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Fiedler A, Dhindsa B, Singh S. Duodenocaval Fistula: Unmasking the Rare Culprit of Gastrointestinal Hemorrhage. ACG Case Rep J 2024; 11:e01340. [PMID: 38638200 PMCID: PMC11025708 DOI: 10.14309/crj.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Duodenocaval fistula is an extremely rare and life-threatening cause of gastrointestinal hemorrhage and septicemia. Diagnosing this condition is challenging due to its nonspecific symptoms, leading to significant delays in diagnosis and contributing to its remarkably high mortality rate. We present a unique case of duodenocaval fistula associated with prior radiation, peptic ulcer disease, and antiangiogenic cancer therapy, nearly resulting in the death of a young patient.
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Affiliation(s)
- Alexandra Fiedler
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Banreet Dhindsa
- Division of Gastroenterology and Hepatology, New York University Langone Health, New York, NY
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
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2
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Carneiro F, Vinceneux A, Larroquette M, Rony M, Carril L, Laguerre B, Blazevic I, Bartelemy P, Teyssonneau D, Goujon M, Linassier C, Thiery-Vuillemin A, Roubaud G, Mourey L, Albiges L, Gravis G, Gross-Goupil M, Cancel M. Gastrointestinal metastases in renal cell carcinoma: A retrospective multicenter GETUG (Groupe d'Étude des Tumeurs Uro-Génitales) study. Eur J Cancer 2024; 199:113534. [PMID: 38241819 DOI: 10.1016/j.ejca.2024.113534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Among patients with renal cell carcinoma (RCC), bone and visceral metastases have a poor prognosis, while endocrine gland metastases have a more favorable prognosis. Gastrointestinal metastases (GIMs) are rare, and their prognosis is still poorly understood. OBJECTIVES To report clinical presentations, patient characteristics, therapeutic strategies, and prognosis of GIMs from RCC. METHODS We retrospectively collected data from RCC patients presenting GIMs, in 10 French GETUG centers, between 2000 and 2021. RESULTS We identified 74 patients with 87 GIMs, mostly gastric or duodenal. The median age at GIM diagnosis was 69 years and 76% of patients already had other metastases. GIMs occurred after a median duration of 5.4 years (IC95%=[4.2-7.1]) and 1.9 years (IC95%=[1.2-3.8]) from RCC diagnosis and first metastasis, respectively. GIMs were symptomatic in 52 patients (70%), with anemia in 41 patients (55%) and/or gastrointestinal bleeding in 31 patients (42%). Only 22 asymptomatic patients (30%) were fortuitously diagnosed. GIM management consisted of systemic treatment only in 29 GIMs (33%), local treatment only in 23 GIMs (26%), and both local and systemic treatment in 18 GIMs (21%). For 17 GIMs (20%), there was no therapeutic modification. After diagnosis of GIM, median overall survival was 19 months. CONCLUSION We report the largest retrospective cohort of GIMs in RCC patients. They should be suspected in case of anemia or gastrointestinal bleeding in any patient with a history of RCC. Their management varies widely depending on their location in the digestive tract and whether or not they are symptomatic.
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Affiliation(s)
- F Carneiro
- Department of Medical Oncology, University Hospital, Tours, France
| | - A Vinceneux
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - M Larroquette
- Department of Medical Oncology, University Hospital, Bordeaux, France
| | - M Rony
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - L Carril
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - B Laguerre
- Department of Medical Oncology, Eugène Marquis Cancer Center, Rennes, France
| | - I Blazevic
- Department of Medical Oncology, IUCT Oncopole, Toulouse, France
| | - P Bartelemy
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - D Teyssonneau
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Goujon
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon, France
| | - C Linassier
- Department of Medical Oncology, University Hospital, Tours, France
| | - A Thiery-Vuillemin
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon, France
| | - G Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - L Mourey
- Department of Medical Oncology, IUCT Oncopole, Toulouse, France
| | - L Albiges
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - G Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - M Gross-Goupil
- Department of Medical Oncology, University Hospital, Bordeaux, France
| | - M Cancel
- Department of Medical Oncology, University Hospital, Tours, France.
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3
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Martins Mendes T, Fonseca T, Pereira Anjos D. [Recurrent Bacteremia after Cyanoacrylate Sclerotherapy of Ectopic Duodenal Varices]. ACTA MEDICA PORT 2024; 37:136-141. [PMID: 37387411 DOI: 10.20344/amp.19444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/31/2023] [Indexed: 07/01/2023]
Abstract
Sclerotherapy with N-butyl-2-cyanoacrylate is the first-line endoscopic approach for gastric and ectopic variceal bleeding, but it can be associated with local or systemic complications. Episodes of transient bacteremia after the procedure are frequent, but documented cases of recurrent bacteremia are rare. The authors report a 47-year-old female patient with liver cirrhosis who underwent duodenal sclerotherapy with cyanoacrylate after upper gastrointestinal bleeding. Subsequently, she developed five episodes of bacteremia with unknown origin. A definitive diagnosis of recurrent bacteremia due to cyanoacrylate was only possible after an exhaustive study to exclude other infectious foci. This case highlights a rare complication in an unusual topography (ectopic varices) and with a high number of episodes of bacteremia. A multidisciplinary management was paramount due to the patient's high surgical and anesthetic risk, comorbidities, and surgical aggressiveness.
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Affiliation(s)
| | - Teresa Fonseca
- Serviço de Medicina Interna. Centro Hospitalar Tâmega e Sousa. Penafiel. Portugal
| | - Diana Pereira Anjos
- Serviço de Medicina Interna. Centro Hospitalar Tâmega e Sousa. Penafiel. Portugal
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4
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Brodskiy I, Fogel J, Douen A, Wagner J, Trillo J. Hypertension and Gastrointestinal Bleed in COVID-19 Patients: Associations with Mortality, Acute Kidney Injury, Vasopressor Use, and Mechanical Ventilation Use. Folia Med Cracov 2023; 63:99-108. [PMID: 38578349 DOI: 10.24425/fmc.2023.148762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
There are mixed findings on the association of hypertension or gastrointestinal bleed (GIB) with mortality in COVID-19 patients but no research on the combination of both hypertension and GIB with mortality in COVID-19 patients. We study in COVID-19 patients the association of hypertension and GIB with mortality, acute kidney injury (AKI), vasopressor use, and/or mechanical ventilation. This is a retrospective study of COVID-19 patients who were categorized into groups of no GIB/no hypertension (n = 653), yes hypertension/no GIB (n = 1,620), yes GIB/no hypertension (n = 104), or yes GIB/yes hypertension (n = 334). Covariates included demographics and medical history variables. In the multi-variate logistic regression analysis for the composite outcome of mortality, AKI, vasopressor use, and/or mechanical ventilation use, yes hypertension/no GIB (OR: 1.47, 95% CI: 1.13, 1.89, p <0.001) and yes GIB/no hypertension (OR: 1.68, 95% CI: 1.02, 2.78, p <0.001) were each significantly positively associated with the composite outcome. The yes GIB/yes hypertension group was not significantly associated with the composite outcome. In conclusion, we found that hypertension or GIB alone were each significantly associated with increased odds for the composite outcome while having both hypertension and GIB was protective and not significantly associated with the composite outcome. We recommend that clinicians be aware of such findings when treating patients with COVID-19, as those with both hypertension and GIB may not need as aggressive treatment as compared to those with either hypertension or GIB.
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Affiliation(s)
- Igor Brodskiy
- Department of Internal Medicine, South Brooklyn Health, Brooklyn, New York, USA.
| | - Joshua Fogel
- Department of Management, Marketing and Entrepreneurship, Brooklyn College, Brooklyn, New York, USA
| | - Aaron Douen
- Department of Internal Medicine, South Brooklyn Health, Brooklyn, New York, USA
| | - Justin Wagner
- Department of Internal Medicine, South Brooklyn Health, Brooklyn, New York, USA
| | - John Trillo
- Department of Internal Medicine, South Brooklyn Health, Brooklyn, New York, USA
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5
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Marques I, Vieira M, Ferreira A, Abreu R, Rodrigues R, Vilaça L, Oliveira J. Emergent Endovascular Repair For Primary Aortoenteric Fistula. Port J Card Thorac Vasc Surg 2023; 30:63-66. [PMID: 37418772 DOI: 10.48729/pjctvs.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/03/2023] [Indexed: 07/09/2023]
Abstract
We report the case of a 64-year-old male with significant cardiac comorbidities who reported three episodes of gastrointestinal bleeding. In the third episode, he presented massive hematemesis, anaemia and hypotension. Despite a standard upper endoscopy, a computed tomography (CT) showed an infrarenal abdominal aortic aneurysm and densification of the aortic fat cover. A primary aortoenteric fistula, with acute bleeding and haemodynamic instability, was assumed, and an emergent endovascular repair was performed. Subsequent CT scans and endoscopies demonstrated control of the enteric lesion. After five months, there was no evidence of infection or rebleeding.
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Affiliation(s)
- Isabel Marques
- Serviço de Cirurgia Geral do Hospital de Braga, Portugal
| | - Mário Vieira
- Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga, Portugal
| | - Ana Ferreira
- Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga, Portugal
| | - Rodolfo Abreu
- Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga, Portugal
| | - Roger Rodrigues
- Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga, Portugal
| | - Luís Vilaça
- Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga, Portugal
| | - João Oliveira
- Serviço de Angiologia e Cirurgia Vascular do Hospital de Braga, Portugal
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Liu K, Gao L, Bai J, Wang L, Zhu S, Zhao X, Han Y, Liu Z. Efficacy of New Hemostatic Techniques in Nonvariceal Gastrointestinal Bleeding: A Systematic Review and Network Meta-analysis. J Dig Dis 2023. [PMID: 37210622 DOI: 10.1111/1751-2980.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This systematic review and network meta-analysis aimed to assess the relative efficacy of currently multiple hemostatic modalities in nonvariceal gastrointestinal bleeding (NVGIB). BACKGROUND Nonvariceal gastrointestinal bleeding is a frequent medical condition with significant mortality and morbidity. There are currently multiple hemostatic modalities, but their relative efficacy is still unknown. METHODS Major databases including PubMed, EMBASE and the Cochrane Library were searched for studies that compared the relative efficacy of different hemostatic techniques for NVGIB (over-the-scope-clip (OTSC), hemostatic powder (HP) and conventional endoscopic treatment (CET)). The 30-day rebleeding rate was the primary outcome. We performed pairwise and network meta-analyses for all treatments. The heterogeneity and transitivity were evaluated. RESULTS Twenty-two studies were included. OTSC and HP + CET showed superior efficacy compared with CET (OTSC vs CET: RR, 0.42 [95% CI, 0.28-0.60]; HP + CET vs CET: RR, 0.40 [95% CI, 0.17-0.87]) while their relative efficacy had not detected any statistically significant difference (OTSC vs HP + CET: RR, 0.95 [95% CI, 0.38-2.31]) in the 30-day rebleeding rate. HP + CET was ranked highest in the network ranking estimate. In addition, the sensitivity analysis showed that it was not robust that OTSC was superior to CET in the short-term rebleeding rate and the initial hemostasis rate. None of the other comparisons found a statistically significant difference. CONCLUSIONS This systematic review and network meta- analysis showed that OTSC and HP + CET significantly reduced 30-day rebleeding rates compared to CET and had similar efficacy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kai Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Li Gao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Jiawei Bai
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Lulu Wang
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shaohua Zhu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Xin Zhao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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7
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Stern J, Dupuis C, Kpeglo H, Reuter J, Vinclair C, Para M, Nataf P, Pelletier AL, de Montmollin E, Bouadma L, Timsit JF, Sonneville R. Upper gastrointestinal bleeding in adults treated with veno-arterial extracorporeal membrane oxygenation: a cohort study. Eur J Cardiothorac Surg 2023; 63:7077138. [PMID: 36916745 PMCID: PMC10089675 DOI: 10.1093/ejcts/ezad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/09/2022] [Accepted: 03/13/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding is a common complication in adults treated with veno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) for refractory cardiogenic shock or cardiac arrest. We aimed to determine risk factors, prevalence and outcomes associated VA-ECMO-associated upper gastrointestinal bleeding (UGIB) in adult patients. METHODS We conducted a retrospective cohort study (2014-2022) on consecutive VA-ECMO patients in the Medical and Infectious Disease intensive care unit of university hospital Bichat-Claude Bernard in Paris, France. UGIB was defined as 1) an overt bleeding (hematemesis, melena, hematochezia), or 2) acute anemia associated with a lesion diagnosed on upper gastrointestinal endoscopy. VA-ECMO-associated UGIB was defined as an UGIB occurring during VA-ECMO, or up to ten days after decannulation in patients weaned-off ECMO. Cause-specific models were used to identify factors associated with UGIB and death, respectively. RESULTS Among the 455 patients included, 48 (10%) were diagnosed with UGIB after a median of 12 [7; 23] days following ECMO cannulation. Mortality occurred in 36 (75%) patients with UGIB and 243 (60%) patients without. UGIB patients had longer ICU stays (32 [19; 60] vs 18 [7; 37] days; p<.01), longer ECMO (14 [9; 18] vs 7 [4; 11] days; p <.01) and mechanical ventilation durations (21 [16; 36] vs. 10 [5; 20] days; p <.01), as compared to non-UGIB patients. Ninety upper gastrointestinal endoscopies (UGE) were performed, and the most frequent lesions detected were gastro-duodenal ulcers (n = 23, 26%), leading to 11/90 therapeutic procedures. By multivariable analysis, a history of peptic ulcer (Cause-specific hazard ratio (CSHR) 2.93, 95%CI 1.01; 8.51), a dual antiplatelet therapy (CSHR 2.0, 95%CI 1.07; 3.72]) and extracorporeal cardiopulmonary resuscitation (ECPR) (CSHR 2.78, 95%CI 1.42; 5.45) were independently associated with an increased risk of UGIB. CONCLUSIONS In adult patients under VA-ECMO, a history of gastric ulcer, dual antiplatelet therapy and ECPR were independently associated with an increased risk of UGIB. This study highlights the potential role of acute ischemia reperfusion injury in the pathophysiology of VA-ECMO-associated UGIB.
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Affiliation(s)
- Jules Stern
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Claire Dupuis
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France.,Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand,France
| | - Hervé Kpeglo
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jean Reuter
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Camille Vinclair
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marylou Para
- Université de Paris, Department of Cardiac Surgery, APHP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM UMR 1137, IAME, Paris, France
| | - Patrick Nataf
- Université de Paris, Department of Cardiac Surgery, APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Anne-Laure Pelletier
- Université de Paris, Department of Hepato-Gastroenterology, APHP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Etienne de Montmollin
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM UMR 1137, IAME, Paris, France
| | - Lila Bouadma
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM UMR 1137, IAME, Paris, France
| | - Jean-François Timsit
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM UMR 1137, IAME, Paris, France
| | - Romain Sonneville
- Université de Paris, Medical and Intensive Care Unit (MI2), APHP, Hôpital Bichat-Claude Bernard, Paris, France.,Université de Paris, INSERM UMR 1137, IAME, Paris, France
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Block PD, Farrell JJ, Li DK. A Rare Cause of Gastrointestinal Bleeding After Pancreaticoduodenectomy. Gastroenterology 2022:S0016-5085(22)01449-4. [PMID: 36592728 DOI: 10.1053/j.gastro.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Peter D Block
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - James J Farrell
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Darrick K Li
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
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9
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Madigan S, Ayres O, Chung A. Obscure Upper GI Bleeding After Liver Transplantation. Gastroenterology 2022; 163:e23-e24. [PMID: 35863527 DOI: 10.1053/j.gastro.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Shauna Madigan
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, Australia.
| | | | - Adrian Chung
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, Australia
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10
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Choi JH, Park SB, Lee JB, Lee TJ, Park HJ, Lee ES. A huge gastric angiolipoma presenting with acute upper gastrointestinal hemorrhage: A case report. Curr Med Imaging 2022; 19:945-949. [PMID: 35996257 DOI: 10.2174/1573405618666220822095201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Angiolipoma is a benign neoplasm with mainly composed of adipose tissue and proliferating blood vessels and relatively rare in gastrointestinal tract. And among them, gastric angiolipomas are extremely rare and tend to be small. CASE PRESENTATION We report the clinical and imaging features of a patient with a huge angiolipoma in the stomach and an episode of hematemesis and melena, caused by the ulceration of the gastric mucosa overlying the gastric subepithelial angiolipoma revealed by endoscopic evaluation. The patient was anemic, and the anemia resolved after local surgical resection of the tumor. We also reviewed the imaging, and histological features of the presenting gastric angiolipoma. CONCLUSION Radiologists should be aware of this rare benign gastric tumor that may present with gastrointestinal hemorrhage.
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Affiliation(s)
- Joo Hyeok Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Bin Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Beum Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae-Jin Lee
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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11
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Kalantari ME, Sardarzadeh N, Mirsadeghi A, Bagherzadeh AA, Zandbaf T. Jejunal Dieulafoy's Lesion as a Rare Cause of Massive Gastrointestinal Bleeding; a Case Report and Literature Review. Arch Acad Emerg Med 2022; 10:e61. [PMID: 36033991 PMCID: PMC9397588 DOI: 10.22037/aaem.v10i1.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Jejunal Dieulafoy's lesion is difficult to diagnose due to its rarity, intermittent hemorrhage, and lesion site, which is largely inaccessible to conventional endoscopes. A 39-year-old man, who had no underlying disease, presented to the emergency department (ED) with weakness, dizziness, and dry cough with a history of several rectal bleeding episodes in the last few years. Endoscopy was normal, and the colon was full of clots on colonoscopy, and no gross pathology was found. On computed tomography (CT) angiography, a hyperdensity was seen in the middle of the jejunum, possibly suggesting contrast extravasation. Due to decreased hemoglobin of the patient, and hemodynamic instability, the patient became a candidate for surgery. A palpable lesion in the Jejunum was touched that opened longitudinally, which revealed active arterial bleeding from the nipple-like lesion. This segment was resected, and an anastomosis was performed. Histopathological examination of the small intestine confirmed a Dieulafoy's lesion. It seems that, when upper endoscopy and colonoscopy fail to identify the cause of gastrointestinal bleeding, a Dieulafoy's lesion should be included in the differential diagnoses.
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Affiliation(s)
| | - Newsha Sardarzadeh
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Mirsadeghi
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Ali Akbar Bagherzadeh
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran
| | - Tooraj Zandbaf
- Department of General Surgery, Faculty of Medicine, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran,Corresponding author: Tooraj Zandbaf; Faculty of Medicine, Bazarche Sarab, Imam Khomeini 14, Mashhad, Iran. ,https://orcid.org/0000-0002-4882-5058, Tel:+98-9155114523 ; +98-513-2250041 ,Fax Number: +98-513-2250048
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12
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Biswas S, Vaishnav M, Pathak P, Gunjan D, Mahapatra SJ, Kedia S, Rout G, Thakur B, Nayak B, Kumar R. Effect of thrombocytopenia and platelet transfusion on outcomes of acute variceal bleeding in patients with chronic liver disease. World J Hepatol 2022; 14:1421-1437. [PMID: 36158909 PMCID: PMC9376768 DOI: 10.4254/wjh.v14.i7.1421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/13/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Platelet transfusion in acute variceal bleeding (AVB) is recommended by few guidelines and is common in routine clinical practice, even though the effect of thrombocytopenia and platelet transfusion on the outcomes of AVB is unclear.
AIM To determine how platelet counts, platelets transfusions, and fresh frozen plasma transfusions affect the outcomes of AVB in cirrhosis patients in terms of bleeding control, rebleeding, and mortality.
METHODS Prospectively maintained database was used to analyze the outcomes of cirrhosis patients who presented with AVB. The outcomes were assessed as the risk of rebleeding at days 5 and 42, and risk of death at day 42, considering the platelet counts and platelet transfusion. Propensity score matching (PSM) was used to compare the outcomes in those who received platelet transfusion. Statistical comparisons were done using Kaplan-Meier curves with log-rank tests and Cox-proportional hazard model for rebleeding and for 42-d mortality.
RESULTS The study included 913 patients, with 83.5% men, median age 45 years, and Model for End-stage Liver Disease score 14.7. Platelet count < 20 × 109/L, 20-50 × 109/L, and > 50 × 109/L were found in 23 (2.5%), 168 (18.4%), and 722 (79.1%) patients, respectively. Rebleeding rates were similar between the three platelet groups on days 5 and 42 (13%, 6.5%, and 4.7%, respectively, on days 5, P = 0.150; and 21.7%, 17.3%, and 14.4%, respectively, on days 42, P = 0.433). At day 42, the mortality rates for the three platelet groups were also similar (13.0%, 23.2%, and 17.2%, respectively, P = 0.153). On PSM analysis patients receiving platelets transfusions (n = 89) had significantly higher rebleeding rates on day 5 (14.6% vs 4.5%; P = 0.039) and day 42 (32.6% vs 15.7%; P = 0.014), compared to those who didn't. The mortality rates were also higher among patients receiving platelets (25.8% vs 23.6%; P = 0.862), although the difference was not significant. On multivariate analysis, platelet transfusion and not platelet count, was independently associated with 42-d rebleeding. Hepatic encephalopathy was independently associated with 42-d mortality.
CONCLUSION Thrombocytopenia had no effect on rebleeding rates or mortality in cirrhosis patients with AVB; however, platelet transfusion increased rebleeding on days 5 and 42, with a higher but non-significant effect on mortality.
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Affiliation(s)
- Sagnik Biswas
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Manas Vaishnav
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Piyush Pathak
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Soumya Jagannath Mahapatra
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Gyanranjan Rout
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Bhaskar Thakur
- Division of Biostatistics, UT Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Baibaswata Nayak
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 800014, Bihar, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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Choi HI, Choi MJ, Kim BM, Namgung H, Choi SK. Identifying Small Bowel Gastrointestinal Stromal Tumor as the Culprit Lesion in Obscure Gastrointestinal Bleeding: Emphasis on Angiographic Findings. Taehan Yongsang Uihakhoe Chi 2022; 83:400-405. [PMID: 36237930 PMCID: PMC9514442 DOI: 10.3348/jksr.2021.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/24/2021] [Accepted: 06/29/2021] [Indexed: 06/16/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are not uncommon and often cause gastrointestinal bleeding. GISTs occurring in the small intestine are occasionally difficult to identify by endoscopy and CT. In this case, the patient underwent CT three times before surgery, and the lesion was found to be located in a different area of the abdominal cavity on each CT scan. Moreover, the lesion was missed in the first two CT images because it was difficult to distinguish it from the nearby collapsed small intestine. The lesion was eventually detected through angiography; however, the correct diagnosis and treatment were delayed for 3 years because it was mistaken for a vascular malformation, which is the most common cause of obscure GI bleeding in elderly patients. This report emphasizes the need for interventional radiologists to be updated and vigilant of the angiographic features of GISTs to make an accurate diagnosis and establish a management strategy.
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14
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Affiliation(s)
- Cheng Fang
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiujun Liao
- Department of General Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xinliang Lu
- Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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15
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Riquoir C, Díaz LA, Chiliquinga D, Candia R, Pimentel F, Arenas A. Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report. Clin Endosc 2021; 54:754-758. [PMID: 34030436 PMCID: PMC8505193 DOI: 10.5946/ce.2021.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022] Open
Abstract
The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory.
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Affiliation(s)
| | - Luis Antonio Díaz
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - David Chiliquinga
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile
| | - Roberto Candia
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile
| | - Fernando Pimentel
- Department of Digestive Surgery, Division of Surgery, School of Medicine, Pontificia Universidad Católica de Chile
| | - Alex Arenas
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Católica de Chile.,Unit of Gastroenterology, Complejo Asistencial Dr. Sótero Del Río, Santiago, Chile
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16
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Rodríguez de Santiago E, Hernández-Tejero M, Rivero-Sánchez L, Ortiz O, García de la Filia-Molina I, Foruny-Olcina JR, Prieto HMM, García-Prada M, González-Cotorruelo A, De Jorge Turrión MA, Jiménez-Jurado A, Rodríguez-Escaja C, Castaño-García A, Outomuro AG, Ferre-Aracil C, de-Frutos-Rosa D, Pellisé M. Management and Outcomes of Bleeding Within 30 Days of Colonic Polypectomy in a Large, Real-Life, Multicenter Cohort Study. Clin Gastroenterol Hepatol 2021; 19:732-742.e6. [PMID: 32272252 DOI: 10.1016/j.cgh.2020.03.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Management of delayed (within 30 days) postpolypectomy bleeding (DPPB) has not been standardized. Patients often undergo colonoscopies that do not provide any benefit. We aimed to identify factors associated with therapeutic intervention and active bleeding after DPPB. METHODS We performed a retrospective study of 548 patients with bleeding within 30 days after an index polypectomy (DPPB; 71.9% underwent colonoscopy, 2.6% underwent primary angiographic embolization, and 25.5% were managed without intervention) at 6 tertiary centers in Spain, from January 2010 through September 2018. We collected demographic and medical data from patients. The primary outcomes were the need for therapeutic intervention and the presence of active bleeding during colonoscopy. RESULTS A need for therapeutic intervention was associated independently with the use of antithrombotic agents, hemoglobin decrease greater than 2 g/dL, hemodynamic instability, and comorbidities (P < .05). The bleeding point during colonoscopy was identified in 344 patients; 74 of these patients (21.5%) had active bleeding. Active use of anticoagulants (odds ratio [OR], 2.6; 95% CI, 1.5-4.5), left-sided polyps (OR, 1.95; 95% CI, 1-3.8), prior use of electrocautery (OR, 2.6; 95% CI, 1.1-6.1), and pedunculated polyp morphology (OR, 1.8, 95% CI, 1-3.2) significantly increased the risk of encountering active bleeding. We developed a visual nomogram to estimate the risk of active bleeding. Overall, 43% of the cohort did not require any hemostatic therapy. Rebleeding (<6%) and transfusion requirements were low in those managed without intervention. CONCLUSIONS In a study of patients with DPPB, we found that almost half do not warrant any therapeutic intervention. Colonoscopy often is overused for patients with DPPB. We identified independent risk factors for active bleeding that might be used to identify patients most likely to benefit from colonoscopy.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria Universidad de Alcalá, Madrid, Spain
| | - Maria Hernández-Tejero
- Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain
| | - Oswaldo Ortiz
- Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain
| | - Irene García de la Filia-Molina
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria Universidad de Alcalá, Madrid, Spain
| | - Jose Ramon Foruny-Olcina
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria Universidad de Alcalá, Madrid, Spain
| | - Hector Miguel Marcos Prieto
- Gastroenterology Department, Hospital Universitario de Salamanca, University of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Maria García-Prada
- Gastroenterology Department, Hospital Universitario de Salamanca, University of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Almudena González-Cotorruelo
- Gastroenterology Department, Hospital Universitario de Salamanca, University of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | | | - Carlos Rodríguez-Escaja
- Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Andres Castaño-García
- Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ana Gómez Outomuro
- Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Ferre-Aracil
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid
| | - Diego de-Frutos-Rosa
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid
| | - María Pellisé
- Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Universitat de Barcelona, Barcelona, Spain.
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17
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Pickell Z, Raghavendran K, Westerhoff M, Williams AM. Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhage. Autops Case Rep 2021; 11:e2020232. [PMID: 33968819 PMCID: PMC8020585 DOI: 10.4322/acr.2020.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acute hemorrhagic cholecystitis is a rare, life-threatening condition that can be further complicated by perforation of the gallbladder. We describe a patient with clinical and radiologic findings of acute cholecystitis with a gallbladder rupture and massive intra-abdominal bleeding. Our patient is a 67-year-old male who presented with an ischemic stroke and was treated with early tissue plasminogen activator. His hospital course was complicated by a fall requiring posterior spinal fusion surgery. He recovered well, but several days later developed subxiphoid and right upper quadrant pain and an episode of hemobilia and melena. A computed tomography scan revealed an inflamed, distended gallbladder with indistinct margins and a large hematoma in the gallbladder fossa extending to the right paracolic gutter. The patient also developed hemodynamic instability concerning for hemorrhagic shock. He underwent an emergent laparoscopic converted to open subtotal fenestrating cholecystectomy with abdominal washout for management of his acute hemorrhagic cholecystitis with massive intra-abdominal hemorrhage. Prompt recognition of this lethal condition in high-risk patients is crucial for optimizing patient care.
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Affiliation(s)
- Zachary Pickell
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, Michigan, USA
| | - Krishnan Raghavendran
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, Michigan, USA
| | - Maria Westerhoff
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, Michigan, USA
| | - Aaron M Williams
- University of Michigan, Michigan Medicine, Department of Surgery, Ann Arbor, Michigan, USA
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18
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Hung KW, Knotts RM, Faye AS, Pont AR, Lebwohl B, Abrams JA, Freedberg DE. Factors Associated With Adherence to Helicobacter pylori Testing During Hospitalization for Bleeding Peptic Ulcer Disease. Clin Gastroenterol Hepatol 2020; 18:1091-1098.e1. [PMID: 31352090 DOI: 10.1016/j.cgh.2019.07.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Guidelines recommend testing patients with peptic ulcer disease for Helicobacter pylori infection. We sought to identify factors associated with adherence to testing for H pylori in patients hospitalized for bleeding ulcers and to evaluate whether performing these tests affect risk for rebleeding. METHODS We performed a retrospective study of 830 inpatients who underwent endoscopy from 2011 through 2016 for gastrointestinal bleeding from gastric or duodenal ulcers. We searched electronic medical records for evidence of tests to detect H pylori by biopsy, serologic, or stool antigen analyses. We used multivariable models to identify clinical, demographic, and endoscopic factors associated with testing for H pylori. Kaplan-Meier analysis was performed to determine whether H pylori testing altered risk for the composite outcome of rebleeding or death within 1 year of admission. RESULTS Among the patients hospitalized for bleeding peptic ulcer disease during the 6-year period, 19% were not tested for H pylori within 60 days of index endoscopy. Hospitalization in the intensive care unit (ICU) was the factor most frequently associated with nonadherence to H pylori testing guidelines (only 66% of patients in the ICU were tested vs 90% of patients not in the ICU; P < .01), even after we adjusted for ulcer severity, coagulation status, extent of blood loss, and additional factors (adjusted odds ratio, 0.42; 95% CI, 0.27-0.66). Testing for H pylori was associated with a 51% decreased risk of rebleeding or death during the year after admission (adjusted hazard ratio 0.49; 95% CI, 0.36-0.67). CONCLUSIONS In an analysis of hospitalized patients who underwent endoscopy for gastrointestinal bleeding from gastric or duodenal ulcers, we found admission to the ICU to be associated with failure to test for H pylori infection. Failure to test for H pylori was independently associated with increased risk of rebleeding or death within 1 year of hospital admission. We need strategies to increase testing for H pylori among inpatients with bleeding ulcers.
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Affiliation(s)
- Kenneth W Hung
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York; Section of Digestive Diseases, Department of Medicine, Yale University, New Haven, Connecticut.
| | - Rita M Knotts
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University, New York, New York
| | - Adam S Faye
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York
| | - Adam R Pont
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York
| | - Benjamin Lebwohl
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Julian A Abrams
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Daniel E Freedberg
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, New York; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Abstract
Heyde syndrome manifests as aortic stenosis associated with gastrointestinal
bleeding. We describe the case of a 64-year-old man who came to the emergency
room due to acute heart failure and intermittent gastrointestinal bleeding.
Treatment involves initial correction of anemia and heart failure followed by
aortic valve replacement. The prosthesis used depends on the characteristics of
each patient and valve replacement allows the resolution of bleeding in most
cases. Gastrointestinal bleeding in patients with aortic stenosis is associated
with severity of the valve obstruction. A mechanical prosthesis was used with no
recurrent bleeding even with the need for lifelong anticoagulation therapy.
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Affiliation(s)
- Leonardo Rufino Garcia
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital das Clínicas Botucatu SP Brazil Serviço de Cirurgia Cardiovascular, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - André Monti Garzesi
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital das Clínicas Botucatu SP Brazil Serviço de Cirurgia Cardiovascular, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Guilherme Tripoli
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital das Clínicas Botucatu SP Brazil Serviço de Cirurgia Cardiovascular, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Nelson Leonardo Kerdahi Leite de Campos
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital das Clínicas Botucatu SP Brazil Serviço de Cirurgia Cardiovascular, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Antonio Sérgio Martins
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital das Clínicas Botucatu SP Brazil Serviço de Cirurgia Cardiovascular, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Marcello Laneza Felicio
- Universidade Estadual Paulista Faculdade de Medicina de Botucatu Hospital das Clínicas Botucatu SP Brazil Serviço de Cirurgia Cardiovascular, Hospital das Clínicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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20
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Feagins LA, Smith AD, Kim D, Halai A, Duttala S, Chebaa B, Lunsford T, Vizuete J, Mara M, Mascarenhas R, Meghani R, Kundrotas L, Dunbar KB, Cipher DJ, Harford WV, Spechler SJ. Efficacy of Prophylactic Hemoclips in Prevention of Delayed Post-Polypectomy Bleeding in Patients With Large Colonic Polyps. Gastroenterology 2019; 157:967-976.e1. [PMID: 31158369 DOI: 10.1053/j.gastro.2019.05.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS The efficacy of prophylactic placement of hemoclips to prevent delayed bleeding after removal of large colonic polyps has not been established. We conducted a randomized equivalence study to determine whether prophylactic placement of hemoclips affects incidence of delayed post-polypectomy bleeding (PPB). METHODS During elective colonoscopy performed at 4 Veterans Affairs Medical Centers, 1098 patients who had polyps ≥1 cm removed were randomly assigned to groups that received prophylactic hemoclips (n = 547) or no hemoclips (n = 551), from September 2011 through September 2018. Data on PPB (rectal bleeding resulting in hemoglobin decreases ≥2 g/dL, hemodynamic instability, colonoscopy, angiography, or surgery) within 30 days of colonoscopy (called delayed PPB) were collected during telephone interviews or hospital visits 7 and 30 days after colonoscopy. The primary outcome was the incidence of important post-polypectomy bleeding. RESULTS Twelve patients in the hemoclip group (2.3%) and 15 patients in the no hemoclip group (2.9%) had important delayed PPB. There were no deaths, and no patients in either group required angiography or surgery. In intention-to-treat analysis, two 1-sided test's lower and upper confidence interval limits were -2.07 and 1.01, indicating that the data approached but did not meet equivalence criteria. On multiple logistic regression analysis, significant predictors of PPB included use of warfarin with bridging, thienopyridines, polyp size, and polyp location, but hemoclip placement did not associate with important delayed PPB. CONCLUSIONS In a randomized trial, we found that prophylactic placement of hemoclips after removal of large colon polyps does not affect the proportion of important delayed PPB events, compared with no hemoclip placement. These findings call into question the widespread, expensive practice of routinely placing prophylactic hemoclips after polypectomy. ClinicalTrials.gov ID: NCT01647581.
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Affiliation(s)
- Linda A Feagins
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Andrew D Smith
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Daniel Kim
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Akeel Halai
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Suneetha Duttala
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Benjamin Chebaa
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Tisha Lunsford
- Department of Medicine, South Texas Veterans Healthcare System, San Antonio, Texas; Department of Medicine, University of Texas San Antonio Health Sciences Center, San Antonio, Texas
| | - John Vizuete
- Department of Medicine, South Texas Veterans Healthcare System, San Antonio, Texas; Department of Medicine, University of Texas San Antonio Health Sciences Center, San Antonio, Texas
| | - Miriam Mara
- Department of Medicine, South Texas Veterans Healthcare System, San Antonio, Texas
| | - Ranjan Mascarenhas
- Department of Medicine, Central Texas Veterans Healthcare System, Austin Outpatient Clinic, Austin, Texas; Department of Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Rabia Meghani
- Department of Medicine, Central Texas Veterans Healthcare System, Austin Outpatient Clinic, Austin, Texas
| | - Leon Kundrotas
- Department of Medicine, South Texas Veterans Healthcare System, San Antonio, Texas; Department of Medicine, University of Texas San Antonio Health Sciences Center, San Antonio, Texas
| | - Kerry B Dunbar
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daisha J Cipher
- The College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - William V Harford
- Department of Medicine, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stuart J Spechler
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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21
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Tabibian JH, Rhoades DP, Forde KA, McLean RC, Chandrasekhara V. Timing of Gastrointestinal Bleeding After Implantation of Left Ventricular Assist Devices Associates With Anatomic Location, Presentation, and Management. Clin Gastroenterol Hepatol 2019; 17:448-454. [PMID: 29906524 DOI: 10.1016/j.cgh.2018.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Continuous-flow left ventricular assist devices (LVADs) for advanced heart failure have been associated with gastrointestinal bleeding (GIB). We examined the association between time of GIB after LVAD implantation and bleeding location (determined by endoscopy), etiology, and patient outcomes. METHODS We performed a retrospective study of consecutive patients who underwent implantation of continuous-flow LVADs from 2008 through 2015. We analyzed data on anatomic location of GIB, etiology, length of hospital stay, transfusion requirement, time to endoscopy, and readmission to the hospital within 30 days (30-day readmission). RESULTS GIB developed in 59 of the 271 patients (22%). Higher proportions of patients with GIB during their index hospitalization for LVAD implantation had upper or lower GIB (86.7%) than patients with GIB during a subsequent hospitalization (50.0%; P = .013). Patients with GIB during their index hospitalization also had lower rates of middle GIB (0 vs 20.5%; P = .052), higher rates of overt GIB (100% vs 63.6%; P = .006), longer hospital stays (24 days vs 11 days; P < .001), and more transfusions before endoscopy (7 units vs 4 units; P = .021) than patients with GIB during a subsequent hospitalization. There were no significant differences between groups in time to endoscopy (2 days vs 2.5 days) or 30-day readmission (6.7% vs 9.3%). Angiodysplasias were identified in 100% of patients with middle GIB compared to 48.5% of patients with upper or lower GIB (P < .001) in whom a bleeding lesion was identified. CONCLUSION In a retrospective study of patients who underwent implantation of continuous-flow LVADs, we found that timing of GIB associates with the location and severity of bleeding. Although patients with LVADs have an overall increase in risk of middle GIB, patients with GIB during their index LVAD hospitalization should undergo initial evaluation by upper endoscopy and colonoscopy, due to insufficient time for development of small bowel angiodysplasias. Patients who later develop GIB should be evaluated early for middle GI bleeding.
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Affiliation(s)
- James H Tabibian
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Daniel P Rhoades
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kimberly A Forde
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rhondalyn C McLean
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
Gastric Dieulafoy’s lesion (DL) is a potentially fatal entity that causes upper digestive hemorrhage as a consequence of the erosion of an abnormal large-caliber artery in the submucosa of the gastrointestinal tract. We report the case of a 59-year-old female patient admitted to the emergency facility due to melena without any active sign of bleeding during the esophagogastroduodenoscopy. Unexpectedly, she progressed presenting a massive hematemesis followed by an irreversible cardiorespiratory arrest. The aim of this study is to draw attention to DL as a possible cause of massive and fatal digestive hemorrhage, and to describe the anatomical autopsy findings.
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Affiliation(s)
- Cesar Cilento Ponce
- Metropolitan University of Santos (UNIMES), Hospital Guilherme Álvaro, Department of Pathology. Santos, SP, Brazil
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23
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Cho SH, Lee YS, Kim YJ, Sohn CH, Ahn S, Seo DW, Kim WY, Lee JH, Lim KS. Outcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding. Clin Gastroenterol Hepatol 2018. [PMID: 28634135 DOI: 10.1016/j.cgh.2017.06.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated clinical outcomes in high-risk patients with acute nonvariceal upper gastrointestinal bleeding (UGIB), and determined if urgent endoscopy is effective. METHODS Consecutive patients with a Glasgow-Blatchford score greater than 7 who underwent endoscopy for acute nonvariceal UGIB at the emergency department from January 1, 2005, to December 31, 2014, were included. Urgent (<6 h) and elective (6-48 h) endoscopies were defined according to the time to endoscopy after the initial presentation. The primary outcomes were mortality and rebleeding within 28 days of admission. RESULTS Among 961 patients, 571 patients underwent urgent endoscopy. The 28-day mortality rate was 2.5%, and the rebleeding rate was 10.4%. There were significant differences in mortality rate (1.6% vs 3.8%), the number of transfused packed red blood cells (2.6 ± 2.5 vs 2.3 ± 2.1 packs), need for intervention (69.5% vs 53.5%), and embolization (2.8% vs 0.5%), but no differences in rebleeding, intensive care unit admission, vasopressor use, and length of stay between the urgent and elective endoscopy groups. Mortality was associated with malignancy (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.33-9.62), cirrhosis (OR, 4.67; 95% CI, 1.85-11.76), urgent endoscopy (OR, 0.36; 95% CI, 0.14-0.95), failed primary endoscopic treatment (OR, 15.03; 95% CI, 4.63-48.82), and rebleeding (OR, 2.77; 95% CI, 1.03-7.45). Rebleeding was associated with Forrest I ulcers (OR, 7.67; 95% CI, 2.71-21.69), Forrest II ulcers (OR, 2.34; 95% CI, 1.51-3.60), and coagulopathy (OR, 2.34; 95% CI, 1.51-3.60). CONCLUSIONS Urgent endoscopy was an independent predictor of lower mortality rate but was not associated with rebleeding in high-risk patients with acute nonvariceal UGIB.
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Affiliation(s)
- Soo-Han Cho
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yoon-Seon Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Hwan Sohn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Ahn
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Woo Seo
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Ho Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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24
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Konecki D, Grabowska-Derlatka L, Pacho R, Rowiński O. Correlation Between Findings of Multislice Helical Computed Tomography (CT), Endoscopic Examinations, Endovascular Procedures, and Surgery in Patients with Symptoms of Acute Gastrointestinal Bleeding. Pol J Radiol 2017; 82:676-684. [PMID: 29662594 PMCID: PMC5894035 DOI: 10.12659/pjr.902331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/10/2017] [Indexed: 12/16/2022] Open
Abstract
Background Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. Material/Methods The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. Results The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. Conclusions CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding.
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Affiliation(s)
- Dariusz Konecki
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Ryszard Pacho
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Olgierd Rowiński
- 2 Department of Radiology, Medical University of Warsaw, Warsaw, Poland
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25
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Lee KE, Shim KN, Tae CH, Ryu MS, Choi SY, Moon CM, Kim SE, Jung HK, Jung SA. Multidisciplinary Approach to Refractory Upper Gastrointestinal Bleeding: Case Series of Angiographic Embolization. J Korean Med Sci 2017; 32:1552-1557. [PMID: 28776354 PMCID: PMC5546978 DOI: 10.3346/jkms.2017.32.9.1552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/29/2016] [Indexed: 12/20/2022] Open
Abstract
Although medical and endoscopic hemostasis is now considered as the first-line therapy for nonvariceal upper gastrointestinal (UGI) bleeding, refractory bleeding still occurs in 5%-10% of the patients. In these patients, transcatheter arterial embolization (TAE) or surgery is required, but research on embolization for unmanageable UGI bleeding in Korea is scanty. We reviewed the medical records of 518 patients who underwent endoscopic hemostasis during 4 years. Among these subjects, 8 patients who required embolization due to failure of endoscopic hemostasis were enrolled. Mean patient age was 74.00 ± 8.25 years, and rebleeding occurred in 4 patients within 48 hours after TAE. Three patients with duodenal rebleeding underwent surgery, and the other patient with a gastric ulcer underwent endoscopic hemostasis. Nonvariceal UGI bleeding remains a serious clinical challenge, especially in older patients. A multidisciplinary approach including endoscopists, interventional radiologists, and surgeons may be important for the treatment of nonvariceal UGI bleeding.
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Affiliation(s)
- Ko Eun Lee
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ki Nam Shim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.
| | - Chung Hyun Tae
- Department of Health Promotion Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min Sun Ryu
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sun Young Choi
- Department of Radiology, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hey Kyung Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
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26
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Peixoto A, Gonçalves R, Macedo G. Acute Gastrointestinal Bleeding Caused by Dieulafoy Lesion of the Esophagus. ACTA MEDICA PORT 2017; 30:426. [PMID: 28865509 DOI: 10.20344/amp.8209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Armando Peixoto
- Gastroenterology Department. Centro Hospitalar de São João. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Regina Gonçalves
- Gastroenterology Department. Centro Hospitalar de São João. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Guilherme Macedo
- Gastroenterology Department. Centro Hospitalar de São João. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
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27
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Abstract
Gastrointestinal bleeding is defined in temporal-spatial terms-as acute or chronic, and/or by its location in the gastrointestinal tract. Here, we define a distinct type of bleeding, which we have coined 'acute on chronic' gastrointestinal bleeding. We prospectively identified all patients who underwent endoscopic evaluation for any form of gastrointestinal bleeding at a University Hospital. Acute on chronic bleeding was defined as the presence of new symptoms or signs of acute bleeding in the setting of chronic bleeding, documented as iron deficiency anemia. Bleeding lesions were categorized using previously established criteria. We identified a total of 776, 254, and 430 patients with acute, chronic, or acute on chronic bleeding, respectively. In patients with acute on chronic gastrointestinal bleeding, lesions were most commonly identified in esophagus (28%), colon and rectum (27%), and stomach (21%) (p<0.0001 vs locations for acute or chronic bleeding). In those specifically with acute on chronic upper gastrointestinal bleeding (n=260), bleeding was most commonly due to portal hypertensive lesions, identified in 47% of subjects compared with 29% of acute and 25% of chronic bleeders, (p<0.001). In all patients with acute on chronic bleeding, 30-day mortality was less than that after acute bleeding alone (2% (10/430) vs 7% (54/776), respectively, p<0.001). Acute on chronic gastrointestinal bleeding is common, and in patients with upper gastrointestinal bleeding was most often a result of portal hypertensive upper gastrointestinal tract pathology. Reduced mortality in patients with acute on chronic gastrointestinal bleeding compared with those with acute bleeding raises the possibility of an adaptive response.
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Affiliation(s)
- Don C Rockey
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA (present Department of Internal Medicine, Medical Univeristy of South Carolina, Charleston, South Carolina, USA)
| | - Adam C Hafemeister
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA (present Austin Gastroenterology, Austin, Texas, USA)
| | - Joan S Reisch
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center and Parkland Memorial Hospital, Dallas, Texas, USA
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28
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Rockey DC, Ahn C, de Melo SW. Randomized pragmatic trial of nasogastric tube placement in patients with upper gastrointestinal tract bleeding. J Investig Med 2017; 65:759-764. [PMID: 28069629 DOI: 10.1136/jim-2016-000375] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/04/2022]
Abstract
The value of nasogastric (NG) tube placement in patients with upper gastrointestinal tract bleeding (UGIB) is unclear. We therefore aimed to determine the usefulness of NG tube placement in patients with UGIB. The study was a single-blind, randomized, prospective, non-inferiority study comparing NG placement (with aspiration and lavage) to no NG placement (control). The primary outcome was the probability that physicians could predict the presence of a high-risk lesion (ie, requiring endoscopic therapy). 140 patients in each arm were included; baseline clinical features were similar in each group. The probability that there would be a high-risk lesion in the control arm was predicted to be 35% compared with 39% in the NG arm (after NG placement)-a probability difference of -4% (95% CI -12% to 3%), which confirmed non-inferiority of the 2 arms (p=0.002). All patients underwent endoscopy and all patients with high-risk lesions had endoscopic therapy. Physicians predicted the specific culprit lesion in 38% (53/140) and 39% (55/140) of patients in the control and NG (after NG placement) groups, respectively. The presence of coffee grounds or red blood in the NG aspirate did not change physician assessments. Pain, nasal bleeding, or failure of NG occurred in 47/140 (34%) patients. There were no differences in rebleeding rates or mortality. In patients with acute UGIB, the ability of physicians to predict culprit bleeding lesions and/or the presence of high-risk lesions was poor. Routine NG placement did not improve physician's predictive ability, did not affect outcomes, and was complicated in one-third of patients. TRAIL REGISTRATION NUMBER NCT00689754.
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Affiliation(s)
- Don C Rockey
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chul Ahn
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Silvio W de Melo
- Department of Internal Medicine, University of Florida at Jacksonville, Jacksonville, Florida, USA
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29
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Abraham NS, Noseworthy PA, Yao X, Sangaralingham LR, Shah ND. Gastrointestinal Safety of Direct Oral Anticoagulants: A Large Population-Based Study. Gastroenterology 2017; 152:1014-1022.e1. [PMID: 28043907 DOI: 10.1053/j.gastro.2016.12.018] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Direct oral anticoagulant (DOAC) agents increase the risk of gastrointestinal (GI) bleeding. We investigated which DOAC had the most favorable GI safety profile and compared differences among these drugs in age-related risk of GI bleeding. METHODS We conducted a retrospective, propensity-matched study using administrative claims data from the OptumLabs Data Warehouse of privately insured individuals and Medicare Advantage enrollees. We created 3 propensity-matched cohorts of patients with non-valvular atrial fibrillation with incident exposure to dabigatran, rivaroxaban, or apixaban from October 1, 2010 through February 28, 2015. We compared data on rivaroxaban vs dabigatran for 31,574 patients, data on apixaban vs dabigatran for 13,084 patients, and data on apixaban vs rivaroxaban for 13,130 patients. Cox proportional hazards models, stratified by age, were used to estimate rates of total GI bleeding. RESULTS Baseline characteristics were well balanced among sub-cohorts. GI bleeding occurred more frequently in patients given rivaroxaban than dabigatran (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.00-1.45). Apixaban was associated with a lower risk of GI bleeding than dabigatran (HR, 0.39; 95% CI, 0.27-0.58; P < .001) or rivaroxaban (HR, 0.33; 95% CI, 0.22-0.49; P < .001). Rates of events for all DOACs increased among patients 75 years or older. Apixaban had a lower risk of association with GI bleeding in the very elderly than dabigatran (HR, 0.45; 95% CI, 0.29-0.71) or rivaroxaban (HR, 0.39; 95% CI, 0.25-0.61). Median times to GI bleeding were <90 days for apixaban and rivaroxaban and <120 days for dabigatran. CONCLUSIONS In a population-based study of patients receiving DOAC agents, we found apixaban had the most favorable GI safety profile and rivaroxaban the least favorable profile. GI bleeding events among patient aged 75 years or older taking DOACs increased with age; the risk was greatest among persons 75 years. Apixaban had the most favorable GI safety profile among all age groups.
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Affiliation(s)
- Neena S Abraham
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota.
| | - Peter A Noseworthy
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Xiaoxi Yao
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lindsey R Sangaralingham
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Nilay D Shah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota; Optum Labs, Cambridge, Massachusetts
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30
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Maddah G, Abdollahi A, Rouhbakhshfar O, Taraz Jamshidi S, Hassanpour M. Arteriovenous malformations of the colon: A report of two cases and review of the literature. Caspian J Intern Med 2017; 8:52-55. [PMID: 28503284 PMCID: PMC5412250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Arteriovenous malformations are one of the most common vascular disorders of the colon. Vascular disorders present as painless, high-volume rectal bleeding. CASE PRESENTATION This study elucidates two rare cases of vascular disorders that are diagnosed as angiodysplasia of the left colon and cavernous hemangioma of the colon and rectum. The chief complaint in two patients was rectorrhagia. The patients who were diagnosed of ulcerative colitis were treated with sulfadiazine and prednisone. Due to continuous bleeding, the patients were referred to the surgery department for operation. The patients underwent total proctocolectomy. CONCLUSION We discuss the faults in the diagnosis and management of vascular disorders of the intestine.
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Affiliation(s)
- Ghodratollah Maddah
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Correspondence: Abbas Abdollahi, Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail: , Tel: 0098 51 38022677, Fax: 0098 51 38525255
| | - Omid Rouhbakhshfar
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Masoumeh Hassanpour
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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31
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Carmo J, Marques S, Bispo M, Barreiro P, Gonçalves B, Guerra A, Pinto-Marques P, Serra D. Massive Gastrointestinal Bleeding from an Ectopic Varix in a Non-Cirrhotic Patient: Angiographic Approach Following Endoscopic Treatment Failure. GE Port J Gastroenterol 2016; 23:177-179. [PMID: 28868456 PMCID: PMC5580007 DOI: 10.1016/j.jpge.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/25/2015] [Indexed: 12/05/2022]
Affiliation(s)
- Joana Carmo
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Susana Marques
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Bispo
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Gastroenterology Department, Hospital da Luz, Lisbon, Portugal
| | - Pedro Barreiro
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Gastroenterology Department, Hospital da Luz, Lisbon, Portugal
| | | | | | | | - David Serra
- Gastroenterology Department, Hospital da Luz, Lisbon, Portugal
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32
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Giestas S, Almeida N, Martins R, Canhoto A, Oliveira P, Figueiredo P, Sofia C. Small Bowel GIST: Clinical Presentation as Intussusception and Obscure Bleeding. GE Port J Gastroenterol 2016; 23:279-281. [PMID: 28868478 PMCID: PMC5580152 DOI: 10.1016/j.jpge.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Sílvia Giestas
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Almeida
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ruben Martins
- Surgery B Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Canhoto
- Surgery B Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Oliveira
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carlos Sofia
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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33
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Lee YJ, Hwang JY, Cho YH, Kim YW, Kim TU, Shin DH. A long-Segmental Vascular Malformation in the Small Bowel Presenting With Gastrointestinal Bleeding in a Preschool-Aged Child. Iran J Radiol 2016; 13:e29260. [PMID: 27110342 PMCID: PMC4835636 DOI: 10.5812/iranjradiol.29260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/30/2015] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
Abstract
Gastrointestinal (GI) bleeding in pediatric patients has several causes. Vascular malformation of the small bowel is a rare disease leading to pediatric GI bleeding. To our knowledge, few reports describe ultrasound and computed tomography findings of venous malformations involving the small bowel. We present a case of long-segmental and circumferential vascular malformation that led to GI bleeding in a pre-school aged child, focusing on the radiologic findings. Although vascular malformation including of the GI tract is rare in children, it should be considered when GI bleeding occurs in pediatric patients.
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Affiliation(s)
- Yeoun Joo Lee
- Department of Pediatrics, Pusan National University Children’s Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
- Corresponding author: Jae-Yeon Hwang, Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea. Tel: +82-553602778, Fax: +82-553601848, E-mail:
| | - Yong Hoon Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Yong-Woo Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Tae Un Kim
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
| | - Dong Hoon Shin
- Department of Pathology, Pusan National University Yangsan Hospital, Pusan National University, School of Medicine, Yangsan, Republic of Korea
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Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, Jensen ET, Lund JL, Pasricha S, Runge T, Schmidt M, Shaheen NJ, Sandler RS. Burden of Gastrointestinal, Liver, and Pancreatic Diseases in the United States. Gastroenterology 2015; 149:1731-1741.e3. [PMID: 26327134 PMCID: PMC4663148 DOI: 10.1053/j.gastro.2015.08.045] [Citation(s) in RCA: 639] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/12/2015] [Accepted: 08/20/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Gastrointestinal (GI), liver, and pancreatic diseases are a source of substantial morbidity, mortality, and cost in the United States. Quantification and statistical analyses of the burden of these diseases are important for researchers, clinicians, policy makers, and public health professionals. We gathered data from national databases to estimate the burden and cost of GI and liver disease in the United States. METHODS We collected statistics on health care utilization in the ambulatory and inpatient setting along with data on cancers and mortality from 2007 through 2012. We included trends in utilization and charges. The most recent data were obtained from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the National Cancer Institute. RESULTS There were 7 million diagnoses of gastroesophageal reflux and almost 4 million diagnoses of hemorrhoids in the ambulatory setting in a year. Functional and motility disorders resulted in nearly 1 million emergency department visits in 2012; most of these visits were for constipation. GI hemorrhage was the most common diagnosis leading to hospitalization, with >500,000 discharges in 2012, at a cost of nearly $5 billion dollars. Hospitalizations and associated charges for inflammatory bowel disease, Clostridium difficile infection, and chronic liver disease have increased during the last 20 years. In 2011, there were >1 million people in the United States living with colorectal cancer. The leading GI cause of death was colorectal cancer, followed by pancreatic and hepatobiliary neoplasms. CONCLUSIONS GI, liver and pancreatic diseases are a source of substantial burden and cost in the United States.
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Affiliation(s)
- Anne F. Peery
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Seth D. Crockett
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Evan S. Dellon
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Swathi Eluri
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | | | - Sarina Pasricha
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Thomas Runge
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Monica Schmidt
- University of North Carolina School of Medicine, Chapel Hill, NC
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Boal Carvalho P, Cotter J. Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel. GE Port J Gastroenterol 2016; 23:28-35. [PMID: 28868427 DOI: 10.1016/j.jpge.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/09/2015] [Indexed: 11/22/2022]
Abstract
Small bowel evaluation is a challenging task and has been revolutionized by high-quality contrasted sectional imaging (CT enterography - CTE) and magnetic resonance enterography (MRE) as well as by small bowel capsule endoscopy (SBCE). The decision of which technique to employ during the investigation of small bowel diseases is not always simple or straightforward. Moreover, contraindications may preclude the use of these techniques in some patients, and although they are noninvasive procedures, may present with various complications. SBCE plays a crucial role in the investigation of both obscure gastrointestinal bleeding and Crohn's disease, but it is also useful for surveillance of patients with Peutz-Jeghers syndrome, while CTE is very accurate in small bowel tumours and in established Crohn's Disease, and its use in patients presenting with gastrointestinal bleeding is increasing. MRE, an expensive and not widely available technique, is essential for the study of patients with Crohn's Disease, and presents an attractive alternative to SBCE in Peutz-Jeghers syndrome surveillance. These diagnostic modalities are often not competitive but synergistic techniques. Knowing their characteristics, strengths and limitations, indications, contraindications and potential complications, as well as the adaptation to local availability and expertise, is essential to better select which procedures to perform in each patient, both safely and effectively, in order to optimize management and improve patient outcomes.
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Barbeiro S, Martins CA, Marcos P, Gonçalves C. Brunner's Gland Hamartoma - A Rare Cause of Upper Gastrointestinal Bleeding. GE Port J Gastroenterol 2015; 22:283-285. [PMID: 28868421 PMCID: PMC5580153 DOI: 10.1016/j.jpge.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sandra Barbeiro
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Pedro Marcos
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Gonçalves
- Gastroenterology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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Eusébio M, Ramos A, Guerreiro H. Intraluminal Duodenal ("Windsock") Diverticulum: A Rare Cause of Gastrointestinal Bleeding. GE Port J Gastroenterol 2015; 23:113-115. [PMID: 28868443 PMCID: PMC5580164 DOI: 10.1016/j.jpge.2015.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/17/2015] [Indexed: 10/26/2022]
Affiliation(s)
- Marta Eusébio
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - André Ramos
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
| | - Horácio Guerreiro
- Gastroenterology Department, Centro Hospitalar do Algarve, Faro, Portugal
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Sawicki M, Marlicz W, Czapla N, Łokaj M, Skoczylas MM, Donotek M, Kołaczyk K. Massive Upper Gastrointestinal Bleeding from a Splenic Artery Pseudoaneurysm Caused by a Penetrating Gastric Ulcer: Case Report and Review of Literature. Pol J Radiol 2015; 80:384-7. [PMID: 26309450 PMCID: PMC4538884 DOI: 10.12659/pjr.894465] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022] Open
Abstract
Background Splenic artery aneurysm and pseudoaneurysm are rare pathologies. True aneurysms are usually asymptomatic. Aneurysm rupture occurring in 2–3% of cases results in bleeding into the lesser sack, peritoneal space or adjacent organs typically presenting as abdominal pain and hemodynamic instability. In contrast, pseudoaneurysms are nearly always symptomatic carrying a high risk of rupture of 37–47% and mortality rate of 90% if untreated. Therefore, prompt diagnosis and treatment are essential in the management of patients with splenic artery pseudoaneurysm. Typical causes include pancreatitis and trauma. Rarely, the rupture of a pseudoaneurysm presents as upper gastrointestinal (UGI) bleeding. Among causes, peptic ulcer is the casuistic one. Case Report This report describes a very rare case of recurrent UGI bleeding from a splenic artery pseudoaneurysm caused by a penetrating gastric ulcer. After negative results of endoscopy and ultrasound, the diagnosis was established in CT angiography. The successful treatment consisted of surgical ligation of the bleeding vessel and suture of the ulcer with preservation of the spleen and pancreas, which is rarely tried in such situations. Conclusions The most important factor in identifying a ruptured splenic artery pseudoaneurysm as a source of GI bleeding is considering the diagnosis. UGI hemorrhage from splenic artery pseudoaneurysm can have a relapsing course providing false negative results of endoscopy and ultrasound if performed between episodes of active bleeding. In such cases, immediate CT angiography is useful in establishing diagnosis and in application of proper therapy before possible recurrence.
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Affiliation(s)
- Marcin Sawicki
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Norbert Czapla
- Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Marek Łokaj
- Clinic of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Michał M Skoczylas
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Maciej Donotek
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
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Garcarek J, Kurcz J, Guziński M, Banasik M, Miś M, Gołębiowski T. Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast - Own Experiences. Pol J Radiol 2015; 80:344-9. [PMID: 26191113 PMCID: PMC4497469 DOI: 10.12659/pjr.894050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 04/09/2015] [Indexed: 11/09/2022] Open
Abstract
Background High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages. Material/Methods Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1–2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6–8 mL of Iodixanol (320 mg/mL) diluted with saline to 18–24 mL was administered at a speed of 4–5 mL/s. Results Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. Conclusions 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site.
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Affiliation(s)
- Jerzy Garcarek
- Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland
| | - Jacek Kurcz
- Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland
| | - Maciej Guziński
- Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland
| | - Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Marcin Miś
- Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland
| | - Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
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Batur A, Yavuz A, Toktas O, Bora A, Bulut MD. Hepatic Artery Pseudoaneurysm: Delayed Presentation after a Blunt Trauma. Pol J Radiol 2015; 80:334-6. [PMID: 26171087 PMCID: PMC4489684 DOI: 10.12659/pjr.894177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/13/2015] [Indexed: 12/29/2022] Open
Abstract
Background Ruptured hepatic artery pseudoaneurysm is a rare condition that is life-threatening if not diagnosed and treated rapidly. We present a case of a spontaneously ruptured hepatic artery pseudoaneurysm that occurred after a blunt trauma, and provide a review of the current literature on this topic. This case study demonstrates a spontaneously ruptured hepatic artery pseudoaneurysm which emerged following a blunt trauma and it also presents current literature studies on the topic. Case Report A man at the age of 34 years with blunt trauma dating back to 1.5 month was admitted to the emergency department of a hospital with hematemesis and epigastric tenderness. He also had a duodenal ulcer, blood in the gastric lumen and a large pseudoaneurysm that developed from the left hepatic artery. Soon after the diagnosis, the patient worsened and underwent distal gastrectomy and cholecystectomy that included removing the bleeding aneurysm. Conclusions Ruptured hepatic artery pseudoaneurysm stands as a deadly condition which has to be diagnosed and managed as soon as possible. Physicians need to take aneurysms of abdominal arteries into consideration after routine diagnostic practises as long as the cause of gastrointestinal haemorrhage is unidentified.
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Affiliation(s)
- Abdussamet Batur
- Department of Radiology, Yuzuncuyil University Dursun Odabas Medical Center, Van Sehri, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Yuzuncuyil University Dursun Odabas Medical Center, Van Sehri, Turkey
| | - Osman Toktas
- Department of Radiology, Yuzuncuyil University Dursun Odabas Medical Center, Van Sehri, Turkey
| | - Aydın Bora
- Department of Radiology, Yuzuncuyil University Dursun Odabas Medical Center, Van Sehri, Turkey
| | - Mehmet Deniz Bulut
- Department of Radiology, Yuzuncuyil University Dursun Odabas Medical Center, Van Sehri, Turkey
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Costa M, Ramos G. Duodenal Variceal Bleeding Successfully Treated by Endoscopic N-butyl-2-cyanoacrylate Injection. GE Port J Gastroenterol 2015; 22:180-181. [PMID: 28868403 PMCID: PMC5580191 DOI: 10.1016/j.jpge.2015.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 12/24/2022]
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Coelho R, Orfão B, Santos-Antunes J, Rodrigues-Pinto E, Pereira P, Baldaia H, Macedo G. Upper Gastrointestinal Hemorrhage as an Unexpected Feature of Hepatocellular Carcinoma. GE Port J Gastroenterol 2015; 22:172-174. [PMID: 28868400 PMCID: PMC5580097 DOI: 10.1016/j.jpge.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Rosa Coelho
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Branca Orfão
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | | | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Helena Baldaia
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal
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Ribeiro I, Pinho R, Rodrigues A, Fernandes C, Silva J, Ponte A, Tente D, Carvalho J. The Importance of Alternative Diagnostic Modalities in the Diagnosis of Small Bowel Tumors After a Negative Capsule Endoscopy. GE Port J Gastroenterol 2015; 22:112-116. [PMID: 28868387 PMCID: PMC5580001 DOI: 10.1016/j.jpge.2015.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/31/2015] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy is widely accepted as the preferred diagnostic test in the evaluation of small bowel diseases, especially in the setting of obscure gastrointestinal bleeding. It has revolutionized small bowel examination and has improved the detection of small bowel tumors. However, small bowel tumors are sometimes missed by capsule endoscopy. Furthermore, there are several recent reports comparing capsule endoscopy with other diagnostic modalities, such as double balloon enteroscopy and CT/RM enterography, that challenge the reportedly high negative predictive value of capsule endoscopy in detecting small bowel tumors. We report the case of a patient with overt obscure gastrointestinal bleeding due to a gastrointestinal stromal tumor diagnosed by CT enterography after two negatives capsule endoscopies. This case shows that capsule endoscopy may overlook significant life threatening lesions and highlights the importance of using other diagnostic modalities after a negative capsule endoscopy, especially in patients with a high index of suspicion for small bowel tumoral pathology or persistent/recurrent bleeding.
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Affiliation(s)
- Iolanda Ribeiro
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
| | - Carlos Fernandes
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
| | - Joana Silva
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
| | - Ana Ponte
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
| | - Davide Tente
- Pathology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Gastroenterology and Hepatology Department, Centro Hospitalar de Vila Nova de Gaia /Espinho, Vila Nova de Gaia, Portugal
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Abstract
Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable.
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Rafeey M, Shoaran M, Majidy H. Diagnostic endoscopy and clinical characteristics of gastrointestinal bleeding in children: a 10-year retrospective study. Iran Red Crescent Med J 2013; 15:794-7. [PMID: 24616788 PMCID: PMC3929813 DOI: 10.5812/ircmj.7075] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 06/14/2013] [Accepted: 06/29/2013] [Indexed: 11/16/2022]
Abstract
Background Upper gastrointestinal (UGI) endoscopy is a tool used frequently in the evaluation of patients presented with hematemesis. Objectives The purpose of this study was to evaluate clinical presentations and features of UGI bleeding (UGIB) in children. Methods/Patients and Materials A descriptive retrospective analysis was carried out on the medical records of the patients. Children and adolescents aging 0 – 18 years who were presented with UGIB were recruited in the survey over a period of 10 years (2000 to 2010) in Children's Hospital, Tabriz, Iran. Results There were 447 patients included in this study and they were all evaluated by upper endoscopy. Clinical manifestations included hematemesis (120 cases, 26.85%), melena (60 cases, 13.42%), and hematochezia (11 cases, 2.46%). Age-related analysis showed that erosive esophagities was a more common cause of hematemesis in the younger age group (under 1 year of age) with a prevalence of 37% when compared with elder children and adolescents (40%). Peptic ulcer disease was seen in only 7.4% of infants under the age of one. Overall, Esophagitis and erosive esophagitis was the most common endoscopic finding (179, 40%) . Conclusions There were 80 (17.90%) patients receiving endoscopic hemostatic therapy. In children with UGIB, upper endoscopy is a diagnostic procedure for the categorization of underlying causes of upper gastrointestinal bleeding in children and various endoscopic lesions may be found in a patient with the impression of UGIB.
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Affiliation(s)
- Mandana Rafeey
- Department of Pediatrics Gastroenterology, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding author: Mandana Rafeey, Department of Pediatrics Gastroenterology, Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel.: +98-4115262280, Fax: +98-4115262280, E-mail:
| | - Maryam Shoaran
- Department of Pediatrics, Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hamideh Majidy
- Department of Nursing, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, IR Iran
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