27 (11.3%), 7 (2.9%) underwent endoscopic re-intervention, and 5 (2.1%) required surgery or angiographic embolization. The composite outcome was similar between the groups. Multivariate analysis showed only hemodynamic instability on admission (OR: 3.05, p=0.006), and the previous history of cancer (OR: 2.42, p=0.029) were significant in predicting composite outcome. In terms of secondary outcomes, the endoscopic intervention was higher in the urgent endoscopy group (p=0.006), whereas the number of transfused erythrocyte suspensions and the length of hospital stay was higher in the early endoscopy group (p=0.002 and p=0.040, respectively). CONCLUSIONS Urgent endoscopy leads to a significant reduction in the length of hospitalization and the number of transfused erythrocyte suspensions in NV-UGIB, which can contribute to patient satisfaction, reduce healthcare expenditure, and improve hospital bed availability. The composite outcome and its sub-outcomes were the same among both groups.
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Affiliation(s)
- İbrahim Ethem Güven
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey
| | - Batuhan Başpınar
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey.
| | - Muhammed Bahaddin Durak
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey
| | - İlhami Yüksel
- Department of Gastroenterology, Ankara City Hospital, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey; Department of Gastroenterology, Ankara Yildirim Beyazit University School of Medicine, Bilkent Avenue, 06800 Çankaya, Ankara, Turkey
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Pallio S, Crinò SF, Maida M, Sinagra E, Tripodi VF, Facciorusso A, Ofosu A, Conti Bellocchi MC, Shahini E, Melita G. Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours. Cancers (Basel) 2023; 15:1285. [PMID: 36831627 PMCID: PMC9954263 DOI: 10.3390/cancers15041285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Gastrointestinal Stromal Tumors (GISTs) are subepithelial lesions (SELs) that commonly develop in the gastrointestinal tract. GISTs, unlike other SELs, can exhibit malignant behavior, so differential diagnosis is critical to the decision-making process. Endoscopic ultrasound (EUS) is considered the most accurate imaging method for diagnosing and differentiating SELs in the gastrointestinal tract by assessing the lesions precisely and evaluating their malignant risk. Due to their overlapping imaging characteristics, endosonographers may have difficulty distinguishing GISTs from other SELs using conventional EUS alone, and the collection of tissue samples from these lesions may be technically challenging. Even though it appears to be less effective in the case of smaller lesions, histology is now the gold standard for achieving a final diagnosis and avoiding unnecessary and invasive treatment for benign SELs. The use of enhanced EUS modalities and elastography has improved the diagnostic ability of EUS. Furthermore, recent advancements in artificial intelligence systems that use EUS images have allowed them to distinguish GISTs from other SELs, thereby improving their diagnostic accuracy.
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Affiliation(s)
- Socrate Pallio
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | | | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | | | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH 45201, USA
| | | | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology—IRCCS “Saverio de Bellis” Castellana Grotte, 70013 Castellana Grotte, Italy
| | - Giuseppinella Melita
- Human Pathology of Adult and Child Department, University of Messina, 98100 Messina, Italy
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Ju J, Cheng Z, Zhu Q, Deng M, Zhang H. Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series. Medicine (Baltimore) 2023; 102:e32819. [PMID: 36749253 PMCID: PMC9902009 DOI: 10.1097/md.0000000000032819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
RATIONALE Owing to the anatomical characteristics of the duodenum, gastroduodenal artery (GDA) pseudoaneurysms can be caused by duodenal ulcers, which may rupture and lead to massive or repeated bleeding. Pseudoaneurysms are usually diagnosed using enhanced computerized tomography or angiography, whereas endoscopic signs have rarely been reported. PATIENT CONCERNS Three patients aged 18 to 83 years with bleeding duodenal ulcers and GDA pseudoaneurysms were treated. DIAGNOSIS All patients had symptoms of gastrointestinal bleeding, and endoscopy revealed duodenal ulcers with visible vessels or adherent clot pulsations. Angiography confirmed the presence of a GDA pseudoaneurysm, which had an adjacent relationship with the duodenum. INTERVENTIONS The GDA pseudoaneurysm was embolized in each patient. OUTCOMES Through transcatheter arterial embolization, endoscopic treatment, and traditional treatment, hematemesis or melena was gradually stopped and all patients were discharged. LESSONS The pulsation of visible vessels or adherent clots observed during endoscopy in patients with duodenal ulcer may indicate the formation of a gastroduodenal artery pseudoaneurysm. Therefore, we suggest that such patients receive enhanced computerized tomography or angiography to assess whether they need timely endovascular intervention treatment to avoid bleeding caused by a pseudoaneurysm.
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Affiliation(s)
- Jiayu Ju
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Ziyao Cheng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qingliang Zhu
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Mingming Deng
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Hailong Zhang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
- * Correspondence: Hailong Zhang, The Affiliated Hospital of Southwest Medical University, No. 25, Taiping Street, Luzhou, Sichuan Province 64600, China (e-mail: )
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de Moura DTH, Hirsch BS, da Conceição Vasconcelos KGM, Siqueira LTDB, Silveira SQ, de Moura EGH, Hoff PM. A novel less-invasive therapy for a bleeding eroded artery in a giant duodenal ulcer: principles and technical description. IGIE 2022; 1:15-18. [DOI: 10.1016/j.igie.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
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Ito N, Funasaka K, Fujiyoshi T, Furukawa K, Kakushima N, Furune S, Ishikawa E, Mizutani Y, Sawada T, Maeda K, Ishikawa T, Yamamura T, Ohno E, Nakamura M, Kawashima H, Miyahara R, Hirooka Y, Haruta JI, Fujishiro M. Modified N score is helpful for identifying patients who need endoscopic intervention among those with black stools without hematemesis. Dig Endosc 2022; 34:1157-1165. [PMID: 35396885 DOI: 10.1111/den.14323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Although black stools are one of the signs of upper gastrointestinal bleeding, not all patients without hematemesis need endoscopic intervention. There is no apparent indicator to select who needs treatment thus far. The aim of this study was to establish a novel score that predicts the need for endoscopic intervention in patients with black stools without hematemesis. METHODS We retrospectively enrolled 721 consecutive patients with black stools without hematemesis who underwent emergency endoscopy from two facilities. In the development stage (from January 2016 to December 2018), risk factors that predict the need for endoscopic intervention were determined from the data of 422 patients by multivariate logistic regression analysis, and a novel scoring system, named the modified Nagoya University score (modified N score), was developed. In the validation stage (from January 2019 to September 2020), we evaluated the diagnostic value of the modified N score for 299 patients. RESULTS Multivariate logistic regression analysis revealed four predictive factors for endoscopic intervention: syncope, the blood urea nitrogen (BUN) level, and the BUN/creatinine ratio as positive indicators and anticoagulant drug use as a negative indicator. In the validation stage, the area under the curve of the modified N score was 0.731, and the modified N score showed a sensitivity of 82.0% and a specificity of 58.8%. CONCLUSIONS Our modified N score, which consists of only four factors, can identify patients who need endoscopic intervention among those with black stools without hematemesis.
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Affiliation(s)
- Nobuhito Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan
| | - Toshihisa Fujiyoshi
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Satoshi Furune
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan
| | - Jun-Ichi Haruta
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
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Feng L, Fu J. Somatostatin plus Gastroscopic Administration of Omeprazole for the Treatment of Acute Upper Gastrointestinal Bleeding: An Exploration of a Promising Alternative. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6329592. [PMID: 35832530 PMCID: PMC9273354 DOI: 10.1155/2022/6329592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
Objective To analyze the efficacy and safety of somatostatin combined with gastroscopic administration of omeprazole in the treatment of acute upper gastrointestinal bleeding. Methods Eligible 112 patients with acute upper gastrointestinal bleeding treated in our hospital from May 2019 to July 2020 were randomized at a ratio of 1 : 1 either to the control group (somatostatin) or observation group (somatostatin combined with omeprazole gastroscope administration). The treatment efficacy, the average hemostasis time, rebleeding rate, average length of hospital stay, and the incidence of adverse reactions were compared. Results The study group demonstrated significantly higher total effective rate than the control group (96.45% vs. 80.36%, <0.05). The study group demonstrated superior performances compared to the control group with respect to the average hemostasis time ((14.17 ± 2.53 h) vs. (28.84 ± 4.07 h)), rebleeding rate (3.57% vs. 14.28%), and average length of hospital stay ((5.86 ± 1.26 d) vs. (9.74 ± 1.07 d)) (all p < 0.05). The chi-square test revealed a remarkably lower total incidence of adverse reactions in the study group vs. control group which was (4 (7.14%) vs. 12 (21.43%)) (p < 0.05). Conclusion The combination of somatostatin and gastroscopic administration of omeprazole might be a promising alternative for the treatment of acute upper gastrointestinal bleeding. It improves the clinical treatment effect and controls the symptoms of patients, with a good safety profile.
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Affiliation(s)
- Lu Feng
- Department of Emegercy, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610000, China
| | - Jing Fu
- Department of Emegercy, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610000, China
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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: 1.7] [Reference Citation Analysis] [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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Nian B, Wang B, Wang L, Yi L. A Cohort Study to Compare Effects between Ulcer- and Nonulcer-Related Nonvariceal Upper Gastrointestinal Bleeding. Appl Bionics Biomech 2022; 2022:3342919. [PMID: 35721238 PMCID: PMC9205735 DOI: 10.1155/2022/3342919] [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: 04/01/2022] [Revised: 05/09/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to better understand the characteristics and etiology of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) in recent years in this region and to provide evidence-based medical evidence. Methods 100 patients with acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) who met the clinical diagnostic criteria of ANVUGIB admitted to Suzhou First People's Hospital from January 2017 to December 2021 were analyzed, as well as the age difference and change rule. According to age, 100 patients were divided into young (18-39 years), middle-aged (40-59 years), and elderly (60 years and above), and the differences in the three groups were compared. The etiology was confirmed by endoscopic examination and was recorded one by one in a well-designed ANVUGIB case data registration form. Statistical software SPSS 23.0 was used for analysis. Results Gastric ulcer was the main cause in the elderly group (50.0%), duodenal ulcer was the main cause in the middle and young groups, and gastrointestinal cancer (7.1%) and marginal ulcer (2.3%) in the elderly group were higher than those in the young group. Nonsteroidal anti-inflammatory drugs (52.3%) were the main inducement in the elderly group, which was significantly higher than in the middle-aged group (13.1%) and the young group (5%) (P < 0.01). Drinking, fatigue, and emotional excitement led to a higher proportion in the middle-aged group and the young group, in comparison to the elderly group (P < 0.01). Conclusion Peptic ulcer is the most common cause of acute nonvariceal upper gastrointestinal bleeding, followed by acute gastric mucosal lesions and upper digestive system tumors, compared with nonulcer.
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Affiliation(s)
- Bi Nian
- Department of Gastroenterology, Suzhou First People's Hospital, China
| | - Bangping Wang
- Department of Gastroenterology, Suzhou First People's Hospital, China
| | - Long Wang
- Gastroenterology Department, Suzhou Municipal Hospital, China
| | - Lanjuan Yi
- Department of Gastroenterology, Yantai Mountain Hospital, Yantai, China
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Yahya H, Umar H, Shekari B, Sani K. Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings. Ann Afr Med 2022; 21:262-268. [PMID: 36204913 PMCID: PMC9671179 DOI: 10.4103/aam.aam_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. Methods: We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. Results: We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10–88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Conclusion: Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.
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Abe H, Kamimura K, Arao Y, Kohisa J, Terai S. Advances in the Treatment of Gastrointestinal Bleeding: Safety and Efficiency of Transnasal Endoscopy. MEDICINES (BASEL, SWITZERLAND) 2021; 8:53. [PMID: 34564095 PMCID: PMC8471608 DOI: 10.3390/medicines8090053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
Acute upper gastrointestinal bleeding (UGIB) is a common disorder and a gastroenterological emergency. With the development of new techniques and devices, the survivability after gastrointestinal bleeding is improving. However, at the same time, we are facing the difficulty of severely complicated cases with various diseases. For example, while endoscopic examination with a normal diameter endoscope is essential for the diagnosis and treatment of UGIB, there are several cases in which it cannot be used. In these cases, transnasal endoscopy (TNE) may be a viable treatment option. This report reviews current hemostatic devices for endoscopic treatment and the safety and efficiency of using TNE in complicated cases. The latter will be demonstrated in a case report where TNE was employed in a patient with severe esophageal stenosis. This review summarizes the advances made in the devices used and will provide further ideas for the physician in terms of combining these devices and TNE.
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Affiliation(s)
- Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Sado General Hospital, 161 Chigusa, Sado 952-1209, Japan;
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 950-2181, Japan; (Y.A.); (J.K.); (S.T.)
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 950-2181, Japan; (Y.A.); (J.K.); (S.T.)
- Department of General Medicine, Niigata University School of Medicine, 1-757 Asahimachido-ri, Chuo-ku, Niigata 951-8510, Japan
| | - Yoshihisa Arao
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 950-2181, Japan; (Y.A.); (J.K.); (S.T.)
| | - Junji Kohisa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 950-2181, Japan; (Y.A.); (J.K.); (S.T.)
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata 950-2181, Japan; (Y.A.); (J.K.); (S.T.)
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Current Status and Future Perspective of Artificial Intelligence in the Management of Peptic Ulcer Bleeding: A Review of Recent Literature. J Clin Med 2021; 10:jcm10163527. [PMID: 34441823 PMCID: PMC8397124 DOI: 10.3390/jcm10163527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
With the decreasing incidence of peptic ulcer bleeding (PUB) over the past two decades, the clinician experience of managing patients with PUB has also declined, especially for young endoscopists. A patient with PUB management requires collaborative care involving the emergency department, gastroenterologist, radiologist, and surgeon, from initial assessment to hospital discharge. The application of artificial intelligence (AI) methods has remarkably improved people's lives. In particular, AI systems have shown great potential in many areas of gastroenterology to increase human performance. Colonoscopy polyp detection or diagnosis by an AI system was recently introduced for commercial use to improve endoscopist performance. Although PUB is a longstanding health problem, these newly introduced AI technologies may soon impact endoscopists' clinical practice by improving the quality of care for these patients. To update the current status of AI application in PUB, we reviewed recent relevant literature and provided future perspectives that are required to integrate such AI tools into real-world practice.
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Maehara K, Esaki M, Minoda Y. Ultra-thin endoscope-assisted insertion of a suction tube for the removal of massive gastric blood clots. Dig Endosc 2021; 33:e106-e108. [PMID: 33905158 DOI: 10.1111/den.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Kosuke Maehara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Goto O, Koizumi E, Higuchi K, Noda H, Onda T, Omori J, Kaise M, Iwakiri K. Cutting-Edge Technologies for Gastrointestinal Therapeutic Endoscopy. J NIPPON MED SCH 2021; 88:17-24. [PMID: 33692281 DOI: 10.1272/jnms.jnms.2021_88-109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.
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Affiliation(s)
- Osamu Goto
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Eriko Koizumi
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Kazutoshi Higuchi
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Hiroto Noda
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Takeshi Onda
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Jun Omori
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Mitsuru Kaise
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
| | - Katsuhiko Iwakiri
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital
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Naga Y, Jayaraj M, Elmofti Y, Hong A, Ohning G. Intraluminal Endovascular Coil Migration: A Rare Complication Post-Embolization of the Gastroduodenal Artery for a Previously Bleeding Duodenal Ulcer. Cureus 2021; 13:e14615. [PMID: 34040915 PMCID: PMC8139854 DOI: 10.7759/cureus.14615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transarterial angiographic embolization is a highly effective, safe treatment for non-variceal upper gastrointestinal bleeding refractory to endoscopic intervention. However, intraluminal coil migration is a possible complication. Coil migration, while usually a self-limiting process, can lead to significant rebleeding. In our case, a patient presented with a life-threatening duodenal ulcer hemorrhage, likely precipitated by intraluminal endovascular coil migration after a recent gastro-duodenal artery embolization. He was successfully managed without endoscopic coil removal and had no additional gastrointestinal bleeding. It is important for endoscopists to be aware of this complication and weigh the risks and benefits of coil removal.
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Affiliation(s)
- Yassin Naga
- Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Mahendran Jayaraj
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Yousif Elmofti
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Annie Hong
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Gordon Ohning
- Gastroenterology, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
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Chuang CH, Chen CC, Wu JH, Hong MY, Kang JW, Kuo HY, Huang CJ, Chen CY. Novel upper gastrointestinal monitoring system to track upper gastrointestinal bleeding: A pilot study. Endosc Int Open 2020; 8:E1811-E1816. [PMID: 33269314 PMCID: PMC7671761 DOI: 10.1055/a-1266-3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background and study aims Early detection of upper gastrointestinal (UGI) rebleeding is not easy by observing clinical symptoms. We developed a novel UGI monitoring system and aimed to test its feasibility of continuous tracking of UGI bleeding. Patients and methods A prospective study was conducted on patients with moderate to high risk of rebleeding. The UGI monitoring system was installed to monitor their gastric contents. It would alarm if rebleeding was suspected and the physician could review the images to make a further decision. The patient's comfort level was also evaluated. Results Sixteen patients were enrolled. Rebleeding occurred in one patient and was detected by this system more than 5 hours earlier than with clinical symptoms. The interobserver reliability for reviewing the images to define the blood clearance in the stomach was excellent (intraclass correlation coefficient 0.79-0.96). The comfort level assessed by patients was 1.90 ± 1.39 (on the scale of 0-5). Conclusions This pilot study demonstrated the potential of this UGI monitoring system for early detection of rebleeding.
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Affiliation(s)
- Chiao-Hsiung Chuang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Cheng Chen
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Jhong-Han Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Yuan Hong
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Wen Kang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Yu Kuo
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Jui Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Yu Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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