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Abe H, Tarasawa K, Hatta W, Koike T, Sato I, Ono Y, Ogata Y, Saito M, Jin X, Kanno T, Uno K, Asano N, Imatani A, Fujimori K, Fushimi K, Masamune A. Similar Effect of Vonoprazan and Oral Proton Pump Inhibitors for Preventing Rebleeding in Cases of Upper Gastrointestinal Bleeding. Intern Med 2024; 63:911-918. [PMID: 37558479 PMCID: PMC11045377 DOI: 10.2169/internalmedicine.2211-23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
Objective The use of a proton pump inhibitor (PPI) reduces rebleeding and mortality in patients with upper gastrointestinal bleeding (UGIB). Vonoprazan is a novel oral agent with strong and sustained acid-inhibitory activity. We clarified the effect of vonoprazan compared with oral PPIs in such patients. Methods We analyzed the Diagnosis Procedure Combination database. The primary outcome was rebleeding, and secondary outcomes were in-hospital mortality and in-hospital mortality after rebleeding. Propensity score matching was performed to balance the comparison groups, and logistic regression analyses were used to compare the outcomes between vonoprazan and oral PPIs. Patients Patients on vonoprazan or oral PPIs who underwent endoscopic hemostasis for UGIB between 2014 and 2019 were included. Results We enrolled 78,964 patients, of whom 27,101 and 51,863 were prescribed vonoprazan and a PPI, respectively. After propensity score matching, the rebleeding rate of vonoprazan did not significantly differ from that of oral PPIs [6.4% vs. 6.1%; odds ratio (OR), 1.05; 95% confidence interval (CI), 0.98-1.13]; similarly, the in-hospital mortality rate (1.4% vs. 1.5%; OR, 0.91; 95% CI, 0.79-1.05) and in-hospital mortality after rebleeding (0.3% vs. 0.2%; OR, 1.09; 95% CI, 0.78-1.54) also did not significantly differ between the groups. The acquired findings were robust across dose-restricted analyses and several sensitivity analyses. Conclusion Rebleeding and in-hospital mortality risks in patients on vonoprazan were similar to those in patients on oral PPIs. Considering the higher cost of vonoprazan, oral PPIs might be an optimal oral agent as an acid-suppressive therapy in such patients.
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Affiliation(s)
- Hiroko Abe
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Isao Sato
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Yoshitaka Ono
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
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Wagih Shaltout S, El Messery A, Elshabrawi A, Amin AI, Elshennawy MH, Ibrahim Mortada M, ElSherbiny W, Elalfy H, Elhammady D. Can Endothelin-1 Levels in Patients with Esophageal Variceal Bleeding at Admission Predict Rebleeding Within 5 Days? Turk J Gastroenterol 2024; 35:136-142. [PMID: 38454245 PMCID: PMC10895874 DOI: 10.5152/tjg.2024.23028] [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] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND/AIMS Portal hypertension complicating liver cirrhosis is associated with vascular resistance, possibly due to overexpression of humoral vasoconstrictors, including endothelin. The study aimed to evaluate the efficacy of serum endothelin-1 levels as a noninvasive predictor of early esophageal rebleeding (within 5 days) following endoscopic treatment. MATERIALS AND METHODS Of the patients presented to the endoscopy unit at Mansoura University Hospital, 50 patients were chosen for this study on the basis of endoscopically proven acute esophageal variceal bleeding consequent to hepatitis C viral infection complicated by liver cirrhosis and portal hypertension. Routine laboratory parameters and serum endothelin-1 levels were assessed prior to endoscopic treatment. Patients were divided into 2 groups depending on the development of early postendoscopic rebleeding. Group A consisted of 16 patients who developed rebleeding, while group B included 34 patients who did not. Statistical analysis was performed to determine the predictors of rebleeding. RESULTS Multivariate logistic regression demonstrated that endothelin-1 level (P < .001) and serum albumin level (P = .04) were independent risk factors for early rebleeding. The most efficient cutoff value for endothelin-1 levels in predicting variceal rebleeding within the 5 days after endoscopic intervention was 65.29, which had an 88.2% specificity, 87.5% sensitivity, 88% accuracy, and area under the curve value of 0.89. In addition, hemoglobin, albumin, and creatinine levels were significantly different between bleeding and nonrebleeding groups (P = .03, P = .014, and P <.001, respectively), as was the duration of hospital stay (P < .001). CONCLUSION Serum endothelin-1 levels appear to be a reliable, practical, noninvasive predictor of early variceal rebleeding and related comorbidities such as the severity of kidney affection and duration of hospital stay.
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Affiliation(s)
- Shaker Wagih Shaltout
- Department of Tropical Medicine, Port Said University Faculty of Medicine, Port Said, Egypt
| | - A. El Messery
- Department of Endemic Medicine, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmed Elshabrawi
- Department of Endemic Medicine, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Ahmed I. Amin
- Department of Internal Medicine, Port Said University Faculty of Medicine, Port Said, Egypt
| | - Mostafa H. Elshennawy
- Department of Tropical Medicine, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Metwaly Ibrahim Mortada
- Division of Hematology, Department of Clinical Pathology,Mansoura University Faculty of Medicine, Egypt
| | - Walid ElSherbiny
- Department of Endemic Medicine, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Hatem Elalfy
- Department of Endemic Medicine, Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Dina Elhammady
- Department of Endemic Medicine, Mansoura University Faculty of Medicine, Mansoura, Egypt
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Yu JH, Lee JW, Seo JY, Park JS, Park SJ, Kim SJ, Jang EJ, Park SW, Yeon JW. Factors influencing re-bleeding after trans-arterial embolization for endoscopically unmanageable peptic ulcer bleeding. Scand J Gastroenterol 2024; 59:7-15. [PMID: 37671790 DOI: 10.1080/00365521.2023.2253346] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND/AIMS Acute peptic ulcer bleeding is the most common cause of non-variceal upper gastrointestinal bleeding (NVUGIB). Endoscopic hemostasis is the standard treatment. However, various conditions complicate endoscopic hemostasis. Transarterial visceral embolization (TAE) may be helpful as a rescue therapy. This study aimed to investigate the factors associated with rebleeding after TAE. METHODS We retrospectively investigated the records of 156 patients treated with TAE between January 2007 and December 2021. Rebleeding was defined as the presence of melena, hematemesis, or hematochezia, with a fall (>2.0 g/dl) in hemoglobin level or shock after TAE. The primary outcomes were rebleeding rate and 30-day mortality. RESULTS Seventy patients with peptic ulcer bleeding were selected, and rebleeding within a month after TAE occurred in 15 patients (21.4%). Among the patients included in rebleeding group, significant increases were observed in the prevalence of thrombocytopenia (73.3% vs. 16.4%, p<.001) and ulcers >1 cm (93.3% vs 54.5%, p = .014). The mean AIMS65 (albumin, international normalized ratio, mental status, systolic blood pressure, age >65 years) score (2.3 vs 1.4, p = .009) was significantly higher in the rebleeding group. Multivariate logistic analysis revealed that thrombocytopenia (odds ratio 31.92, 95% confidence interval 6.24-270.6, p<.001) and larger ulcer size (odds ratio 27.19, 95% confidence interval 3.27-677.7, p=.010) significantly increased the risk of rebleeding after TAE. CONCLUSION TAE was effective in the treatment of patients with high-risk peptic ulcer bleeding. AIMS65 score was a significant predictor of rebleeding after TAE, and thrombocytopenia and larger ulcer size increased the risk of rebleeding after TAE.
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Affiliation(s)
- Ji Hoon Yu
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Jeong Woo Lee
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Jun-Young Seo
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Ju Sang Park
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Jong Park
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang-Jung Kim
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Eun Jeong Jang
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Sang Woon Park
- Division of Gastroenterology, Department of Internal Medicine, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Woo Yeon
- Department of Radiology, Bundang Jesaeng General Hospital, Gyeonggi-do, Republic of Korea
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Jatin Y, Sharma S, Singh N, Qamar S, Agarwal S, Gopi S, Gunjan D, Saraya A. An Open-label Randomized Controlled Trial of Early Initiation of Nasogastric Feeding After Endotherapy in Variceal Bleeding: A Proof-of-concept Study. J Clin Exp Hepatol 2024; 14:101260. [PMID: 38076376 PMCID: PMC10709198 DOI: 10.1016/j.jceh.2023.07.413] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/22/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND AND AIMS Limited data exist on the safety of early nasogastric (NG) feeding in patients with cirrhosis after endotherapy for variceal bleeding (VB). We studied the impact of early NG tube feeding in these patients in this proof-of-concept open-label randomized controlled trial. METHODS Eligible patients with cirrhosis undergoing endotherapy for VB were randomized to receive either a liquid diet through a 14 Fr NG tube (commencing 1 h after endotherapy) (early feeding [EF] group) or sips of water and lemon water orally (standard-of-care [SOC] group) for total duration of 48 h. The primary outcome was 5-day rebleeding in both arms. Other outcomes included 5-day infection rate, hepatic encephalopathy during hospitalization, and 6-week mortality. RESULTS Eighty patients (Mean age: 41 ± 11.5 years; males [82.5%]; alcohol etiology [55%]) were included. Baseline median Child-Pugh and MELD scores were similar (CTP: 8 [IQR: 8-9] vs 9 [8-9.25]; P = 0.47 and MELDNa: 13 [10.75-16.25] vs 15 [12-18.25]; P = 0.16). The 5-day rebleeding rates in EF and SOC groups were 2.5% and 5%, respectively (P = 0.55), and non-inferiority or superiority of either could not be demonstrated. The incidence of infection (2.5% [EF] vs 2.5% [SOC]; P = 1.00) and development of HE (5% [EF] vs 2.5% [SOC]; P = 0.36) during hospitalization were comparable. The average daily calorie and protein intake in the EF group during the 48 h was 1318 ± 240 Kcals and 43.4 ± 9.2 g of proteins. No patient in the EF group had feed intolerance. CONCLUSION Early initiation of NG tube-based feeding after endotherapy in VB appears safe and well tolerated without the additional risk of rebleeding or encephalopathy.
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Affiliation(s)
- Yegurla Jatin
- All India Institute of Medical Sciences, New Delhi, India
| | - Sanchit Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Sumaira Qamar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Srikanth Gopi
- All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- All India Institute of Medical Sciences, New Delhi, India
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Kienzler JC, Fandino J. The Impact of Aspirin in Brain Tumor Surgery: To Stop or Not to Stop? Cureus 2023; 15:e51231. [PMID: 38283531 PMCID: PMC10821756 DOI: 10.7759/cureus.51231] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
Given the lack of guidelines regarding perioperative management of neurosurgical patients taking antiplatelet medication, a break of aspirin intake for elective brain surgery is recommended. To the best of our knowledge, only three clinical studies have been published comparing re-bleeding rates in patients undergoing elective brain surgery with and without aspirin. We present a case of an 81-year-old woman who was admitted for elective craniotomy and brain metastases resection. She presented with a right-sided hemianopsia for > two weeks and further investigation by magnetic resonance imaging (MRI) showed the left occipital lesion. For primary cardiovascular prevention, the patient was prescribed prophylactic low-dose aspirin 100 mg. A platelet function test on the day of admission detected highly pathological values. Surgery was scheduled the next day, and aspirin intake was paused. The platelet function test was repeated the morning before surgery. Interestingly, the test showed a 20% above-normal level platelet function. Craniotomy and tumor resection were performed in a routine fashion and no increased bleeding tendency was reported intraoperatively. Postoperatively, the right-sided hemianopsia was immediately regressive. MRI performed 24 hours after surgery demonstrated a complete tumor resection without any signs of rebleeding. The patient was discharged five days after surgery without any neurological deficits. The literature is limited and guidelines are missing on the topic of management of antiplatelet medication in elective brain surgery. As confirmed by the present case and a review of the literature, elective craniotomy and tumor resection under antiplatelet medication may be considered in certain cases with risk and benefit stratification. More data and randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
| | - Javier Fandino
- Department of Neurosurgery, Hirslanden Medical Center Aarau and Zurich, Aarau, CHE
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Zheng H, Guo X, Huang X, Xiong Y, Gao W, Ke C, Chen C, Pan Z, Ye L, Wang L, Hu W, Zheng F. Effect of magnesium sulfate on cerebral vasospasm in the treatment of aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Front Neurol 2023; 14:1249369. [PMID: 38020616 PMCID: PMC10668149 DOI: 10.3389/fneur.2023.1249369] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The use of magnesium sulfate for treating aneurysmal subarachnoid hemorrhage (aSAH) has shown inconsistent results across studies. To assess the impact of magnesium sulfate on outcomes after aSAH, we conducted a systematic review and meta-analysis of relevant randomized controlled trials. Methods PubMed, Embase, and the Cochrane Library were searched for relevant literature on magnesium sulfate for aSAH from database inception to March 20, 2023. The primary outcome was cerebral vasospasm (CV), and secondary outcomes included delayed cerebral ischemia (DCI), secondary cerebral infarction, rebleeding, neurological dysfunction, and mortality. Results Of the 558 identified studies, 16 comprising 3,503 patients were eligible and included in the analysis. Compared with control groups (saline or standard treatment), significant differences were reported in outcomes of CV [odds ratio (OR) = 0.61, p = 0.04, 95% confidence interval (CI) (0.37-0.99)], DCI [OR = 0.57, p = 0.01, 95% CI (0.37-0.88)], secondary cerebral infarction [OR = 0.49, p = 0.01, 95% CI (0.27-0.87)] and neurological dysfunction [OR = 0.55, p = 0.04, 95% CI (0.32-0.96)] after magnesium sulfate administration, with no significant differences detected in mortality [OR = 0.92, p = 0.47, 95% CI (0.73-1.15)] and rebleeding [OR = 0.68, p = 0.55, 95% CI (0.19-2.40)] between the two groups. Conclusion The superiority of magnesium sulfate over standard treatments for CV, DCI, secondary cerebral infarction, and neurological dysfunction in patients with aSAH was demonstrated. Further randomized trials are warranted to validate these findings with increased sample sizes.
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Affiliation(s)
- Hanlin Zheng
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Xiumei Guo
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Xinyue Huang
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Yu Xiong
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Wen Gao
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Chuhan Ke
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Chunhui Chen
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Zhigang Pan
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Lichao Ye
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Lingxing Wang
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Weipeng Hu
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Feng Zheng
- Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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El Naamani K, Morse C, Ghanem M, Barbera J, Amllay A, Severance G, Ruiz R, Sweid A, Gooch MR, Herial NA, Jabbour P, Rosenwasser RH, Nyquist GG, Tjoumakaris S. Endovascular Embolization for Epistaxis: A Single Center Experience and Meta-Analysis. J Clin Med 2023; 12:6958. [PMID: 38002574 PMCID: PMC10672438 DOI: 10.3390/jcm12226958] [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: 08/30/2023] [Revised: 10/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The optimal treatment for intractable epistaxis is still controversial. Various studies have demonstrated high success rates and low complication rates for endovascular embolization. Herein, the authors report an institutional experience and meta-analysis in terms of efficacy and safety of endovascular embolization of intractable epistaxis. This was a retrospective observational study of 35 patients with epistaxis who underwent 40 embolization procedures between 2010 and 2023. The primary outcome was immediate success defined by immediate cessation of epistaxis at the end of the procedure. Immediate success was achieved in most of the procedures (39, 97.5%). During follow-up, three (7.5%) patients experienced a rebleed. Forty-one studies from 3595 articles were identified for inclusion in the meta-analysis and comprised 1632 patients. The mean pooled age was 57.5 years (95% CI: 57.2-57.8) and most patients were males (mean: 70.4, 95% CI: 69.8-71.0). Immediate success was achieved at a pooled mean of 90.9% (95% CI: 90.4-91.4) and rebleeding was observed at a pooled mean of 17% (95% CI: 16.5-17.5). In conclusion, endovascular embolization proved to be both safe and effective in treating intractable epistaxis carrying a low risk of post-operative stroke.
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Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Charles Morse
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Marc Ghanem
- School of Medicine, Lebansese American University, Beirut 1102-2801, Lebanon;
| | - Julie Barbera
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Abdelaziz Amllay
- School of Medicine, Hassan II University, Casablanca 8118, Morocco;
| | - Grace Severance
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ramon Ruiz
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Michael R. Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Nabeel A. Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Robert H. Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
| | - Gurston G. Nyquist
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA; (K.E.N.); (C.M.); (J.B.); (G.S.); (R.R.); (A.S.); (M.R.G.); (N.A.H.); (P.J.); (R.H.R.)
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Li F, Wang T, Liang J, Qian B, Tang F, Gao Y, Lv J. Albumin‑bilirubin grade and INR for the prediction of esophagogastric variceal rebleeding after endoscopic treatment in cirrhosis. Exp Ther Med 2023; 26:501. [PMID: 37822588 PMCID: PMC10562956 DOI: 10.3892/etm.2023.12200] [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] [Received: 03/25/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023] Open
Abstract
Rebleeding following endoscopic treatment in patients with cirrhosis is a serious life-threatening complication. In the present study, a novel, reliable and non-invasive score for prediction of rebleeding following endoscopic therapy for esophagogastric variceal bleeding (EGVB) was developed. The present retrospective study recruited cirrhotic patients with EGVB (n=596) who underwent endoscopic therapy. Patients hospitalized from January 2015 to January 2020 were grouped into a training (n=437) cohort to develop the new score and those hospitalized from February 2020 to February 2022 were grouped into a validation (n=159) cohort to validate the score. The international normalized ratio (INR) and albumin-bilirubin (ALBI) grade were used to develop the INR-ALBI (IALBI) score to predict risk of rebleeding. In the training cohort, the prognostic performance of the IALBI score and other ALBI-associated scores (modified ALBI, platelet-ALBI and ALBI-fibrosis-4) at 1, 3 and 12 months was assessed using receiver operating characteristic (ROC) curve and Kaplan-Meier analysis. At each time point, most areas under the ROC curve of IALBI were higher than those of other ALBI-associated scores, particularly for prediction of early rebleeding. At 1 month, the rebleeding rates of patients with IALBI grade 2 and 3 were ~10.0- and 19.5-times higher than those of patients with grade 1, respectively. The negative predictive value (NPV) of IALBI for the training and validation cohort at 1 month was 100.0 and 97.8%, respectively. For viral and non-viral patients in the training cohort, IALBI showed good predictive ability and NPV for early rebleeding. The IALBI grading system successfully assessed rebleeding, particularly early rebleeding, in cirrhotic patients with EGVB following endoscopic therapy IALBI grade 1, predicted low risk of rebleeding and may not require endoscopic treatment again in the short-term.
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Affiliation(s)
- Fenghui Li
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
| | - Tao Wang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
| | - Jing Liang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
| | - Baoxin Qian
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
| | - Fei Tang
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
| | - Yanying Gao
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
| | - Jiayu Lv
- Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Extra-Corporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, Tianjin 300170, P.R. China
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9
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Nielsen MM, Schaffalitzky de Muckadell OB, Laursen SB. Doppler-Guided Second-Look Endoscopy in Peptic Ulcer Bleeding: A Randomised Controlled Trial. J Clin Med 2023; 12:6722. [PMID: 37959188 PMCID: PMC10647717 DOI: 10.3390/jcm12216722] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Endoscopic treatment guided by Doppler endoscopic probes (DEPs) during index endoscopy may be associated with improved outcome in patients with peptic ulcer bleeding (PUB). As competencies for DEP evaluation are not always available for index endoscopy, we examined the outcome associated with DEP evaluation at second-look endoscopy. METHODS The study was designed as a non-blinded, parallel group, randomised controlled trial. Patients admitted with PUB from Forrest Ia-IIb ulcers, controlled by endoscopic therapy, were randomised (1:1 ratio) to second-look endoscopy <24 h with DEP evaluation of the bleeding ulcer or continued standard treatment. Patients were followed up for 30 days. The primary outcome was rebleeding. Secondary outcomes included the number of transfusions, length of hospital stay, and 30-day mortality. RESULTS A total of 62 patients were included. At second-look endoscopy, 91% (29/32) of patients had a positive DEP signal at the ulcer base and were treated with contact thermal therapy (n = 29), injection of diluted adrenaline (n = 23), and haemoclips (n = 7). Among the 32 patients treated with DEP evaluation, only one rebled (3%) compared to four patients (13%) in the control group (p = 0.20). There were no differences in the secondary outcomes between groups, and there were no complications related to DEP evaluation. CONCLUSIONS Second-look endoscopy with DEP-guided evaluation and treatment is safe and associated with a very low risk of rebleeding (3%) in patients with PUB. Second-look endoscopy with DEP evaluation may be considered in selected PUB patients at high risk of rebleeding, and may represent an alternative to the use of DEP for index endoscopy. Nevertheless, we did not find that second-look endoscopy with DEP evaluation significantly improved patient outcome compared to standard treatment.
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Affiliation(s)
- Michael Milek Nielsen
- Department of Gastroenterology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; (M.M.N.)
| | - Ove B Schaffalitzky de Muckadell
- Department of Gastroenterology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; (M.M.N.)
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Stig Borbjerg Laursen
- Department of Gastroenterology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark; (M.M.N.)
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
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10
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Uchikawa H, Kin T, Koizumi S, Sato K, Uchida T, Takeda Y, Koike T, Kiyofuji S, Yamashiro S, Mukasa A, Saito N. Aneurysmal Inflow Rate Coefficient Predicts Ultra-early Rebleeding in Ruptured Intracranial Aneurysms: Preliminary Report of a Computational Fluid Dynamics Study. Neurol Med Chir (Tokyo) 2023; 63:450-456. [PMID: 37612121 PMCID: PMC10687667 DOI: 10.2176/jns-nmc.2023-0003] [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: 01/21/2023] [Accepted: 05/25/2023] [Indexed: 08/25/2023] Open
Abstract
Rebleeding from a ruptured intracranial aneurysm has poor outcomes. Although numerous factors are associated with rebleeding, studies on computational fluid dynamics (CFD) on hemodynamic parameters associated with early rebleeding are scarce. In particular, no report of rebleeding in ultra-early phase exists. We aimed to elucidate the specific hemodynamic parameters associated with ultra-early rebleeding using CFD. In this study, the rebleeding group included patients with aneurysmal subarachnoid hemorrhage (aSAH) that rebled within 6 h from the onset. The control group included patients without rebleeding, observed for >10 h following the initial rupture. Clinical images after initial rupture and before rebleeding were used to build 3D vessel models for hemodynamic analysis focusing on the following parameters: time-averaged wall shear stress (WSS), normalized WSS, low shear area, oscillatory shear index, relative residence time, pressure loss coefficient, and aneurysmal inflow rate coefficient (AIRC). Five and 15 patients in the rebleeding and control groups, respectively, met the inclusion criteria. The World Federation of Neurosurgical Surgeons grade was significantly higher in the rebleeding group (p = 0.0088). Hemodynamic analysis showed significantly higher AIRC in the rebleeding group (p = 0.042). The other parameters were not significantly different between groups. There were no significant differences or correlations between SAH severity and AIRC. AIRC was identified as a hemodynamic parameter associated with ultra-early rebleeding of ruptured intracranial aneurysms. Thus, AIRC calculation may enable the prediction of ultra-early rebleeding.
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Affiliation(s)
- Hiroki Uchikawa
- Department of Neurosurgery, The University of Tokyo
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo
| | | | - Katsuya Sato
- Department of Neurosurgery, The University of Tokyo
| | | | | | | | | | | | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
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11
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Hassan M, Merza N, Nawras Y, Bahbah EI, Al-Hillan A, Ahmed Z, ElSheref SEDM, Dahiya DS, Dar S, Al Azzawi M, Kobeissy A. Continuous vs. intermittent terlipressin infusion for portal hypertension: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:5001-5010. [PMID: 37811089 PMCID: PMC10553058 DOI: 10.1097/ms9.0000000000001261] [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] [Received: 05/27/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background Portal hypertension, a major complication of chronic liver disease, often leads to life-threatening variceal bleeding, managed effectively with vasoactive drugs like terlipressin. However, the most optimal method of terlipressin administration, continuous versus intermittent infusion, remains a subject of debate, necessitating this systematic review and meta-analysis for evidence-based decision-making in managing this critical condition. Methods This systematic review and meta-analysis adhered to the PRISMA standards and explored multiple databases until 6 April 2023, such as MEDLINE through PubMed, Scopus, Web of Science, and CENTRAL. Independent reviewers selected randomized controlled trials (RCTs) that met specific inclusion criteria. After assessing study quality and extracting necessary data, statistical analysis was performed using Review Manager (RevMan), with results presented as risk ratios (RR) or mean differences. Results Five RCTs (n=395 patients) were included. The continuous terlipressin group had a significantly lower risk of rebleeding (RR=0.43, P=0.0004) and treatment failure (RR=0.22, P=0.02) and fewer total adverse effects (RR=0.52, P<0.00001) compared to the intermittent group. However, there were no significant differences between the two groups in mean arterial pressure (P=0.26), length of hospital stays (P=0.78), and mortality rates (P=0.65). Conclusion This study provides robust evidence suggesting that continuous terlipressin infusion may be superior to intermittent infusions in reducing the risk of rebleeding, treatment failure, and adverse effects in patients with portal hypertension. However, further large-scale, high-quality RCTs are required to confirm these findings and to investigate the potential benefits of continuous terlipressin infusion on mortality and hospital stays.
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Affiliation(s)
| | | | - Yusuf Nawras
- The University of Toledo, College of Medicine and Life Sciences, Toledo, Ohio
| | - Eshak I. Bahbah
- Department of Internal Medicine, Al Azhar University, New Damietta, Egypt
| | - Alsadiq Al-Hillan
- Gastroenterology Department, Corewell health/Willam Beaumont University Hospital, Michigan
| | | | | | - Dushyant S. Dahiya
- Division of Gastroenterology, University of Kansas School of Medicine, Kansas City
| | - Sophia Dar
- Gastroenterology Department, Southern Illinois University, Springfield, Illinois, USA
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12
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Song P, Lei P, Li Z, Zhou L, Wei H, Gao L, Cheng L, Wang W, Hua Q, Chen Q, Luo M, Cai Q. Post-operative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage: factors and clinical outcomes. Am J Transl Res 2023; 15:5168-5183. [PMID: 37692943 PMCID: PMC10492089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/22/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To explore factors affecting postoperative rebleeding in patients with spontaneous supratentorial intracerebral hemorrhage (SSICH). METHODS We retrospectively analyzed data from 724 patients with SSICH treated at Renmin Hospital of Wuhan University from December 2018 to October 2021. Finally, 294 people were eligible to be included in this study. Hematoma locations were classified as basal ganglia, thalamus, subcortex, or intraventricular. Surgery was categorized as neuroendoscopic surgery, burr hole (stereotactic drilling and drainage), or open craniotomy. Postoperative rebleeding was recorded. The incidence, risk factors, and prognosis of postoperative rebleeding were evaluated. RESULTS All procedures were successfully completed. Postoperative rebleeding occurred in 57 patients (19.83%, 57/294). Univariate logistic regression analysis identified these risk factors for rebleeding: admission Glasgow Coma Scale (GCS) score, irregular hematoma morphology by preoperative Computed Tomography (CT), postoperative hypertension, hematoma location, surgical method (P<0.05), and preoperative hematoma volume (P<0.1). Multivariate logistic regression analysis confirmed admission GCS score, irregular hematoma morphology by preoperative CT, postoperative hypertension, hematoma location, and surgical method as significant risk factors (P<0.05). Burr hole surgery and basal ganglia hematomas were associated with increased odds of rebleeding, and the mortality rates in patients with rebleeding versus no rebleeding were 7.02% versus 0.84%. CONCLUSIONS Neuroendoscopic surgery, craniotomy, and burr hole are all effective for treating SSICH, but burr hole surgery was an important risk factor for rebleeding and an adverse outcome. Admission GCS score, irregular hematoma morphology, blood pressure control, hematoma location, and surgical method are affected the risk of postoperative rebleeding. 3D Slicer-assisted neuroendoscopic surgery may be the most effective treatment for many patients with SSICH.
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Affiliation(s)
- Ping Song
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Pan Lei
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Zhiyang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Long Zhou
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Hangyu Wei
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Lun Gao
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Li Cheng
- Department of Intensive Care Units, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Wenju Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Qiuwei Hua
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
| | - Ming Luo
- Department of Neurosurgery, The First Hospital of WuhanWuhan 430022, Hubei, China
| | - Qiang Cai
- Department of Neurosurgery, Renmin Hospital of Wuhan UniversityWuhan 430060, Hubei, China
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Liu C, Cui X, Du Y, Wang X, Kim J, Li S, Zhang L, Zhao X, Zhao L, Tian P, Zhang H, Su K, Li X, Pan H. Unusual Surface Coagulation Activation Patterns of Crystalline and Amorphous Silicate-Based Biominerals. Adv Healthc Mater 2023; 12:e2300039. [PMID: 37000691 DOI: 10.1002/adhm.202300039] [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: 01/04/2023] [Revised: 03/17/2023] [Indexed: 04/01/2023]
Abstract
Activation of coagulation cascades, especially FX and prothrombin, prevents blood loss and reduces mortality from hemorrhagic shock. Inorganic salts are efficient but cannot stop bleeding completely in hemorrhagic events, and rebleeding carries a significant mortality risk. The coagulation mechanism of biominerals has been oversimplified in the past two decades, limiting the creation of novel hemostats. Herein, at the interface, the affinity of proteins, the protease activity, fibrinolysis, hydration shell, and dynamic microenvironment are monitored at the protein level. Proteomic analysis reveals that fibrinogen and antithrombin III's affinity for kaolin's interface causes a weak thrombus and rebleeding during hemostasis. Inspiringly, amorphous bioactive glass (BG) with a transient-dynamic ion microenvironment breaches the hydration layer barrier and selectively and slightly captures procoagulant components of kiniogen-1, plasma kallikrein, FXII, and FXI proteins on its interface, concurrently generating a continuous biocatalytic interface to rapidly activate both intrinsic and extrinsic coagulation pathways. Thus, prothrombin complexes are successfully hydrolyzed to thrombin without platelet membrane involvement, speeding production of high-strength clots. This study investigates how the interface of inorganic salts assists in coagulation cascades from a more comprehensive micro-perspective that may help elucidate the clinical application issues of kaolin-gauze and pave the way to new materials for managing hemorrhage.
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Affiliation(s)
- Chunyu Liu
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xu Cui
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Yunbo Du
- Department of Critical Care Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518000, P. R. China
| | - Xue Wang
- R&D Department, Shenzhen Healthemes Biotechnology Co. Ltd, Shenzhen, 518102, P. R. China
| | - Jua Kim
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Shuaijie Li
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
- Department of orthopedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Liyan Zhang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xiaoli Zhao
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Limin Zhao
- Department of Critical Care Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, 518000, P. R. China
| | - Pengfei Tian
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Hao Zhang
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Kun Su
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Xian Li
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
| | - Haobo Pan
- Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, P. R. China
- R&D Department, Shenzhen Healthemes Biotechnology Co. Ltd, Shenzhen, 518102, P. R. China
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14
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Fatima K, Ur Rehman MA, Asmar A, Farooq H, Ahmad NUS, Danial A, Ur Rehman ME, Khan AA, Tahir S, Ahmed U, Zubair S, Khawaja A. The efficacy of antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Future Sci OA 2023; 9:FSO866. [PMID: 37228855 PMCID: PMC10203907 DOI: 10.2144/fsoa-2023-0014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
Aim The efficacy of antifibrinolytics in subarachnoid hemorrhage remains unclear due to conflicting evidence from studies. Materials & methods Online databases were queried to include randomized controlled trials and propensity matched observational studies. We used Review Manager for the statistical analysis, presenting results as odds ratios with 95% CI. Results The 12 shortlisted studies included 3359 patients, of which 1550 (46%) were in the intervention (tranexamic acid) group and 1809 (54%) in the control group. Antifibrinolytic therapy significantly reduced the risk of rebleeding (OR: 0.55; 95% CI: 0.40-0.75; p = 0.0002) with no significant decrease in poor clinical outcome (OR: 1.02; 95% CI: 0.86-1.20; p = 0.85) and all-cause mortality (OR: 0.92; CI: 0.72-1.17; p = 0.50). Conclusion In patients with subarachnoid hemorrhage, antifibrinolytics reduce the risk of rebleeding without significantly affecting mortality or clinical outcomes.
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Affiliation(s)
- Kaneez Fatima
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Sindh, 74200, Pakistan
| | | | - Abyaz Asmar
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Hareem Farooq
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Noor-Us-Sabah Ahmad
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Ahmad Danial
- Quaid-e-Azam Medical College, Bahawalpur, 63100, Pakistan
| | | | - Abdullah Ali Khan
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Sidra Tahir
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Umair Ahmed
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Salman Zubair
- St Anthony Hospital, 1000 N Lee Ave, Oklahoma City, OK 73102, USA
| | - Ayaz Khawaja
- Wayne State University, 540 E Canfield St, Detroit, MI 48201, USA
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15
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Aoki R, Kobayashi Y, Nawata S, Kamide H, Sekikawa Z, Utsunomiya D. Gastrointestinal Bleeding Due to the Rupture of Splenic Artery Caused by Pancreatic Carcinoma: A Case Requiring Repeated Transcatheter Arterial Embolization in a Short Period of Time. Interv Radiol (Higashimatsuyama) 2023; 8:88-91. [PMID: 37485488 PMCID: PMC10359172 DOI: 10.22575/interventionalradiology.2022-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/22/2022] [Indexed: 07/25/2023]
Abstract
In this report, we present a case of gastrointestinal bleeding due to splenic artery rupture, which required repeated transcatheter arterial embolization (TAE) within a short period of time. A 75-year-old man with pancreatic carcinoma was transported to our hospital with active hematemesis and vital signs consistent with shock. Contrast-enhanced computed tomography images showed a pancreatic tumor that had caused a pseudoaneurysm of the splenic artery to rupture. The pseudoaneurysm was embolized using only an N-butyl-2-cyanoacrylate (NBCA) and lipiodol mixture. However, hematemesis with signs of shock recurred 13 h later, and angiography showed rebleeding from the origin of the splenic artery. The splenic artery was subsequently embolized using an NBCA and lipiodol mixture. Repeated TAE finally controlled the hemorrhage; however, asymptomatic splenic infarction and hepatic infarction occurred due to nontarget embolization.
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Affiliation(s)
- Ryo Aoki
- Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Japan
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Yusuke Kobayashi
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Shintaro Nawata
- Department of Radiology, St. Marianna University School of Medicinen, Japan
| | - Hiroyuki Kamide
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Zenjiro Sekikawa
- Department of Radiology, Yokohama City University Medical Center, Japan
| | - Daisuke Utsunomiya
- Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Japan
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16
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Zhang M, Mou H, Wang G, Li P, Kong D, Li S, Feng Q, Sun R, Yan J, Huang G, Shi Y, Tuo B, Zhang C. Clinical outcomes of clip-assisted endoscopic cyanoacrylate injection versus conventional endoscopic cyanoacrylate injection in treating gastric varices with a gastrorenal shunt. Scand J Gastroenterol 2023; 58:1173-1179. [PMID: 37128690 DOI: 10.1080/00365521.2023.2204388] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND STUDY AIMS The optimal treatment for gastric varices (GVs) is a topic that remains definite for this study. This study compared the clinical outcomes of clip-assisted endoscopic cyanoacrylate injection (clip-ECI) to conventional endoscopic cyanoacrylate injection (con-ECI) for the treatment of GVs with a gastrorenal shunt. PATIENTS AND METHODS Data were collected retrospectively in five medical centers from 2015 to 2020. The patients were treated with con-ECI (n = 126) or clip-ECI (n = 148). Clinical characteristics and procedural outcomes were compared. Patients were followed until death, liver transplantation or 6 months after the treatment. The primary outcome was rebleeding, and the secondary outcome was survival. RESULTS There were no significant differences in age, sex, etiology, shunt diameter and Child-Pugh classification between the two groups. Fewer GVs obliteration sessions were required in the clip-ECI group than in the con-ECI group (p = 0.015). The cumulative 6-month rebleeding-free rates were 88.6% in the clip-ECI group and 73.7% in the con-ECI group (p = 0.002). The cumulative 6-month survival rates were 97.1% in the clip-ECI group and 94.8% in the con-ECI group (p = 0.378). CONCLUSIONS Compared with con-ECI, clip-ECI appears more effective for the treatment of GVs with a gastrorenal shunt, which required less sessions and achieved a higher 6-month rebleeding-free rate.
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Affiliation(s)
- Mingyan Zhang
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Haijun Mou
- Department of Gastroenterology, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Guangchuan Wang
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ping Li
- Department of Gastroenterology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Derun Kong
- Department of Gastroenterology, Anhui Geriatric Institute, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Senlin Li
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Qian Feng
- Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China
| | - Ruonan Sun
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jinming Yan
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guangjun Huang
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yongjun Shi
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Biguang Tuo
- Department of Gastroenterology, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Chunqing Zhang
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Gastroenterology and Hepatology, Shandong Provincial Hospital, Shandong University, Jinan, China
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Ammar H, Said MA, Beltaifa M, Azri M, Zgaya R, Majdoub W, Belkacem O, Gupta R, Ben Hamada H, Ben Ali A. Recurrent Life-Threatening Gastrointestinal Bleeding From Primary Intestinal Choriocarcinoma: A Case Report. Cureus 2023; 15:e41823. [PMID: 37575827 PMCID: PMC10423014 DOI: 10.7759/cureus.41823] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Choriocarcinoma is a highly aggressive, malignant tumor that arises from trophoblastic cells. Although choriocarcinomas usually arise in the genital organs, they can also originate in extragenital organs, but gastrointestinal tract lesions are rare. Gastrointestinal choriocarcinoma can be primary or metastatic. Most primary gastrointestinal choriocarcinomas are associated with adenocarcinomas. We report a case of jejunal choriocarcinoma presenting with acute abdominal pain and intestinal bleeding. The patient had a very high serum beta-human chorionic gonadotropin (β-HCG) level with an isolated jejunal lesion on contrast-enhanced computed tomography of the abdomen and pelvis. The patient underwent emergency surgical resection of the jejunal lesion with good recovery. The histopathological analysis of the resected specimen confirmed the diagnosis of choriocarcinoma. However, the patient suffered from life-threatening rebleeding one month after surgery and succumbed to her illness.
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Affiliation(s)
- Houssem Ammar
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
| | | | - Mahdi Beltaifa
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
| | - Marwa Azri
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
| | - Rym Zgaya
- Obstetrics and Gynaecology, Farhat Hached Hospital, University of Sousse, Sousse, TUN
| | - Wiem Majdoub
- Pathology, Sahloul Hospital, University of Sousse, Sousse, TUN
| | | | - Rahul Gupta
- Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Habiba Ben Hamada
- Anaesthesiology, Sahloul Hospital, University of Sousse, Sousse, TUN
| | - Ali Ben Ali
- General Surgery, Sahloul Hospital, University of Sousse, Sousse, TUN
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Zhang XH, He JH, Zhang XS, Zhang J, Wang CJ, Dong YP, Tao W. Comparison of revascularization and conservative treatment for hemorrhagic moyamoya disease in East Asian Countries: a single-center case series and a systematic review with meta-analysis. Front Neurol 2023; 14:1169440. [PMID: 37332987 PMCID: PMC10272728 DOI: 10.3389/fneur.2023.1169440] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients. Methods We conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors' institutional series of 24 patients were also included and reviewed in the analysis. Results A total of 19 East Asian studies involving 1,571 patients as well as our institution's retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively). Conclusion The current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.
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Affiliation(s)
- Xiang-Hua Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jun-Hua He
- Department of Neurosurgery, Zhejiang Provincial Tongde Hospital, Hangzhou, China
| | - Xiang-Sheng Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Cheng-jun Wang
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Yi-Peng Dong
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
| | - Wu Tao
- Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China
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Okumura E, Onuki H, Otsuka K, Sunaga S, Tanaka A, Jimbo H. A Case of Acquired Factor XIII Deficiency with Systemic Lupus Erythematosus Diagnosed after Repeated Intracerebral Hemorrhages. NMC Case Rep J 2023; 10:121-124. [PMID: 37293197 PMCID: PMC10247216 DOI: 10.2176/jns-nmc.2022-0373] [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] [Received: 12/01/2022] [Accepted: 02/09/2023] [Indexed: 06/10/2023] Open
Abstract
We present a case of autoimmune-acquired factor XIII deficiency associated with systemic lupus erythematosus, which was diagnosed as a cause of repeated intracerebral hemorrhage. An intracerebral hemorrhage occurred in a 24-year-old female patient. Craniotomy was performed to remove the hematoma, but rebleeding occurred at the same site on days 2 and 11, respectively. Detailed blood tests revealed that factor XIII activity decreased. Although autoimmune-acquired factor XIII deficiency is a very rare disease, it can sometimes be fatal when intracerebral hemorrhage occurs. If there is repeated intracerebral hemorrhage, factor XIII activity should be confirmed.
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Affiliation(s)
- Eitaro Okumura
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroyuki Onuki
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Kunitoshi Otsuka
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shigeki Sunaga
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Asashi Tanaka
- Department of Clinical Laboratory Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
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20
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Li X, Zheng X, Wang Y, Shao L, Xiao Y, Lv X. Construction of a risk prediction model for non-variceal upper gastrointestinal bleeding and rebleeding based on multi-dimensional indicators and its application research. Am J Transl Res 2023; 15:3697-3704. [PMID: 37303679 PMCID: PMC10250983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To construct a predictive model for the risk of rebleeding in non-variceal upper gastrointestinal bleeding (NVUGIB) based on multidimensional indicators to provide an assessment tool for early screening of rebleeding in NVUGIB. METHODS Retrospective analysis of the 3-month follow-up data of 85 patients with NVUGIB diagnosed at the Fifth Hospital of Wuhan from January 2019 to December 2021 who were discharged from the hospital after medical treatment. Patients were divided into a rebleeding group (n=45) and a non-rebleeding group (n=95) based on whether they rebleed during follow-up. The demographic characteristics, clinical characteristics and biochemical indicators of the two groups were compared. A multivariate logistic regression was used to analyze the influencing factors of NVUGIB rebleeding. A nomograph model was built using the screening results. The area under the working characteristic curve of the subject (AUC) was used to analyze the model differentiation, evaluate the model specificity and sensitivity, and verify the prediction performance of the model with the validation set. RESULTS There were significant differences in age, hematemesis, red blood cell count (RBC), platelet (PLT), albumin (Alb), prothrombin time (PT), TT, fibrinogen (Fib), plasma D-dimer (D-D), and blood lactate (LAC) levels between the two groups (all P<0.05). Logistic regression analysis shows that, age ≥75, hematemesis more than 5 times, PLT≤100*109/L, D-D>0.5 mg/L were associated with greater risk of rebleeding. The nomogram model was constructed based on the above four indicators. The AUC of the training set (n=98) for predicting the risk of NVUGIB rebleeding was 0.887 (95% CI: 0.812-0.962), the specificity was 0.882, and the sensitivity was 0.833. The AUC of the validation set (n=42) was 0.881 (95% CI: 0.777-0.986), the specificity was 0.815, and the sensitivity was 0.867. After 500 times of sampling by bootstrap method, the mean absolute error of the calibration curve of the validation set model was 0.031, indicating that the calibration curve and the ideal curve fit well, and the predicted value of the model was in good agreement with the actual value. CONCLUSION Age ≥75, hematemesis >5 times, lower PLT, and higher D-D levels rise the risk of rebleeding in NVUGIB patients and have some reference value in clinical diagnosis and disease assessment.
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Affiliation(s)
- Xiaoxia Li
- Department of Digestive System, The Fifth Hospital of Wuhan Wuhan 430050, Hubei, China
| | - Xiaolan Zheng
- Department of Digestive System, The Fifth Hospital of Wuhan Wuhan 430050, Hubei, China
| | - Yuanyuan Wang
- Department of Digestive System, The Fifth Hospital of Wuhan Wuhan 430050, Hubei, China
| | - Lihua Shao
- Department of Digestive System, The Fifth Hospital of Wuhan Wuhan 430050, Hubei, China
| | - Yan Xiao
- Department of Digestive System, The Fifth Hospital of Wuhan Wuhan 430050, Hubei, China
| | - Xiaohong Lv
- Department of Digestive System, The Fifth Hospital of Wuhan Wuhan 430050, Hubei, China
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21
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Saleepol A, Kaosombatwattana U. Outcomes and performance of risk scores in acute lower gastrointestinal bleeding. JGH Open 2023; 7:372-376. [PMID: 37265927 PMCID: PMC10230105 DOI: 10.1002/jgh3.12907] [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] [Received: 01/04/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023]
Abstract
Background and Aim Treatment of acute lower gastrointestinal bleeding (LGIB) remains problematic, and clinical data is limited compared to that of upper GIB. This study aimed to describe the clinical outcomes and predictors of rebleeding and validate the performance of proposed scoring systems in patients with acute overt LGIB. Methods Patients with LGIB who underwent colonoscopies between 2013 and 2018 were retrospectively reviewed. Overt LGIB patients who presented within 72 h after bleeding onset were included. Demographics, comorbidities, initial management, endoscopic finding, and treatment outcomes were collected. Factors associated with rebleeding were explored, and the performance of Oakland, NOBLAD, and Strate scores regarding mortality and rebleeding were validated. Results A total of 537 patients from 3402 (age 72 years, 63-80) were included. Of this, 53% took antithrombotic agents and 59% required red cell transfusion, with a median of 4 red cell units. The most common diagnoses were diverticular bleeding (31.3%) and colorectal polyp/cancer (28.9%). The median time to colonoscopy was 2.3 days, and 80.3% of patients did not receive any hemostatic intervention. The 30-day mortality and rebleeding were 2.6% and 18.3%, respectively. Patients with radiation proctitis, angioectasia, diverticulosis and using dual antiplatelet drugs were associated with recurrent bleeding. The risk scores showed low performance in predicting recurrent bleeding and mortality. Conclusion Acute, overt LGIB was common among elders with comorbidities. The rebleeding risk was mostly linked to underlying lesions and the use of antiplatelet drugs. The performance of current risk stratification scores remains unsatisfactory and requires further development.
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Affiliation(s)
- Aniwat Saleepol
- Internal Medicine DivisionJainad Narendra HospitalChai NatThailand
| | - Uayporn Kaosombatwattana
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
- Siriraj GI Endoscopy CenterSiriraj HospitalBangkokThailand
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22
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Mou H, Zou C, Shi G, Wu S, Xie R, Liu X, Yang J, Tuo B. Endoscopic cyanoacrylate injection therapy for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy. Scand J Gastroenterol 2023; 58:331-338. [PMID: 36222583 DOI: 10.1080/00365521.2022.2132535] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of endoscopic cyanoacrylate injection therapy for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy. METHODS 154 patients with refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy at the Affiliated Hospital of Zunyi Medical Univesity and the People's Hospital of Liupanshui City from January 2018 to December 2021were enrolled in this study. Endoscopic intracellular cyanoacrylate injection was first carried out. When failure, perintravascullar injection was carried out. The data were retrospectively collected. RESULTS Among the 154 patients, 102 patients (66.23%) obtained successful intravascular injection and perivascular injection was performed in 52 patients (33.77%). Immediate hemostatic rate for active bleeding achieved 93.18%. Overall rebleeding rate within 30 days was 12.99% and successful hemostasis rate achieved 87.01%. Immediate hemostatic rate and successful hemostasis rate in intravascular injection patients were markedly superior over perivascular injection. Rebleeding rate in intravascular injection patients was markedly lower than that in perivascular injection patients. 14 patients complicated abdominal pain and no other complication occurred. CONCLUSION Endoscopic cyanoacrylate injection therapy, especial intravascular injection, was effective and safe, with high successful hemostasis rate for refractory high-risk peptic ulcer bleeding by conventional endoscopic therapy.
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Affiliation(s)
- Haijun Mou
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Cheng Zou
- Department of Gastroenterology, People's Hospital of Liupanshui City, Liupanshui, China
| | - Guoqing Shi
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Sheng Wu
- Department of Gastroenterology, People's Hospital of Liupanshui City, Liupanshui, China
| | - Rui Xie
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xuemei Liu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jie Yang
- Department of Gastroenterology, People's Hospital of Liupanshui City, Liupanshui, China
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Biguang Tuo
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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23
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Fang Y, Wang J, Chen L, Yan W, Gao S, Liu Y, Wang X, Dong X, Zhang J, Chen S, Liu F, Wang Z, Zhang Y. Functional Outcome Analysis of Stereotactic Catheter Aspiration for Spontaneous Intracerebral Hemorrhage: Early or Late Hematoma Evacuation? J Clin Med 2023; 12:jcm12041533. [PMID: 36836067 PMCID: PMC9962962 DOI: 10.3390/jcm12041533] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Minimally invasive stereotactic catheter aspiration becoming a promising surgical alternative for intracerebral hemorrhage (ICH) patients. Our goal is to determine the risk factors that lead to poor functional outcomes in patients undergoing this procedure. METHODS Clinical data of 101 patients with stereotactic catheter ICH aspiration were retrospectively reviewed. Univariate and multiple logistic analyses were used to identify risk factors for poor outcomes 3 months and 1 year after discharge. Univariate analysis was used to compare the functional outcome between early (<48 h after ICH onset) and late hematoma evacuation (≥48 h after ICH onset) groups, as well as for the odd ratios assessment in terms of rebleeding. RESULTS Independent factors for poor 3-month outcome included lobar ICH, ICH score > 2, rebleeding, and delayed hematoma evacuation. Factors for poor 1-year outcome included age > 60, GCS < 13, lobar ICH, and rebleeding. Early hematoma evacuation was linked to a lower likelihood of poor outcome both 3 months and 1 year post-discharge, but with higher risk of postoperative rebleeding. CONCLUSIONS Lobar ICH and rebleeding independently predicted both poor short- and long-term outcomes in patients with stereotactic catheter ICH evacuation. Early hematoma evacuation with preoperative rebleeding risk evaluation may benefit patients with stereotactic catheter ICH evacuation.
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Affiliation(s)
- Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Y.F.); (Z.W.); (Y.Z.); Tel.: +86-571-87784719 (Y.F. & Y.Z.); +86-571-87784715 (Z.W.); Fax: +86-571-87784755 (Y.F. & Z.W. & Y.Z.)
| | - Junjie Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Department of Neurosurgery, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu 310030, China
| | - Luxi Chen
- Department of Medical Genetics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
- Department of Neurology, Research Center of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wei Yan
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Shiqi Gao
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Yibo Liu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
| | - Xiao Dong
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Sheng Chen
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Fengqiang Liu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
| | - Zefeng Wang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Y.F.); (Z.W.); (Y.Z.); Tel.: +86-571-87784719 (Y.F. & Y.Z.); +86-571-87784715 (Z.W.); Fax: +86-571-87784755 (Y.F. & Z.W. & Y.Z.)
| | - Yang Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, China
- Clinical Research Center for Neurological Diseases of Zhejiang Province, Hangzhou 310009, China
- Correspondence: (Y.F.); (Z.W.); (Y.Z.); Tel.: +86-571-87784719 (Y.F. & Y.Z.); +86-571-87784715 (Z.W.); Fax: +86-571-87784755 (Y.F. & Z.W. & Y.Z.)
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Jo SY, Noh JH, Cha B, Ahn JY, Oh SP, Seo JY, Na HK, Lee JH, Jung KW, Kim DH, Choi KD, Song HJ, Lee GH, Jung HY. Clinical outcomes of Dieulafoy's lesion compared with peptic ulcer in upper gastrointestinal bleeding. J Gastroenterol Hepatol 2023. [PMID: 36740948 DOI: 10.1111/jgh.16139] [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: 09/09/2022] [Revised: 01/23/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Although Dieulafoy's lesion (DL) is an important cause of nonvariceal upper gastrointestinal (GI) bleeding, few studies have investigated the clinico-epidemiological outcomes due to its rarity. Here, we investigated clinical features of upper GI bleeding caused by peptic ulcer (PU) or DL and compared endoscopic treatment outcomes. METHODS Patients with upper GI bleeding resulting from PU or DL who visited emergency room between January 2013 and December 2017 were eligible. Clinical features and treatment outcomes were retrospectively investigated. RESULTS Overall, 728 patients with upper GI bleeding due to PU (n = 669) and DL (n = 59) were enrolled. The median age was 64 years (interquartile range [IQR], 56-75 years), and 74.3% were male. Endoscopic intervention was performed in 53.7% (n = 359) and 98.3% (n = 58) of the PU and DL groups, respectively (P < 0.0001). Patients were matched by sex, age, body mass index, comorbidity, and past medical history, and 190 PU and 52 DL were finally selected. The rebleeding rates within 7 (7.37% vs 17.31%, P = 0.037) and 30 (7.37% vs 26.92%, P < 0.001) days after initial endoscopy were significantly lower in the PU than in the DL group after propensity score matching. During the median follow-up period of 52 months (IQR, 34-70 months), there was no difference in overall survival rate (67.9% vs 82.7%, P = 0.518). CONCLUSIONS Although DL is a rare cause of upper GI bleeding, it requires endoscopic hemostasis more frequently and has a higher rate of rebleeding than PU even after therapeutic endoscopy. Endoscopists should pay attention and perform active endoscopic hemostasis for DL bleeding.
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Affiliation(s)
- Sang Yong Jo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boram Cha
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Pyo Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Young Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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25
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Muacevic A, Adler JR, Tsujimoto Y, Okazaki Y, Shiojiri T. Clinical Characteristics and Outcomes of Hospital-Acquired Lower Gastrointestinal Bleeding: A Single Centre Retrospective Cohort Study. Cureus 2022; 14:e32651. [PMID: 36654553 PMCID: PMC9842936 DOI: 10.7759/cureus.32651] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Lower gastrointestinal bleeding (LGIB) is common in inpatient and outpatient settings; however, there are limited studies on the clinical characteristics and patient outcomes of those with hospital-acquired LGIB. Methods We performed a retrospective cohort study of patients with hospital-acquired LGIB who underwent colonoscopy during hospitalization between January 2017 and December 2021. We described the clinical characteristics, etiology, and clinical outcomes of patients stratified as those undergoing colonoscopy within 24 hours from haematochezia onset (early colonoscopy group) or after 24 hours from onset (late colonoscopy group). We used multivariable logistic regression to identify factors associated with endoscopic intervention in the early and late colonoscopy groups. Results Of the 272 patients included, the median age was 79 years (interquartile range: 72-85 years), 153 (56%) were bedridden, and 172 (63%) had hypoalbuminemia. The most frequent etiology was rectal ulcer (101 cases, 37%), whereas 7 (2.6%) had diverticular bleeding. The endoscopic intervention was performed on 16.7% and 7.9% of early and late colonoscopy patients. There were more patients with both non-severe and severe rebleeding in the early colonoscopy group (16% and 12%, respectively) than in the late colonoscopy group (11% and 6.5%, respectively). Colonoscopy-on-worktime was the only factor independently associated with a higher occurrence of endoscopic intervention. Conclusions In our sample, very old patients with hospital-acquired LGIB required endoscopy mainly due to rectal ulcers. Further studies will be necessary to investigate the differences between community-acquired LGIB and hospital-acquired LGIB and the optimal timing of colonoscopy for these patients.
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Abstract
BACKGROUND Rebleeding is a frequent complication of peptic ulcer bleeding (PUB). The associated prognosis remains rather unclear because previous studies generally also included non-ulcer lesions. OBJECTIVE We aimed to identify predictors for rebleeding; clarify the prognostic consequence of rebleeding; and develop a score for predicting rebleeding. METHODS Nationwide cohort study of consecutive patients presenting to hospital with PUB in Denmark from 2006-2014. Logistic regression analyses were used to identify predictors for rebleeding, evaluate the association between rebleeding and 30-day mortality, and develop a score to predict rebleeding. Patients with persistent bleeding were excluded. RESULTS Among 19,258 patients (mean age 74 years, mean ASA-score 2.4), 10.8% rebled, and 10.2% died. Strongest predictors for rebleeding were endoscopic high-risk stigmata of bleeding (Odds Ratio (OR): 2.12 [95% Confidence Interval (CI): 1.91-2.36]), bleeding from duodenal ulcers (OR: 1.87 [95% CI: 1.69-2.08]), and presentation with hemodynamic instability (OR: 1.55 [95% CI: 1.38-1.73]). Among patients with all three factors (7.9% of total), 24% rebled, 50% with rebleeding failed endoscopic therapy, and 23% died. Rebleeding was associated with increased mortality (OR: 2.04 [95% CI: 1.78-2.32]). We were unable to develop an accurate score to predict rebleeding. CONCLUSION Rebleeding occurs in ∼10% of patients with PUB and is overall associated with a two-fold increase in 30-day mortality. Patients with hemodynamic instability, duodenal ulcers, and high-risk endoscopic stigmata are at highest risk of rebleeding. When rebleeding occurs in such patients, consultation with surgery and/or interventional radiology should be obtained prior to repeat endoscopy.
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Affiliation(s)
- Stig B Laursen
- Department of Gastroenterology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Adrian J Stanley
- Department of Gastroenterology, Walton Building, Glasgow Royal Infirmary, Glasgow, UK
| | - Loren Laine
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ove B Schaffalitzky de Muckadell
- Department of Gastroenterology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Raţiu I, Lupuşoru R, Popescu A, Sporea I, Goldiş A, Dănilă M, Miuţescu B, Moga T, Barbulescu A, Şirli R. Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding. Medicine (Baltimore) 2022; 101:e31543. [PMID: 36397398 PMCID: PMC9666142 DOI: 10.1097/md.0000000000031543] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Acute upper gastrointestinal bleeding (UGIB) is a typical medical emergency, with an incidence of 84 to 160 cases per 100,000 individuals and a mortality rate of approximately 10%. This study aimed to identify all cases of UGIB hospitalized in a tertiary gastroenterology department, to identify possible predictive factors involved in rebleeding and mortality, potential associations between different elements and the severity of bleeding, and the differences between the upper digestive hemorrhage due to nonvariceal and variceal bleeding. This was an observational, retrospective study of patients with UGIB admitted to the tertiary Department of Gastroenterology between January 2013 and December 2020. A total of 1499 patients were enrolled in the study. One thousand four hundred and ninety-nine patients were hospitalized for 7 years with active upper digestive hemorrhage, 504 variceal bleeding, and 995 nonvariceal bleeding. When comparing variceal with nonvariceal bleeding, in nonvariceal bleeding, the mean age was higher, similar sex, higher mortality rate, higher rebleeding rate, and higher hemorrhagic shock rate. Endoscopy treatment was also performed more frequently in variceal bleeding than in nonvariceal bleeding. Severe anemia was found more frequently in patients with variceal bleeding. The mortality rate was 10% in the entire study group, which was not significantly different between the 2 batches. However, the rebleeding rate is higher in patients with variceal gastrointestinal bleeding.
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Affiliation(s)
- Iulia Raţiu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Raluca Lupuşoru
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
- *Correspondence: Raluca Lupuşoru, Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, RomaniaCenter for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania (e-mail: )
| | - Alina Popescu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Ioan Sporea
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Adrian Goldiş
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Mirela Dănilă
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Bogdan Miuţescu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Tudor Moga
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Andreea Barbulescu
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
| | - Roxana Şirli
- Advanced Regional Research Center in Gastroenterology and Hepatology, Department VII: Internal Medicine II, Discipline of Gastroenterology and Hepatology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Romania
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28
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Extrat C, Grange S, Mayaud A, Villeneuve L, Chevalier C, Williet N, Le Roy B, Boutet C, Grange R. Transarterial Embolization for Active Gastrointestinal Bleeding: Predictors of Early Mortality and Early Rebleeding. J Pers Med 2022; 12:jpm12111856. [PMID: 36579589 PMCID: PMC9694438 DOI: 10.3390/jpm12111856] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The aim of this study was to determine predictive factors of early mortality and early rebleeding (≤30 days) following transarterial embolization (TAE) for treatment of acute gastrointestinal bleeding. Methods: All consecutive patients admitted for acute gastrointestinal bleeding to the interventional radiology department in a tertiary center between January 2012 and January 2022 were included. Exclusion criteria were patients: (1) aged < 18-year-old, (2) referred to the operation room without TAE, (3) treated for hemobilia, (4) with mesenteric hematoma, (5) lost to follow-up within 30 days after the procedure. We evaluated pre and per-procedure clinical data, biological data, outcomes, and complications. Results: Sixty-eight patients were included: 55 (80.9%) experienced upper gastrointestinal bleeding and 13 (19.1%) lower gastrointestinal bleeding. Median age was 69 (61−74) years. There were 49 (72%) males. Median hemoglobin was 7.25 (6.1−8.3) g/dL. There were 30 (50%) ulcers. Coils were used in 46 (67.6%) procedures. Early mortality was 15 (22.1%) and early rebleeding was 17 (25%). In multivariate analysis, hyperlactatemia (≥2 mmol/L) were predictive of early mortality (≤30 days). A high number of red blood cells units was associated with early rebleeding. Conclusion: This study identified some predictive factors of 30-day mortality and early rebleeding following TAE. This will assist in patient selection and may help improve the management of gastrointestinal bleeding.
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Affiliation(s)
- Chloé Extrat
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Alexandre Mayaud
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Loïc Villeneuve
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Clément Chevalier
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Nicolas Williet
- Department of Gastro-Enterology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Bertrand Le Roy
- Department of Oncologic and Digestive Surgery, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, 42270 Saint-Priest-en-Jarez, France
- Correspondence:
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Kojima Y, Katano T, Shimura T, Shimohira M, Sugiyama T, Ebi M, Harada T, Yamamoto Y, Hirata Y, Kataoka H. Efficacy of transcatheter arterial embolization for first-line treatment of colonic diverticular bleeding with extravasation on contrast-enhanced computed tomography. Medicine (Baltimore) 2022; 101:e31442. [PMID: 36343028 PMCID: PMC9646497 DOI: 10.1097/md.0000000000031442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Colonic diverticular bleeding (CDB) is the most frequent cause of acute lower gastrointestinal bleeding. The aim of this study was to evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for CDB as first-line treatment with extravasation on contrast-enhanced computed tomography (CECT), compared with endoscopic hemostasis. Three Japanese institutions participated in this retrospective cohort study. Data from consecutive patients admitted with a diagnosis of CDB with extravasation on CECT were reviewed. One hospital performed TAE and the others conducted urgent colonoscopy (CS) as the first-line treatment for CDB with extravasation on CECT. The primary outcome was rebleeding rate within 30 days after first-line treatment. In total, 165 CDB cases with extravasation on CECT (TAE group, n = 39; CS group, n = 126) were analyzed in this study. The rebleeding rate within 30 days was significantly lower in the TAE group (7.69%) than in the CS group (23.02%; P = .038). The bleeding point detection rate was significantly higher in the TAE group (89.74%, 35/39) than in the CS group (37.30%, 47/126; P < .0001). Even in those cases in which a bleeding point was detected, the rebleeding rate was significantly lower in the TAE group (0%) than in the endoscopic hemostasis-success group (23.91%; P = .005). No severe complications of Grade 3 or more were seen with TAE. We showed that TAE is an effective, safe hemostatic method, and a useful alternative to endoscopic hemostasis for first-line treatment of CDB.
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Affiliation(s)
- Yuki Kojima
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Takahito Katano
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
- *Correspondence: Takahito Katano, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan (e-mail: )
| | - Takaya Shimura
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Tomoya Sugiyama
- Department of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Masahide Ebi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Yazakokarimata, Nagakute, Aichi, Japan
| | - Takahito Harada
- Department of Gastroenterology, Kasugai Municipal Hospital, Takaki-cho, Kasugai, Aichi, Japan
| | - Yuki Yamamoto
- Department of Gastroenterology, Kasugai Municipal Hospital, Takaki-cho, Kasugai, Aichi, Japan
| | - Yoshikazu Hirata
- Department of Gastroenterology, Kasugai Municipal Hospital, Takaki-cho, Kasugai, Aichi, Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
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30
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Matsumoto Y, Nagata Y, Nakagawa S, Hashikawa T, Sakai H, Takahashi S, Hashimoto Y, Goto S, Sugita Y, Takahashi K. New aneurysm formation and regrowth associated with rebleeding of residual pediatric ruptured arteriovenous malformation: patient series. J Neurosurg Case Lessons 2022; 4:CASE22205. [PMID: 36317238 PMCID: PMC9624159 DOI: 10.3171/case22205] [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] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND If complete obliteration of ruptured pediatric arteriovenous malformation (AVM) cannot be achieved, the appropriate follow-up duration and predictors of rebleeding remain unknown. OBSERVATIONS Pediatric patients with ruptured AVMs admitted to the authors' hospital within the past 30 years were evaluated. Rebleeding was confirmed in two patients. The first patient was a 5-year-old boy who experienced right thalamic hemorrhage. AVM was found in the bilateral thalamus and treated with stereotactic radiosurgery (SRS). New aneurysm formation and residual AVM regrowth were confirmed 21 years after the SRS. Eight months later, rebleeding occurred. The second patient was a 5-year-old boy who underwent removal of a left cerebellar hemorrhage and AVM. The residual AVM was treated with SRS. Residual AVM regrowth was detected at 6 years 7 months after SRS. Five months later, new aneurysm formation was confirmed. Two additional days later, rebleeding occurred. LESSONS New aneurysm formation and residual AVM regrowth may predict rebleeding and can occur >20 years after the initial rupture and treatment. If AVM obliteration is not achieved, long-term follow-up is needed, even in adulthood, with attention to new aneurysm formation and residual AVM regrowth. Further treatment is recommended if these findings are confirmed.
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Affiliation(s)
| | - Yui Nagata
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Setsuko Nakagawa
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Takuro Hashikawa
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Hideki Sakai
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Shinji Takahashi
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Yosuke Hashimoto
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Shin Goto
- Department of Neurosurgery, Tanushimaru Central Hospital, Fukuoka, Japan
| | - Yasuo Sugita
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
| | - Kenji Takahashi
- Department of Neurosurgery, St. Mary’s Hospital, Fukuoka, Japan; and
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31
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Chung MW, Chuang CC, Wang CC, Chen HC, Hsu PW. Prognostic Factors Analysis for Intracranial Cavernous Malformations Treated with Linear Accelerator Stereotactic Radiosurgery. Life (Basel) 2022; 12:life12091363. [PMID: 36143399 PMCID: PMC9505264 DOI: 10.3390/life12091363] [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] [Received: 08/09/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Stereotactic radiosurgery (SRS) is generally considered a substitute for cranial cavernous malformations (CCMs). However, prognostic factors for post-radiosurgery CCM rebleeding and adverse radiation effects have not been well evaluated, and the effect of timing and optimal treatment remains controversial. Therefore, this study evaluated prognostic factors for post-radiosurgical rebleeding and focal edematous changes in 30 patients who developed symptomatic intracranial hemorrhage due to solitary non-brainstem CCM and received linear accelerator (LINAC) SRS in a single medical center from October 2002 to June 2018. An overall post-radiosurgical annual hemorrhage rate with 4.5% was determined in this study. In addition, a higher marginal dose of >1600 centigray and earlier LINAC SRS intervention were correlated with a significantly lower post-radiosurgical annual hemorrhage rate. A lesion size larger than 3 cm3 and a coexisting developmental venous anomaly were significant risk factors for post-radiosurgical focal brain edema but mostly resulted in no symptoms and were temporary. This study demonstrated the efficacy of LINAC SRS in preventing CCM rebleeding and suggests that earlier radiosurgery treatment with a higher dose for non-brainstem symptomatic CCMs be considered.
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Affiliation(s)
- Meng-Wu Chung
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Cheng Chuang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsien-Chih Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University, Taoyuan 333, Taiwan
| | - Peng-Wei Hsu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence:
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32
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Wang X, Zhang Y, Chong W, Hai Y, Wang P, Deng H, You C, Fang F. Association of Rebleeding and Delayed Cerebral Ischemia with Long-term Mortality Among 1-year Survivors After Aneurysmal Subarachnoid Hemorrhage. Curr Neurovasc Res 2022; 19:282-292. [PMID: 35996234 DOI: 10.2174/1567202619666220822105510] [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: 06/16/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The potential impact of rebleeding and Delayed Cerebral Ischemia (DCI) on long-term survival in patients with aneurysmal subarachnoid hemorrhage (aSAH) remained unclear. This study aimed to investigate whether DCI and rebleeding increase the risk of long-term all-cause mortality in patients with aSAH who survived the follow-up period of one year. METHODS We retrospectively collected data on patients with atraumatic aSAH who were still alive 12 months after aSAH occurrence between December 2013 and June 2019 from the electronic health system. Patients were then classified by the occurrence of rebleeding or DCI during hospitalization. Death records were obtained from an administrative database, the Chinese Household Registration Administration System, until April 20, 2021. Multivariable Cox proportional hazards models were used to compare overall survival in different groups. Sensitivity analysis was performed with propensity-score matching (PSM). RESULTS A total of 2,607 patients were alive one year after aSAH. The crude annual death rate from any cause among patients who had rebleeding (7.2 per 100 person-years) and patients who had DCI (3.7 per 100 person-years) during hospitalization was higher than that of patients with neither event (2.1 per 100 person-years). Multivariate analysis showed that rebleeding is an independent risk factor for long-term mortality (adjusted hazard ratio (aHR), 2.37; 95% confidence interval (CI), 1.47- 3.81). DCI was an independent prognostic factor of poorer overall survival (aHR, 2.09; 95% CI, 1.54-2.84). CONCLUSION Amongst patients alive one year after aSAH, rebleeding and DCI during hospitalization were independently associated with higher rates of long-term mortality.
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Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, 19144 USA
| | - Yang Hai
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, 19144 USA
| | - Peng Wang
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Haidong Deng
- Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Fang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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33
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Alzubaidi AS, Basilim AF. Comparison of intermittent and continuous proton pump inhibitor infusions in patients with non-variceal upper gastrointestinal bleeding at King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A retrospective study. Saudi Med J 2022; 43:941-945. [PMID: 35964952 PMCID: PMC9749666 DOI: 10.15537/smj.2022.43.8.20220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the effectiveness of intermittent and continuous proton pump inhibitors (PPIs) infusion on the outcomes of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB). METHODS The study was a single-centred retrospective study in adult patients with active upper gastrointestinal bleeding who received intermittent or continuous PPI infusion at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2013 to October 2019. The outcomes assessed were rebleeding, length of hospital stays and mortality within 30 days of admission, and were compared between the treatment groups. A statistically significant p-value was set at 0.05. RESULTS The study involved 97 patients with NVUGIB treated with intermittent (n=56) and continuous (n=41) PPI infusions, with mean (±SD) ages of 66.0±16.1 and 58.0±19.5 years, respectively. The baseline and clinical characteristics between the 2 treatment groups; age (p=0.116), gender (p=0.345) and comorbidities (p=0.401), were comparable. There were no significant differences in rebleeding rates within 30 days (5 [8.9%] versus 1 [2.4%], p=0.396), length of hospital stays (4 vs 5, p=0.067), and mortality rate (1 [1.7%] vs 3 [7.3%], p=0.308) between the 2 groups. CONCLUSION The management of NVUGIB with intermittent and continuous PPI infusions demonstrated comparable outcomes in reducing rebleeding rate, length of hospital stays, and mortality rate among patients attending the university hospital in Saudi Arabia.
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Affiliation(s)
- Abeer S. Alzubaidi
- From the Pharmacy Department (Alzubaidi), and from the Department of Pharmacy Practice (Basilim), Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Address correspondence and reprint request to: Dr. Abeer S. Alzubaidi, Pharmacy Department, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid/org/0000-0003-0505-1360
| | - Ahmed F. Basilim
- From the Pharmacy Department (Alzubaidi), and from the Department of Pharmacy Practice (Basilim), Faculty of Pharmacy, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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34
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Calviere L, Gathier CS, Rafiq M, Koopman I, Rousseau V, Raposo N, Albucher JF, Viguier A, Geeraerts T, Cognard C, Rinkel GJE, Vergouwen MDI, Olivot JM. Rebleeding After Aneurysmal Subarachnoid Hemorrhage in Two Centers Using Different Blood Pressure Management Strategies. Front Neurol 2022; 13:836268. [PMID: 35280266 PMCID: PMC8905619 DOI: 10.3389/fneur.2022.836268] [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] [Received: 12/15/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background High systolic blood pressure (SBP) after aneurysmal subarachnoid hemorrhage (aSAH) has been associated with an increased risk of rebleeding. It remains unclear if an SBP lowering strategy before aneurysm treatment decreases this risk without increasing the risk of a delayed cerebral ischemia (DCI). Therefore, we compared the rates of in-hospital rebleeding and DCI among patients with aSAH admitted in two tertiary care centers with different SBP management strategies. Methods Retrospective cohort study. Consecutive patients from Utrecht and Toulouse admitted within 24 h after the aSAH onset were enrolled. In Toulouse, the target SBP before aneurysm treatment was ≤140 mm Hg, while, in Utrecht, an increased SBP was only treated in extreme situations. We compared SBP levels, the incidence of rebleeding within 24 h after admission, and DCI during hospitalization. Results We enrolled 373 patients in Utrecht and 149 in Toulouse. The mean SBP on admission was similar but lower in Toulouse 4 h after admission (127.3 ± 17.4 vs. 138. ± 25.7 mmHg; p < 0.0001). After a median delay of 3.7 h (IQR, 2.3-7.4) from admission, 4 patients (3%) in Toulouse vs. 29 (8%) in Utrecht experienced a rebleeding. After adjustment for Prognosis on Admission of Aneurysmal Subarachnoid Hemorrhage (PAASH) score, aneurysm size, age, and delay from ictus to admission, the HR was 0.66 (95% CI: 0.23-1.92). Incidence of DCI was 18% in Toulouse and 25% in Utrecht (adjusted OR, 0.68; 95% CI: 0.41-1.11). Conclusion Our results suggest that an intensive SBP lowering strategy between admission and aneurysm treatment does not decrease the risk of rebleeding and does not increase the risk of DCI compared to a more conservative strategy.
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Affiliation(s)
- Lionel Calviere
- Stroke Unit, CHU Toulouse, Toulouse, France.,Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France
| | - Celine S. Gathier
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Inez Koopman
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Vanessa Rousseau
- MeDatAS-CIC, CIC1436, Centre Hospitalier Universitaire, Toulouse, France
| | - Nicolas Raposo
- Stroke Unit, CHU Toulouse, Toulouse, France.,Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France
| | - Jean François Albucher
- Stroke Unit, CHU Toulouse, Toulouse, France.,Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France
| | - Alain Viguier
- Stroke Unit, CHU Toulouse, Toulouse, France.,Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France
| | - Thomas Geeraerts
- Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France.,Department of Anesthesiology and Critical Care, CHU Toulouse, Toulouse, France
| | | | - Gabriel J E Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Mervyn D I Vergouwen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jean-Marc Olivot
- Stroke Unit, CHU Toulouse, Toulouse, France.,Toulouse Neuroimaging Center, INSERM, UPS, Toulouse, France
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Romstad KK, Detlie TE, Søberg T, Thomas O, Ricanek P, Jahnsen ME, Lerang F, Jahnsen J. Treatment and outcome of gastrointestinal bleeding due to peptic ulcers and erosions - (BLUE study). Scand J Gastroenterol 2022; 57:8-15. [PMID: 34663154 DOI: 10.1080/00365521.2021.1988701] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Peptic ulcers and erosions are the most common causes of upper gastrointestinal bleeding. The aim of this study was to investigate the management and outcomes of these patients. MATERIALS AND METHODS A total of 543 patients with endoscopically confirmed bleeding from peptic ulcers and erosions were included from March 2015 to December 2017. The patient characteristics, endoscopic findings, Forrest classification and endoscopic treatment were recorded. Moreover, the rebleeding rates, repeated endoscopies and transcatheter angiographic embolization and surgery incidences were registered. A follow-up endoscopy after discharge from the hospital was scheduled. RESULTS Among the patients, high-risk stigmata ulcers were present in 36% (198/543) and low-risk stigmata ulcers and erosions in 60% (327/543) at first endoscopy. Endoscopic therapy was performed in 30% (165/543) of the patients, and hemostasis was achieved in 94% (155/165). The incidence of rebleeding was 9% (49/543) for the whole cohort and 14.8% (23/155) for those patients who had received successful endoscopic treatment. Moreover, rebleeding was significantly more frequent in duodenal ulcers than in gastric ulcers (11.9% vs 4.0%, p = .004). In a multivariable analysis, rebleeding was significantly related to comorbidity and Forrest classification. Transcatheter angiographic embolization and surgery were required in 6% (34/543) and 0.07% (4/543) of patients, respectively. Complete peptic ulcer healing was found at follow-up in 73.3% (270/368) of patients. CONCLUSIONS Endoscopic hemostasis was achieved in the majority of patients with high-risk ulceration, although the occurrence of rebleeding is a significant challenge, especially in patients with duodenal ulcers. Clinical trial registration: Bleeding Ulcer and Erosions Study (BLUE Study), ClinicalTrials.gov identifier: NCT03367897.
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Affiliation(s)
- Katrine Kauczynska Romstad
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Taran Søberg
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Owen Thomas
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Marte Eide Jahnsen
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Frode Lerang
- Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway
| | - Jørgen Jahnsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
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Tamai Y, Tanaka H, Fujimori M, Iwasa M, Nakagawa H. Successful endoscopic cyanoacrylate injection therapy for ruptured duodenal varices immediately after balloon-occluded retrograde transvenous obliteration. JGH Open 2021; 5:1401-1403. [PMID: 34950785 PMCID: PMC8674538 DOI: 10.1002/jgh3.12683] [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] [Received: 10/21/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/11/2022]
Abstract
We present a rare case of acute duodenal variceal rupture after B-RTO that was successfully treated with endoscopic CA injection therapy. A 74-year-old Japanese woman was transferred to our hospital due to progressive general malaise and hematemesis. Gastroduodenoscopy (GDS) showed duodenal varices without active bleeding in the second portion of duodenum. Balloon-occluded retrograde transvenous obliteration (B-RTO) was carried out to prevent duodenal variceal rebleeding. Good pooling of ethanolamine oleate with iopamidol (EOI) was observed in duodenal varices using balloon catheters. However, massive melena was observed immediately after B-RTO. Emergent GDS revealed a white plug on the treated varix, thus endoscopic cyanoacrylate (CA) injection therapy was performed. We speculated that the injection of EOI increased the pressure in the duodenal varices which resulted in rupture of duodenal varices. B-RTO was effective therapy to prevent duodenal variceal rebleeding, but postprocedural monitoring is required as illustrated by this case. We suggest that careful monitoring and backup system for endoscopy are required during or after B-RTO.
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Affiliation(s)
- Yasuyuki Tamai
- Department of Gastroenterology and Hepatology Mie University Graduate School of Medicine Tsu Mie Japan
| | - Hideaki Tanaka
- Department of Gastroenterology and Hepatology Mie University Graduate School of Medicine Tsu Mie Japan
| | - Masashi Fujimori
- Department of Radiology Mie University Graduate School of Medicine Tsu Mie Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology Mie University Graduate School of Medicine Tsu Mie Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology Mie University Graduate School of Medicine Tsu Mie Japan
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Wu Y, Chen M, Huang M, Liao G, Tang S, Zheng H, Li Y, Peng B, Zheng X, Pan S, Hou J, Chen B. [Value of purple sign for predicting rebleeding events in cirrhotic patients following endoscopic selective varices devascularization]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41:1822-1827. [PMID: 35012914 PMCID: PMC8752418 DOI: 10.12122/j.issn.1673-4254.2021.12.10] [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] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the value of the purple sign for predicting long-term rebleeding events in cirrhotic patients following endoscopic selective varices devascularization. METHODS We retrospectively analyzed the clinical data of 97 patients with liver cirrhosis, who had a history of gastroesophageal variceal bleeding and underwent endoscopic selective varices devascularization. Thirty-two of the patients showed purple sign after endoscopic treatment. We used propensity score matching (PSM) to minimize the selection bias of the patients (purple sign vs no purple sign) and reduce the intergroup differences of clinical characteristics. The primary outcome measure of this study was cumulative rebleeding events after endoscopic selective varices devascularization. RESULTS The 1-year rebleeding rate (27.0% vs 36.7%) or 6-month rebleeding rate (10.9% vs 26.9%) following endoscopic treatment was not significantly different between the purple sign group and no purple sign group before PSM (P=0.2385). But after PSM, the 1-year rebleeding rate (28.2% vs 56.4%) and 6-month rebleeding rate (5.0% vs 37.0%) were significantly lower in the purple sign group than in the no purple sign group (P=0.0304). CONCLUSIONS The presence of purple sign indicates a lower risk of rebleeding after endoscopic treatment of cirrhotic gastroesophageal varices and a potentially favorable treatment response after endoscopic therapy, thus providing a clinical indicator for stratification of the patients for sequential endoscopic sessions.
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Affiliation(s)
- Y Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - M Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - M Huang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - G Liao
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - S Tang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - H Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - Y Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - B Peng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - X Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - S Pan
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - J Hou
- Department of Gastroenterology and Hepatology of First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - B Chen
- Department of Gastroenterology and Hepatology of First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou 510000, China
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Hashimoto M, Hatta W, Tsuji Y, Yoshio T, Yabuuchi Y, Hoteya S, Doyama H, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Sugimoto M, Fujishiro M, Masamune A, Ohira H. Rebleeding in patients with delayed bleeding after endoscopic submucosal dissection for early gastric cancer. Dig Endosc 2021; 33:1120-1130. [PMID: 33539035 DOI: 10.1111/den.13943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/29/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Delayed bleeding is a major adverse event in endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). Some patients may experience rebleeding after successful hemostasis for delayed bleeding, yet the details of rebleeding remain unclear. We aimed to clarify the frequency and risk factors of rebleeding. METHODS Among 11,452 patients who underwent ESD for EGC at 33 institutions in Japan between 2013 and 2016, we analyzed 489 patients showing delayed bleeding. The rate of rebleeding was investigated. Subsequently, 15 candidate variables were evaluated for their influence on the risk of rebleeding via logistic regression analysis. RESULTS Rebleeding occurred in 11.2% (55/489) of the enrolled patients. Multivariate analysis revealed that warfarin [odds ratio (OR), 2.71; 95% confidence interval (CI), 1.26-5.84] and a resection size >40 mm (OR, 1.99; 95% CI, 1.08-3.67) were independent risk factors for rebleeding. In the analysis of the management of warfarin after index bleeding, only warfarin discontinuation (OR, 3.66; 95% CI, 1.37-9.78) was significantly associated with rebleeding in comparison with no use of warfarin. However, many rebleeding events (75.0%) occurred following the resumption of warfarin. The rebleeding rate during discontinuation status and that in taking warfarin (continuation or resumption) were 6.1% and 20.0%, respectively. CONCLUSIONS Rebleeding was not a rare event in patients experiencing delayed bleeding after ESD for EGC. In addition to having a resection size >40 mm, warfarin usage placed patients at high risk for rebleeding, especially at the timing of its resumption following discontinuation as well as its continuation.
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Affiliation(s)
- Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.,Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masakuni Kobayashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Hyogo, Japan.,Department of Gastroenterology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | | | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideomi Tomida
- Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.,Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Takuya Inoue
- Division of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan
| | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Jun Nishikawa
- Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan.,Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Kristinsdottir EA, Asgeirsdottir S, Skulason H, Bjornsson A, Vilmarsson V, Sigvaldason K. [Critical care management of patients with spontaneous subarachnoid haemorrhage - a review]. LAEKNABLADID 2021; 107:529-33. [PMID: 34704966 DOI: 10.17992/lbl.2021.11.661] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Spontaneous subarachnoid haemorrhage is characterized by extravasation of blood into the subarachnoid space without a preceding trauma. The leading cause is a ruptured intracranial aneurysm. Serious neurologic complications can occur, such as rebleeding, cerebral vasospasm and delayed cerebral ischemia. Subarachnoid haemorrhage is a serious condition with a high mortality rate and those who survive often suffer long-term consequences. Prevention of rebleeding by aneurysm repair is essential and guidelines recommend this procedure should be done as soon as possible or within 72 hours. Management requires intensive care with emphasis on accurate blood pressure control, maintaining normal fluid and electrolyte balance and monitoring the level of consciousness. All patients should be treated with the calcium channel blocker nimodipine to reduce the risk of vasospasm and delayed cerebral ischemia which are among the most serious complications of subarachnoid haemorrhage.
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Abstract
Background To identify the risk factors associated with rebleeding in obscure gastrointestinal bleeding (OGIB) patients from southern China. Methods This retrospective study involved 229 patients who underwent small bowel endoscopy in our hospital between 1 January 2018 and 1 December 2020. The clinical characteristics and risk factors related to rebleeding were retrospectively evaluated. Results Rebleeding patients were significantly older than non-rebleeding patients (53.0 ± 15.9 vs. 46.2 ± 17.8 years), had lower hemoglobin concentrations (89.2 ± 28.1 vs. 126.2 ± 25.1 g/L), and higher blood urea nitrogen concentrations (5.4 ± 2.6 vs. 4.5 ± 2.2 µmol/L), respectively. A higher percentage of rebleeding patients had diabetes mellitus (13.9% vs. 2.9%) and overt bleeding (70.4% vs. 38.6%), and required blood transfusions (43.1% vs. 8.0%), compared with non-rebleeding patients, respectively. Multivariate logistic analysis indicated that drinking alcohol (odds ratio (OR): 9.27; 95% confidence interval (CI) = 1.35–63.78), anemia (OR: 17.38; 95% CI = 5.48–55.10), and blood transfusion (OR: 3.76; 95% CI = 1.04–13.56) increased the risk of rebleeding in OGIB patients. Conclusion Our data suggested that OGIB patients who drink alcohol, have anemia, and require blood transfusion have an increased risk of rebleeding.
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Affiliation(s)
- Boying Liu
- Department of Gastroenterology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Sudong Liu
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, P. R. China
| | - Pingwu Wen
- Department of Gastroenterology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Shengbing Wang
- Department of Gastroenterology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Fuqun Wang
- Department of Gastroenterology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Xiaodong Gu
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, P. R. China
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Yokoyama S, Ishizu Y, Ishigami M, Honda T, Kuzuya T, Ito T, Hinoki A, Sumida W, Shirota C, Tainaka T, Makita S, Yokota K, Uchida H, Fujishiro M. Factors associated with bleeding after endoscopic variceal ligation in children. Pediatr Int 2021; 63:1223-1229. [PMID: 33464654 DOI: 10.1111/ped.14614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Endoscopic variceal ligation (EVL) is a widely accepted treatment for esophagogastric varices in patients with portal hypertension (PHT). It is used for urgent treatment and prophylactic treatment of esophagogastric varices in pediatric as well as adult patients. However, major life-threatening adverse events such as early rebleeding can occur. Although early rebleeding after EVL among children and adolescents has been reported, the risk factors remain obscure. This study evaluated the risk factors for early rebleeding after EVL in children and adolescents. METHODS The subjects were children and adolescents (<18 years) with PHT who underwent EVL for esophagogastric varices. Early rebleeding was defined as hematemesis, active bleeding, or blood retention in the stomach, confirmed by esophagogastroduodenoscopy from 2 h to 5 days after EVL. RESULTS A total of 50 EVL sessions on 22 patients were eligible for this study. There were four episodes of early rebleeding. No other major adverse event has occurred. Multivariate analysis showed that EVL implemented at cardiac varices just below the esophagogastric junction (EGJ), within 5 mm from the EGJ, is the independent factor for a higher risk of early rebleeding: odds ratio 18.2 (95% confidence interval: 1.40-237.0), P = 0.02. CONCLUSIONS Children and adolescents who undergo EVL for cardiac varices just below the EGJ have a higher risk of early rebleeding than those who do not.
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Affiliation(s)
- Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Teiji Kuzuya
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University, Graduate School of Medicine, Nagoya-shi, Japan
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Liu Q, Yang Y, Yang J, Li M, Yang S, Wang N, Wu J, Jiang P, Wang S. Rebleeding of Ruptured Intracranial Aneurysm After Admission: A Multidimensional Nomogram Model to Risk Assessment. Front Aging Neurosci 2021; 13:692615. [PMID: 34539377 PMCID: PMC8440913 DOI: 10.3389/fnagi.2021.692615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/08/2021] [Accepted: 06/28/2021] [Indexed: 12/23/2022] Open
Abstract
Objective Rebleeding is recognized as the main cause of mortality after intracranial aneurysm rupture. Though timely intervention can prevent poor prognosis, there is no agreement on the surgical priority and choosing medical treatment for a short period after rupture. The aim of this study was to investigate the risk factors related to the rebleeding after admission and establish predicting models for better clinical decision-making. Methods The patients with ruptured intracranial aneurysms (RIAs) between January 2018 and September 2020 were reviewed. All patients fell to the primary and the validation cohort by January 2020. The hemodynamic parameters were determined through the computational fluid dynamics simulation. Cox regression analysis was conducted to identify the risk factors of rebleeding. Based on the independent risk factors, nomogram models were built, and their predicting accuracy was assessed by using the area under the curves (AUCs). Result A total of 577 patients with RIAs were enrolled in this present study, 86 patients of them were identified as undergoing rebleeding after admission. Thirteen parameters were identified as significantly different between stable and rebleeding aneurysms in the primary cohort. Cox regression analysis demonstrated that six parameters, including hypertension [hazard ratio (HR), 2.54; P = 0.044], bifurcation site (HR, 1.95; P = 0.013), irregular shape (HR, 4.22; P = 0.002), aspect ratio (HR, 12.91; P < 0.001), normalized wall shear stress average (HR, 0.16; P = 0.002), and oscillatory stress index (HR, 1.14; P < 0.001) were independent risk factors related to the rebleeding after admission. Two nomograms were established, the nomogram including clinical, morphological, and hemodynamic features (CMH nomogram) had the highest predicting accuracy (AUC, 0.92), followed by the nomogram including clinical and morphological features (CM nomogram; AUC, 0.83), ELAPSS score (AUC, 0.61), and PHASES score (AUC, 0.54). The calibration curve for the probability of rebleeding showed good agreement between prediction by nomograms and actual observation. In the validation cohort, the discrimination of the CMH nomogram was superior to the other models (AUC, 0.93 vs. 0.86, 0.71 and 0.48). Conclusion We presented two nomogram models, named CMH nomogram and CM nomogram, which could assist in identifying the RIAs with high risk of rebleeding.
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Affiliation(s)
- Qingyuan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junhua Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Maogui Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuzhe Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nuochuan Wang
- Department of Blood Transfusion, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pengjun Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Liu S, Zhang X, Walline JH, Yu X, Zhu H. Comparing the Performance of the ABC, AIMS65, GBS, and pRS Scores in Predicting 90-day Mortality Or Rebleeding Among Emergency Department Patients with Acute Upper Gastrointestinal Bleeding: A Prospective Multicenter Study. J Transl Int Med 2021; 9:114-22. [PMID: 34497750 DOI: 10.2478/jtim-2021-0026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Acute upper gastrointestinal bleeding (UGIB) is a common problem that can cause significant morbidity and mortality. We aimed to compare the performance of the ABC score (ABC), the AIMS65 score (AIMS65), the Glasgow-Blatchford score (GBS), and the pre-endoscopic Rockall score (pRS) in predicting 90-day mortality or rebleeding among patients with acute UGIB. Methods This was a prospective multicenter study conducted at 20 tertiary hospitals in China. Data were collected between June 30, 2020 and February 10, 2021. An area under the receiver operating characteristic curve (AUC) analysis was used to compare the performance of the four scores in predicting 90-day mortality or rebleeding. Results Among the 1072 patients included during the study period, the overall 90-day mortality rate was 10.91% (117/1072) and the rebleeding rate was 12.03% (129/1072). In predicting 90-day mortality, the ABC and pRS scores performed better with an AUC of 0.722 (95% CI 0.675-0.768; P<0.001) and 0.711 (95% CI 0.663-0.757; P<0.001), respectively, compared to the AIMS-65 (AUC, 0.672; 95% CI, 0.624-0.721; P<0.001) and GBS (AUC, 0.624; 95% CI, 0.569-0.679; P<0.001) scores. In predicting rebleeding in 90 days, the AUC of all scores did not exceed 0.70. Conclusion In patients with acute UGIB, ABC and pRS performed better than AIMS-65 and GBS in predicting 90-day mortality. The performance of each score is not satisfactory in predicting rebleeding, however. Newer predictive models are needed to predict rebleeding after UGIB.
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Liu L, Nie Y, Zhang Y, Liu Q, Zhu X. Liver Stiffness Is a Predictor of Rebleeding in Patients With Hepatitis B-Related Cirrhosis: A Real-World Cohort Study. Front Med (Lausanne) 2021; 8:690825. [PMID: 34395474 PMCID: PMC8355367 DOI: 10.3389/fmed.2021.690825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/04/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Esophageal vein rebleeding is a life-threatening complication of liver cirrhosis. However, the role of non-invasive methods that were developed to evaluate the severity of chronic liver disease, especially in rebleeding, remains unclear. Aims: To evaluate the performance of liver stiffness and non-invasive fibrosis scores in predicting esophageal vein rebleeding in hepatitis B virus (HBV) cirrhotic patients. Methods: A prospective analysis of 194 HBV patients between 2017 and 2021 was performed. Receiver operating characteristic (ROC) curves and time-dependent ROC curves were used to assess the power for predicting rebleeding with non-invasive fibrosis score and liver stiffness. Results: During the median follow-up time of 68.28 weeks, 55 patients experienced rebleeding. In the entire cohort, the area under the ROC curve for liver stiffness measurement (LSM) predicting for rebleeding was 0.837, with a cut-off value of 17.79 kPa, and the time-dependent ROC curve also showed stable prediction performance of LSM. The predictive ability of the non-invasive fibrosis score was less than that of LSM, and there were statistical differences. Moreover, patients using non-selective beta-blockers and HBV DNA-negative patients experienced significantly reduced rebleeding. Conclusions: Compared with non-invasive fibrosis scores, LSM can more simply and accurately predict rebleeding events of hepatitis B liver cirrhosis.
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Affiliation(s)
- Linxiang Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuan Nie
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yue Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Bhurwal A, Patel A, Mutneja H, Goel A, Palomera-Tejeda E, Brahmbhatt B. The role of endoscopic doppler probe in the management of bleeding peptic ulcers: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:835-843. [PMID: 33206568 DOI: 10.1080/17474124.2021.1850261] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Forrest classification for ulceration has significant intra and inter-observer variability. The endoscopic doppler probe (DOP-US) identifies arterial blood flow at the base to direct therapy. We performed a systematic review and meta-analysis to evaluate the role of the DOP-US in bleeding peptic ulcers. METHODS Three independent reviewers performed a comprehensive review of all original articles published from inception to December 2019, evaluating the use of DOP-US in peptic ulcer bleeding. Primary outcomes were the comparison of rebleeding rate, mortality, and surgical intervention in patients with DOP-US signal-guided therapy versus standard visual evaluation guided therapy. RESULTS Eight studies were included after a thorough search was concluded using the key words. The use of DOP-US probe decreases rebleeding, mortality, and surgical intervention as compared to Forrest Classification. The risk of rebleeding is significantly higher if the signal persists despite endoscopic therapy (48.5% (95% CI 29.5-67.9%)). CONCLUSION The first systematic review and meta-analysis showed that the DOP-US is a beneficial tool in the management of bleeding ulcers and adds valuable information to visual evaluation.
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Affiliation(s)
- Abhishek Bhurwal
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - Anish Patel
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | - Hemant Mutneja
- Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, Illinois
| | - Akshay Goel
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Emanuel Palomera-Tejeda
- Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, Illinois
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Choe AR, Moon CM, Tae CH, Chun J, Bang KB, Lee YJ, Lee HS, Jung Y, Park SC, Koo HS. Characteristics, Location, and Clinical Outcomes of Gastrointestinal Bleeding in Patients Taking New Oral Anticoagulants Compared to Vitamin K Antagonists. J Clin Med 2021; 10:jcm10122693. [PMID: 34207296 PMCID: PMC8234640 DOI: 10.3390/jcm10122693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/06/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
New oral anticoagulants (NOACs) are commonly used in clinical practice as alternatives to vitamin K antagonists (VKA). However, the etiology, clinical course, and risk of gastrointestinal (GI) bleeding remain unclear. We aimed to evaluate the clinical characteristics and location of acute GI bleeding associated with NOACs and its severity and outcomes compared to VKA. This retrospective multicenter study included 381 subjects on anticoagulants who underwent appropriate diagnostic examination due to GI bleeding. Regarding the characteristics of acute GI bleeding, the proportion of vascular lesions was significantly lower in the NOACs group than that in the VKA group. Small bowel bleeding occurred less commonly in the NOACs group, but the difference did not reach statistical significance. Regarding severity and clinical outcomes, patients on NOACs received significantly smaller volumes of transfused blood products and had shorter ICU stays than those on VKA. Moreover, the need for surgery and the risk of rebleeding in the NOACs group were significantly lower than those in the VKA group. Patients on NOACs have better clinical outcomes in terms of severity of acute GI bleeding or rebleeding than patients on VKA. Patients on NOACs demonstrate different characteristics and location of acute GI bleeding than those on VKA.
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Affiliation(s)
- A Reum Choe
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea; (A.R.C.); (C.H.T.)
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea; (A.R.C.); (C.H.T.)
- Inflammation-Cancer Microenvironment Research Center, College of Medicine, Ewha Womans University, Seoul 07804, Korea
- Correspondence: ; Tel.: +82-2-2650-2945
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea; (A.R.C.); (C.H.T.)
| | - Jaeyoung Chun
- Department of Internal Medicine, Seoul National University College of Medicine, Liver Research Institute, Seoul 03080, Korea;
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Ki Bae Bang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Korea;
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Korea;
| | - Hyun Seok Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41404, Korea;
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan 31151, Korea;
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Korea;
| | - Hoon Sup Koo
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Korea;
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Chang HY, Liu ZG, Li YL, Liu B, Wang WJ, Wang W, Wang YZ. Endovascular stenting and coil embolization for management of radiation-induced pseudoaneurysms of the peripheral arteries. J Int Med Res 2021; 49:300060520984933. [PMID: 33845651 PMCID: PMC8047089 DOI: 10.1177/0300060520984933] [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: 11/30/2022] Open
Abstract
Objective This study was performed to evaluate the safety and efficacy of endovascular stenting and embolization for the management of radiation-induced peripheral arterial pseudoaneurysms. Methods Twelve consecutive patients with radiation-induced peripheral arterial pseudoaneurysms (diameter of 10–30 mm and mean size of 20.42 mm) were admitted to our hospital from 1 January 2015 to 31 October 2019. The patients’ baseline characteristics, perioperative parameters, device characteristics, and curative effects were systematically recorded and analyzed. Results The 12 patients comprised 3 men and 9 women with a mean age of 62.90 ± 13.97 years. The iliac artery was the most commonly involved artery, followed by the subclavian artery. In all patients, the pseudoaneurysms were detected by enhanced computed tomography. Twelve covered stents were deployed (7 or 8 mm in diameter and 50 mm in length). Additional coil embolization was performed in three patients (Patients 8, 9, and 10). The primary and secondary technical success rate was 91.7% and 100%, respectively. Apart from one death caused by rebleeding, no patients developed rebleeding during follow-up. Conclusion Endovascular stenting and coil embolization are feasible and effective for the management of radiation-induced peripheral arterial pseudoaneurysms in highly selected patients.
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Affiliation(s)
- Hai-Yang Chang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Zhen-Guo Liu
- Department of Oncology, Gaoqing People's Hospital, Gaoqing, Shandong Province, People's Republic of China
| | - Yu-Liang Li
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Bin Liu
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wu-Jie Wang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Wei Wang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Yong-Zheng Wang
- Department of Interventional Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China.,Interventional Oncology Institute of Shandong University, Jinan, Shandong Province, People's Republic of China
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Sato Y, Yasuda H, Nakamoto Y, Kiyokawa H, Yamashita M, Matsuo Y, Maehata T, Yamamoto H, Itoh F. Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals. J Anus Rectum Colon 2021; 5:148-157. [PMID: 33937555 PMCID: PMC8084535 DOI: 10.23922/jarc.2020-081] [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] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to examine the clinical characteristics of colonic diverticular bleeding (CDB) in elderly individuals. Methods This retrospective case-control study was conducted at a single tertiary center. A total of 519 patients (356 men and 163 women; mean age of 73.1 ± 12.5 years) with CDB and hospitalized between January 2004 and May 2019 were analyzed. The subjects were divided into two groups: the elderly (274 individuals aged ≥75 years; mean age, 82.1 ± 5.3 years) and non-elderly (245 individuals aged <75 years; mean age, 63.0 ± 10.3 years) groups. Primary outcomes were early and late rebleeding rates, and secondary outcomes were the risk factors for late rebleeding in elderly individuals. Rebleeding occurring within 30 days of hospitalization was defined as early rebleeding, whereas rebleeding occurring after 31 days was defined as late rebleeding. Results The early rebleeding rates were 30.6% and 33.1% (p = 0.557) in the elderly and non-elderly groups, respectively. The late rebleeding rates were 42.3% and 30.6% (p = 0.005) in the elderly and non-elderly groups, respectively. The 3-year recurrence-free survival was 63.6% in the elderly group and 75.6% in the non-elderly group (log-rank test: p < 0.001). Multivariate analysis revealed the use of non-steroidal anti-inflammatory drugs (NSAIDs) [odds ratio (OR), 3.55], chronic kidney disease (OR, 2.89), and presence of bilateral diverticula (OR, 1.83) as the independent risk factors for late rebleeding in elderly individuals. Conclusions Elderly individuals with CDB require careful follow-up even after discharge. Furthermore, it is important to consider discontinuing NSAIDs to prevent rebleeding.
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Affiliation(s)
- Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroshi Yasuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yusuke Nakamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Hirofumi Kiyokawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Masaki Yamashita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yasumasa Matsuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Tadateru Maehata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroyuki Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
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Cho YK, Park H, Moon JR, Jeon SR, Kim HG, Lee TH, Park J, Kim JO, Lee JS, Goong HJ, Ko BM, Park S. Clinical Outcomes between P1 and P0 Lesions for Obscure Gastrointestinal Bleeding with Negative Computed Tomography and Capsule Endoscopy. Diagnostics (Basel) 2021; 11:diagnostics11040657. [PMID: 33917389 PMCID: PMC8067371 DOI: 10.3390/diagnostics11040657] [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] [Received: 02/24/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A simple classification for the relevance of lesions (P0, P1, and P2; no bleeding potential, less likely to bleed, and more likely to bleed, respectively) based on capsule endoscopy (CE) findings has been used. This study aimed at investigating rebleeding rates and predictive factors of P0 and P1 lesions after obtaining negative findings in both, CE and computed tomography (CT), for patients with obscure gastrointestinal bleeding (OGIB). METHODS Among 193 patients resulted in negative CE findings defined as P0 or P1 lesions, 84 patients with negative results on CT images were enrolled in this study. The rebleeding rates and predictive factors were assessed in the P0 and P1 groups. RESULTS Overall rebleeding rate in patients with negative CT and CE was 17.9%; 18.4% in the P0 group; 17.4% in the P1 group within a median follow-up duration of 18.5 months. In the P0 and P1 groups, the cumulative rebleeding rates were 9.2%, 25.4%, and 25.4%, and 6.9%, 11.8%, and 18.6% at 12, 24, and 60 months, respectively (p = 0.97). There were no independent rebleeding associated factors in the P0 group, whereas Charlson comorbidity index (CCI) (hazard ratio (HR) = 2.019, 95% confidence interval (CI): 1.158-3.519, p = 0.013), and initial low hemoglobin (Hb) level (<8 g/dL) (HR = 15.085, 95% CI: 1.182-192.514, p = 0.037) were independent predictive factors responsible for rebleeding in the P1 group. CONCLUSIONS Despite having negative findings on CT and CE, patients with OGIB have a significant potential rebleeding risk. Although there was no significant difference in rebleeding rates between the P0 and P1 groups on CE, the P1 group, with CCI or low initial Hb level, should be cautiously observed after the first bleeding episode.
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Affiliation(s)
- Young Kyu Cho
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Heesu Park
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Jung Rock Moon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
- Correspondence: ; Tel.: +82-2-709-9202; Fax: +82-2-709-9581
| | - Hyun Gun Kim
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Tae Hee Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Junseok Park
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Jin-Oh Kim
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Joon Seong Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Hyeon Jeong Goong
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Bong Min Ko
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea; (Y.K.C.); (H.P.); (J.R.M.); (H.G.K.); (T.H.L.); (J.P.); (J.-O.K.); (J.S.L.); (H.J.G.); (B.M.K.)
| | - Suyeon Park
- Department of biostatistics, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-Gu, Seoul 04401, Korea;
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Wang S, Qian X. Effect of multidisciplinary team care on the management of cirrhotic patients with upper gastrointestinal bleeding: a retrospective cohort study. Ann Palliat Med 2021; 10:3050-3058. [PMID: 33752435 DOI: 10.21037/apm-21-85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/05/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Multidisciplinary team care (MDTC) has been proposed to improve the prognosis and quality of life of patients through the collaboration of multiple disciplines. However, it is still unclear whether MDTC is effective in the management of cirrhotic patients with upper gastrointestinal bleeding (UGIB). METHODS This was a retrospective cohort study enrolling cirrhotic patients with UGIB receiving traditional care or MDTC between July 2015 and December 2019. Clinical data and laboratory test results of enrolled patients were collected by 2 independent investigators. The primary outcomes were mortality and the incidence of rebleeding within 1 year. Furthermore, the quality of life of enrolled patients was chosen as the secondary outcome. Multivariable logistic regression was used to determine the risk factors of mortality and rebleeding, after adjusting for confounding variables by univariable logistic regression. Also, multivariable linear regression was used to determine the effects of MDTC on the quality of life of enrolled patients. RESULTS This study finally included 206 cirrhotic patients with UGIB, with 101 patients in the traditional care group and 105 patients in the MDTC group. Compared with the traditional care group, patients in the MDTC group had significantly higher Child-Pugh and model for end-stage liver disease (MELD) scores (P=0.02 and 0.04, respectively). Furthermore, patients in the MDTC group had a significantly lower level of white blood cells (WBC) and a significantly higher level of aspartate transaminase (AST) compared to the traditional care group (P=0.01 and 0.02, respectively). Multivariable logistic regression then identified MDTC as a protective factor for rebleeding and mortality within 1 year. Higher MELD scores and more required units of packed red blood cells (RBC) were associated with a higher incidence of rebleeding and mortality. Additionally, patients in the MDTC group had less discomfort and depression than those in the traditional care group (both P<0.01), and MDTC was associated with improved quality of life according to the multivariable linear regression analysis. CONCLUSIONS MDTC, compared with traditional care, reduced the incidence of rebleeding and mortality over the long term. It was also useful for relieving anxiety and improving the quality of life of patients.
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Affiliation(s)
- Songliu Wang
- Department of Gastroenterology, Nantong Haimen People's Hospital, Nantong, China
| | - Xiangyun Qian
- Nursing Department, Third Affiliated Hospital of Nantong University, Nantong, China.
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