AIM： To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal （UGI） bleeding under today＇s therapeutic regimen. METHODS： From 1998 to 2001, 121 patients with the diagnosis ...AIM： To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal （UGI） bleeding under today＇s therapeutic regimen. METHODS： From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients＇ data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis： age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time （PT）, gastric ulcer （small curvature）, duodenal ulcer （bulbus back wall）, Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding, conservative and surgical therapy. RESULTS： Seventy male （58%） and 51 female （42%） patients with a median age of 70 （range： 21-96） years were treated. Their in-hospital mortality was 14%. While 12% （11/91） of the patients died after conservative therapy, 20% （6/30） died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer （n = 36; 30%）, gastric ulcer （n = 35; 29%）, esophageal varicosis （n = 12; 10%）, Mallory-Weiss syndrome （n = 8, 7%）, erosive lesions of the mucosa （n = 20; 17%）, cancer （n = 5; 4%）, coagulopathy （n = 4; 3%）, lymphoma （n = 2; 2%）, benign tumor （n = 2; 2%） and unknown reason （n = 1, 1%）. A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer （bulbus back wall） were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis, the location of a bleeding ulcer （bulbus back wall） andpatients＇ gender （male） were of prognostic importance for the clinical outcome （mortality） of patients with a bleeding ulcer.CONCLUSION： Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient＇s vital threat posed by an UGI bleeding.Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.展开更多
AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years,1997 to January 2007.METHODS:A total of 25 patients(20 female and five male:aged 18-75 years),wit...AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years,1997 to January 2007.METHODS:A total of 25 patients(20 female and five male:aged 18-75 years),with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract,were included in the study.The main symptom was abdominal pain.The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control.RESULTS:Eleven strictures were located in the colon,13 at the anastomosis after ileocecal resection,three at the Bauhin valve and four in the ileum.Four patients had two strictures and one patient had three strictures.Of the 31 strictures,in 30 was balloon dilatation successful in a single endoscopic session,so that eventually the strictures could be passed easily with the standard colonoscope.In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart,sufficient dilatation was not possible.This patient therefore required surgery.Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation,althoughin one case perforation occurred after dilatation of a recurrent stricture.Available follow-up was in the range of 54-118 mo(mean of 81 mo).The relapse rate over this period was 46%,but 64% of relapsing strictures could be successfully dilated again.Only in four patients was surgery required during this follow-up period.CONCLUSION:We conclude from these initial results that endoscopic balloon dilatation,especially for short strictures in Crohn's disease,can be performed with reliable success.Perforation is a rare complication.It is our opinion that in the long-term,the relapse rate is probably higher than after surgery,but usually a second endoscopic treatment can be performed successfully,leading to a considerable success rate of the endoscopic procedure.展开更多
文摘AIM： To analyze the importance in predicting patients risk of mortality due to upper gastrointestinal （UGI） bleeding under today＇s therapeutic regimen. METHODS： From 1998 to 2001, 121 patients with the diagnosis of UGI bleeding were treated in our hospital. Based on the patients＇ data, a retrospective multivariate data analysis with initially more than 270 single factors was performed. Subsequently, the following potential risk factors underwent a logistic regression analysis： age, gender, initial hemoglobin, coumarines, liver cirrhosis, prothrombin time （PT）, gastric ulcer （small curvature）, duodenal ulcer （bulbus back wall）, Forrest classification, vascular stump, variceal bleeding, MalloryWeiss syndrome, RBC substitution, recurrent bleeding, conservative and surgical therapy. RESULTS： Seventy male （58%） and 51 female （42%） patients with a median age of 70 （range： 21-96） years were treated. Their in-hospital mortality was 14%. While 12% （11/91） of the patients died after conservative therapy, 20% （6/30） died after undergoing surgical therapy. UGI bleeding occurred due to duodenal ulcer （n = 36; 30%）, gastric ulcer （n = 35; 29%）, esophageal varicosis （n = 12; 10%）, Mallory-Weiss syndrome （n = 8, 7%）, erosive lesions of the mucosa （n = 20; 17%）, cancer （n = 5; 4%）, coagulopathy （n = 4; 3%）, lymphoma （n = 2; 2%）, benign tumor （n = 2; 2%） and unknown reason （n = 1, 1%）. A logistic regression analysis of all aforementioned factors revealed that liver cirrhosis and duodenal ulcer （bulbus back wall） were associated risk factors for a fatal course after UGI bleeding. Prior to endoscopy, only liver cirrhosis was an assessable risk factor. Thereafter, liver cirrhosis, the location of a bleeding ulcer （bulbus back wall） andpatients＇ gender （male） were of prognostic importance for the clinical outcome （mortality） of patients with a bleeding ulcer.CONCLUSION： Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient＇s vital threat posed by an UGI bleeding.Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.
文摘AIM:To examine the long-term results of endoscopic treatment in a prospective study conducted over a period of 10 years,1997 to January 2007.METHODS:A total of 25 patients(20 female and five male:aged 18-75 years),with at least one symptom of stricture not passable with the standard colonoscope and with a confirmed scarred Crohn's stricture of the lower gastrointestinal tract,were included in the study.The main symptom was abdominal pain.The endoscopic balloon dilatation was performed with an 18 mm balloon under endoscopic and radiological control.RESULTS:Eleven strictures were located in the colon,13 at the anastomosis after ileocecal resection,three at the Bauhin valve and four in the ileum.Four patients had two strictures and one patient had three strictures.Of the 31 strictures,in 30 was balloon dilatation successful in a single endoscopic session,so that eventually the strictures could be passed easily with the standard colonoscope.In one patient with a long stricture of the ileum involving the Bauhin valve and an additional stricture of the ileum which were 15 cm apart,sufficient dilatation was not possible.This patient therefore required surgery.Improvement of abdominal symptoms was achieved in all cases which had technically successful balloon dilatation,althoughin one case perforation occurred after dilatation of a recurrent stricture.Available follow-up was in the range of 54-118 mo(mean of 81 mo).The relapse rate over this period was 46%,but 64% of relapsing strictures could be successfully dilated again.Only in four patients was surgery required during this follow-up period.CONCLUSION:We conclude from these initial results that endoscopic balloon dilatation,especially for short strictures in Crohn's disease,can be performed with reliable success.Perforation is a rare complication.It is our opinion that in the long-term,the relapse rate is probably higher than after surgery,but usually a second endoscopic treatment can be performed successfully,leading to a considerable success rate of the endoscopic procedure.
