Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as ...Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as 12%-17% of patients,endoscopy is either not available or unsuccessful. Endovascular therapy with selective catheterization of the culprit vessel and injection of embolic material has emerged as an alternative to emergent operative intervention in high-risk patients. There has not been a systematic literature review to assess the role for embolotherapy in the treatment of acute upper gastrointestinal bleeding from gastroduo-denal ulcers after failed endoscopic hemostasis. Here,we present an overview of indications,techniques,and clinical outcomes after endovascular embolization of acute peptic-ulcer bleeding. Topics of particular relevance to technical and clinical success are also discussed. Our review shows that transcatheter arterial embolization is a safe alternative to surgery for massive gastroduodenal bleeding that is refractory to endoscopic treatment,can be performed with high technical and clinical success rates,and should be considered the salvage treatment of choice in patients at high surgical risk.展开更多
AIM： To evaluate the feasibility and utility of confocal laser endomicroscopy （CLE） in the description of normal gastrointestinal （GI） mucosa and in the diagnosis of GI disorders in children, in comparison to his...AIM： To evaluate the feasibility and utility of confocal laser endomicroscopy （CLE） in the description of normal gastrointestinal （GI） mucosa and in the diagnosis of GI disorders in children, in comparison to histology.METHODS： Forty-four patients （19 female） median age 10.9 years （range 0.7-16.6 years） with suspected or known GI pathology underwent esophago-gastro- duodenoscopy （OGD） （n = 36） and/or ileocolonoscopy （IC） （n = 31） with CLE using sodium fluorescein and acriflavine as contrast agents. Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists, respectively.RESULTS： Duodenum and ileum were intubated in all but one patient undergoing OGD and IC. The median procedure time was 16.4 min （range 7-25 rain） for OGD and 27.9 min （range 15-45 min） for IC. A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures, and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures.Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis, Helicobacter pylori gastritis, celiac disease, inflammatory bowel disease, colonic heterotopia, and graft versus host disease.CONCLUSION： CLE offers the prospect of targeting biopsies to abnormal mucosa, thereby increasing diagnostic yield, reducing the number of biopsies, decreasing the burden on the histopathological services, and reducing costs.展开更多
文摘Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as 12%-17% of patients,endoscopy is either not available or unsuccessful. Endovascular therapy with selective catheterization of the culprit vessel and injection of embolic material has emerged as an alternative to emergent operative intervention in high-risk patients. There has not been a systematic literature review to assess the role for embolotherapy in the treatment of acute upper gastrointestinal bleeding from gastroduo-denal ulcers after failed endoscopic hemostasis. Here,we present an overview of indications,techniques,and clinical outcomes after endovascular embolization of acute peptic-ulcer bleeding. Topics of particular relevance to technical and clinical success are also discussed. Our review shows that transcatheter arterial embolization is a safe alternative to surgery for massive gastroduodenal bleeding that is refractory to endoscopic treatment,can be performed with high technical and clinical success rates,and should be considered the salvage treatment of choice in patients at high surgical risk.
基金Supported by Peel Research Foundation and Yorkshire Cancer ResearchThe Egyptian Cultural Bureau
文摘AIM： To evaluate the feasibility and utility of confocal laser endomicroscopy （CLE） in the description of normal gastrointestinal （GI） mucosa and in the diagnosis of GI disorders in children, in comparison to histology.METHODS： Forty-four patients （19 female） median age 10.9 years （range 0.7-16.6 years） with suspected or known GI pathology underwent esophago-gastro- duodenoscopy （OGD） （n = 36） and/or ileocolonoscopy （IC） （n = 31） with CLE using sodium fluorescein and acriflavine as contrast agents. Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists, respectively.RESULTS： Duodenum and ileum were intubated in all but one patient undergoing OGD and IC. The median procedure time was 16.4 min （range 7-25 rain） for OGD and 27.9 min （range 15-45 min） for IC. A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures, and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures.Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis, Helicobacter pylori gastritis, celiac disease, inflammatory bowel disease, colonic heterotopia, and graft versus host disease.CONCLUSION： CLE offers the prospect of targeting biopsies to abnormal mucosa, thereby increasing diagnostic yield, reducing the number of biopsies, decreasing the burden on the histopathological services, and reducing costs.
