Background and study aims:In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16-24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding.In this study...Background and study aims:In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16-24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding.In this study,we sought to identify factors that might predict further rebleeding after this scheduled second-look endoscopy.Patients and methods:We studied 249 patients(181 men,68 women) with acute bleeding peptic ulcers who were treated at the United Christian Hospital,Hong Kong from 1999 to 2002 and who underwent a scheduled second endoscopy.Those patients who developed rebleeding after the second endoscopy were evaluated,and possible predictive factors for rebleeding were analyzed using a logistic regression model.Results:Of the 249 patients who underwent scheduled second-look endoscopy,17 patients(6.8%) developed rebleeding:seven of these patientswere treated by another endoscopic therapy;ten patients required surgery.The overall mortality rate was 3.1%.A logistic regression analysis performed on the possible predictive factors for rebleeding found that the following factors were associated with a significant risk of further rebleeding after scheduled second endoscopy:American Society of Anesthesiologists(ASA) grade III or grade IV status(odds ratio 3.81,95% CI 1.27-11.44) ,ulcer size greater than 1.0 cm(odds ratio 4.69,95% CI 1.60-13.80) ,and a finding of persistent stigmata of recent hemorrhage at the scheduled second endoscopy(odds ratio 6.65,95% CI 2.11-20.98) .Conclusions:Endoscopic factors,including large ulcer size and the persistence of endoscopic stigmata of recent hemorrhage are important predictors for recurrent bleeding after scheduled second endoscopy.展开更多
Background and Study Aims:We have previously reported the success of a method of virtual histology using laser-scanning confocal microscopy(LCM)in vitro on untreated fresh specimens obtained from the gastrointestinal ...Background and Study Aims:We have previously reported the success of a method of virtual histology using laser-scanning confocal microscopy(LCM)in vitro on untreated fresh specimens obtained from the gastrointestinal mucosa.In the present study,we aimed to apply LCM to both fresh and formalin-fixed specimens,without additional treatment,in order to validate and compare the quality of the images obtained.Methods:We obtained 18 specimens from 11 patients,either by endoscopic biopsy or following surgical resection.First,we observed the fresh,saline-immersed specimen with LCM using the Fluroview microscope(Olympus Co.Ltd.,Tokyo,Japan).We then fixed the specimen with formalin and obtained further LCM images 1 hour,3 hours,and 24 hours after fixation.Three independent observers observed the images and were asked to assess the origin of the samples,the treatment of the samples,the time after formalin fixation,and whether they showed benign or malignant lesions.We used kappa statistics to compare the agreement among the three observers in each of these four areas of interest.Results:Between January and March 2003,we obtained 191 LCM images from 18 specimens.Thirty images were randomly selected for observation.The overall accuracy for differentiating between esophagus and stomach specimens was 96.6%.The accuracy of differentiating normal from cancerous lesions was 92.2%.The differentiation between saline-immersed and formalin-fixed specimens was 59.7%accurate and the assessment of the time interval after formalin fixation was only 37.3%accurate.The kappa statistics showed that there was strong interobserver agreement on the differentiation of specimen origin and of cancerous from benign lesions.However,there was no agreement among the observers on the method of specimen preparation or on the estimated time interval after formalin fixation.Conclusions:We concluded that images obtained from fresh specimens using LCM were of a quality good enough to make an accurate diagnosis of upper gastrointestinal carcinoma.展开更多
文摘Background and study aims:In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16-24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding.In this study,we sought to identify factors that might predict further rebleeding after this scheduled second-look endoscopy.Patients and methods:We studied 249 patients(181 men,68 women) with acute bleeding peptic ulcers who were treated at the United Christian Hospital,Hong Kong from 1999 to 2002 and who underwent a scheduled second endoscopy.Those patients who developed rebleeding after the second endoscopy were evaluated,and possible predictive factors for rebleeding were analyzed using a logistic regression model.Results:Of the 249 patients who underwent scheduled second-look endoscopy,17 patients(6.8%) developed rebleeding:seven of these patientswere treated by another endoscopic therapy;ten patients required surgery.The overall mortality rate was 3.1%.A logistic regression analysis performed on the possible predictive factors for rebleeding found that the following factors were associated with a significant risk of further rebleeding after scheduled second endoscopy:American Society of Anesthesiologists(ASA) grade III or grade IV status(odds ratio 3.81,95% CI 1.27-11.44) ,ulcer size greater than 1.0 cm(odds ratio 4.69,95% CI 1.60-13.80) ,and a finding of persistent stigmata of recent hemorrhage at the scheduled second endoscopy(odds ratio 6.65,95% CI 2.11-20.98) .Conclusions:Endoscopic factors,including large ulcer size and the persistence of endoscopic stigmata of recent hemorrhage are important predictors for recurrent bleeding after scheduled second endoscopy.
文摘Background and Study Aims:We have previously reported the success of a method of virtual histology using laser-scanning confocal microscopy(LCM)in vitro on untreated fresh specimens obtained from the gastrointestinal mucosa.In the present study,we aimed to apply LCM to both fresh and formalin-fixed specimens,without additional treatment,in order to validate and compare the quality of the images obtained.Methods:We obtained 18 specimens from 11 patients,either by endoscopic biopsy or following surgical resection.First,we observed the fresh,saline-immersed specimen with LCM using the Fluroview microscope(Olympus Co.Ltd.,Tokyo,Japan).We then fixed the specimen with formalin and obtained further LCM images 1 hour,3 hours,and 24 hours after fixation.Three independent observers observed the images and were asked to assess the origin of the samples,the treatment of the samples,the time after formalin fixation,and whether they showed benign or malignant lesions.We used kappa statistics to compare the agreement among the three observers in each of these four areas of interest.Results:Between January and March 2003,we obtained 191 LCM images from 18 specimens.Thirty images were randomly selected for observation.The overall accuracy for differentiating between esophagus and stomach specimens was 96.6%.The accuracy of differentiating normal from cancerous lesions was 92.2%.The differentiation between saline-immersed and formalin-fixed specimens was 59.7%accurate and the assessment of the time interval after formalin fixation was only 37.3%accurate.The kappa statistics showed that there was strong interobserver agreement on the differentiation of specimen origin and of cancerous from benign lesions.However,there was no agreement among the observers on the method of specimen preparation or on the estimated time interval after formalin fixation.Conclusions:We concluded that images obtained from fresh specimens using LCM were of a quality good enough to make an accurate diagnosis of upper gastrointestinal carcinoma.
