Background and Aim:Gastric varices are associated with high mortality.There have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemi...Background and Aim:Gastric varices are associated with high mortality.There have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt(TIPS)is more effective in the treatment of gastric varices.We compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal bleeding.Methods:The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to 2011.Primary compared to studied between the two treatment modalities were the short-term treatment outcomes,including re-bleeding within 30 days,length of hospital stay and in-hospital mortality.Kaplan-Meier survival analysis was performed to assess factors associated with in-hospital mortality.Results:A total of 169 patients were included in the analysis.The TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 patients.There was no evidence to suggest any significant differences in demographics or disease severity.There were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days(17.4%vs.17.2%;P=0.98),median length of stay in the hospital(4.5 days vs.6.0 days;P紏0.35)or in-hospital mortality(9.0%vs.11.1%;P=0.74).In-hospital mortality was evaluated for 149 patients and lower albumin(P=0.015),higher MELD score(P<0.001),higher CTP score(P=0.005)and bleeding(P=0.008)were all significantly associated with in-hospital death.Conclusion:These findings suggest that both treatments are equally effective.Cyanoacrylate offers a safe,effective alternative to TIPS for gastric varices,and physician may choose the best therapy for each patient,factoring in the availability of TIPS or cyanoacrylate,the individual patient’s presentation,and cost.展开更多
Background.The role of urgent colonoscopy in lower gastro-intestinal bleeding(LGIB)remains controversial.Over the last two decades,a number of studies have indicated that urgent colonoscopy may facilitate the identifi...Background.The role of urgent colonoscopy in lower gastro-intestinal bleeding(LGIB)remains controversial.Over the last two decades,a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions;however,studies comparing this approach to elective colonoscopy for LGIB are limited.Aims.To determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit(ICU)with acute LGIB.Methods.Consecutive patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed retrospectively.Patients were grouped into urgent vs.elective colonoscopy,depending on the timing of colonoscopy after admission to the ICU.Urgent colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered elective.Outcomes included length of hospital stay,early re-bleeding rates,and the need for additional diagnostic or therapeutic interventions.Multivariable logistic regression analysis was performed to identify factors associated with increased transfusion requirements.Results.Fifty-seven patients underwent colonoscopy for the evaluation of suspected LGIB,24 of which were urgent.There was no significant difference in patient demographics,co-morbidities,or medications between the two groups.Patients who underwent urgent colonoscopy were more likely to present with hemodynamic instability(P=0.019)and require blood transfusions(P=0.003).No significant differences in length of hospital stay,re-bleeding rates,or the need for additional diagnostic or therapeutic interventions were found.Patients requiring blood transfusions(n=27)were more likely to be female(P=0.016)and diabetics(P=0.015).Fourteen patients re-bled at a median of 2 days after index colonoscopy.Those with hemodynamic instability were more likely to re-bleed[HR 3.8(CI 1.06–13.7)],undergo angiography[HR 9.8(CI 1.8–54.1)],require surgery[HR 13.5(CI 3.2–56.5)],and had an increased length of hospital stay[HR 1.1(1.05–1.2)].Conclusion:The use of urgent colonoscopy,as an initial approach to investigate acute LGIB,did not result in significant differences in length of ICU stay,re-bleeding rates,the need for additional diagnostic or therapeutic interventions,or 30-day mortality compared with elective colonoscopy.In a pre-specified subgroup analysis,patients with hemodynamic instability were more likely to re-bleed after index colonoscopy,to require additional interventions(angiography or surgery)and had increased length of hospital stay.展开更多
文摘Background and Aim:Gastric varices are associated with high mortality.There have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt(TIPS)is more effective in the treatment of gastric varices.We compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal bleeding.Methods:The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to 2011.Primary compared to studied between the two treatment modalities were the short-term treatment outcomes,including re-bleeding within 30 days,length of hospital stay and in-hospital mortality.Kaplan-Meier survival analysis was performed to assess factors associated with in-hospital mortality.Results:A total of 169 patients were included in the analysis.The TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 patients.There was no evidence to suggest any significant differences in demographics or disease severity.There were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days(17.4%vs.17.2%;P=0.98),median length of stay in the hospital(4.5 days vs.6.0 days;P紏0.35)or in-hospital mortality(9.0%vs.11.1%;P=0.74).In-hospital mortality was evaluated for 149 patients and lower albumin(P=0.015),higher MELD score(P<0.001),higher CTP score(P=0.005)and bleeding(P=0.008)were all significantly associated with in-hospital death.Conclusion:These findings suggest that both treatments are equally effective.Cyanoacrylate offers a safe,effective alternative to TIPS for gastric varices,and physician may choose the best therapy for each patient,factoring in the availability of TIPS or cyanoacrylate,the individual patient’s presentation,and cost.
文摘Background.The role of urgent colonoscopy in lower gastro-intestinal bleeding(LGIB)remains controversial.Over the last two decades,a number of studies have indicated that urgent colonoscopy may facilitate the identification and treatment of bleeding lesions;however,studies comparing this approach to elective colonoscopy for LGIB are limited.Aims.To determine the utility and assess the outcome of urgent colonoscopy as the initial test for patients admitted to the intensive care unit(ICU)with acute LGIB.Methods.Consecutive patients who underwent colonoscopy at our institution for the initial evaluation of acute LGIB between January 2011 and January 2012 were analysed retrospectively.Patients were grouped into urgent vs.elective colonoscopy,depending on the timing of colonoscopy after admission to the ICU.Urgent colonoscopy was defined as being performed within 24 hours of admission and those performed later than 24 hours were considered elective.Outcomes included length of hospital stay,early re-bleeding rates,and the need for additional diagnostic or therapeutic interventions.Multivariable logistic regression analysis was performed to identify factors associated with increased transfusion requirements.Results.Fifty-seven patients underwent colonoscopy for the evaluation of suspected LGIB,24 of which were urgent.There was no significant difference in patient demographics,co-morbidities,or medications between the two groups.Patients who underwent urgent colonoscopy were more likely to present with hemodynamic instability(P=0.019)and require blood transfusions(P=0.003).No significant differences in length of hospital stay,re-bleeding rates,or the need for additional diagnostic or therapeutic interventions were found.Patients requiring blood transfusions(n=27)were more likely to be female(P=0.016)and diabetics(P=0.015).Fourteen patients re-bled at a median of 2 days after index colonoscopy.Those with hemodynamic instability were more likely to re-bleed[HR 3.8(CI 1.06–13.7)],undergo angiography[HR 9.8(CI 1.8–54.1)],require surgery[HR 13.5(CI 3.2–56.5)],and had an increased length of hospital stay[HR 1.1(1.05–1.2)].Conclusion:The use of urgent colonoscopy,as an initial approach to investigate acute LGIB,did not result in significant differences in length of ICU stay,re-bleeding rates,the need for additional diagnostic or therapeutic interventions,or 30-day mortality compared with elective colonoscopy.In a pre-specified subgroup analysis,patients with hemodynamic instability were more likely to re-bleed after index colonoscopy,to require additional interventions(angiography or surgery)and had increased length of hospital stay.
