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Update on the management of gastrointestinal varices 被引量:19
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作者 Umesha Boregowda chandraprakash umapathy +7 位作者 Nasir Halim Madhav Desai Arpitha Nanjappa Subramanyeswara Arekapudi Thimmaiah Theethira Helen Wong Marina Roytman Shreyas Saligram 《World Journal of Gastrointestinal Pharmacology and Therapeutics》 CAS 2019年第1期1-21,共21页
Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gast... Cirrhosis of liver is a major problem in the western world. Portal hypertension is a complication of cirrhosis and can lead to a myriad of pathology of which include the development of porto-systemic collaterals. Gastrointestinal varices are dilated submucosal veins, which often develop at sites near the formation of gastroesophageal collateral circulation. The incidence of varices is on the rise due to alcohol and obesity. The most significant complication of portal hypertension is life-threatening bleeding from gastrointestinal varices, which is associated with substantial morbidity and mortality. In addition, this can cause a significant burden on the health care facility. Gastrointestinal varices can happen in esophagus, stomach or ectopic varices. There has been considerable progress made in the understanding of the natural history, pathophysiology and etiology of portal hypertension. Despite the development of endoscopic and medical treatments, early mortality due to variceal bleeding remains high due to significant illness of the patient. Recurrent variceal bleed is common and in some cases, there is refractory variceal bleed. This article aims to provide a comprehensive review of the management of gastrointestinal varices with an emphasis on endoscopic interventions, strategies to handle refractory variceal bleed and newer endoscopic treatment modalities. Early treatment and improved endoscopic techniques can help in improving morbidity and mortality. 展开更多
关键词 PORTAL hypertension ESOPHAGEAL VARICES Gastric VARICES ECTOPIC VARICES ENDOSCOPY
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Endoscopic ultrasound guided gallbladder drainage - is it ready for prime time? 被引量:2
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作者 UmeshaBoregowda chandraprakash umapathy +5 位作者 Arpitha Nanjappa Helen Wong Madhav Desai Marina Roytman Thimmaiah Theethira Shreyas Saligram 《World Journal of Gastrointestinal Pharmacology and Therapeutics》 CAS 2018年第6期47-54,共8页
Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the ... Management of acute cholecystitis includes initial sta-bilization and antibiotics. However, the most definitive treatment is cholecystectomy. A small percentage of patients who are not suitable for surgery due to the severity of cholecystitis or comorbidities will require a temporary measure as a bridge to surgery or permanent nonoperative management to decrease the mortality and morbidity. Most of these patients who require conservative management were managed with percutaneous transhepatic cholecystostomy or trans-papillary drainage of gallbladder drainage with cystic duct stenting through endoscopic retrograde cholangiopancreaticography (ERCP). Although, these conservative measures are effective, they can cause signifcant discomfort to the patients especially if used as a long-term measure. In view of this, there is a need for further minimally invasive procedures, which is safe, effective and comfortable to patients. Endoscopic ultrasound (EUS) guided gallbladder drainage is a novel method of gallbladder drainage frst described in 2007[1]. Over the last decade, EUS guided gallbladder drainage has evolved as an effective alternative to percutaneouscholecystostomy and trans-papillary gallbladder drai-nage. Our goal is to review available literature regarding the scope of EUS guided gallbladder drainage as a viable alternative to percutaneous cholecystostomy or cystic duct stenting through ERCP among patients who are not suitable for cholecystectomy. 展开更多
关键词 Acute cholecystitis Acute acalculous cholecystitis Endoscopic ultrasound guided gallbladder drainage Percutaneous cholecystostomy Trans-papillary gallbladder drainage
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