Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Cap...Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI) bleed.展开更多
Neuroendocrine tumors(NETs) are uncommon gastrointestinal neoplasms but have been increasingly recognized over the past few decades. Luminal NETs originate from the submucosa of the gastrointestinal tract and careful ...Neuroendocrine tumors(NETs) are uncommon gastrointestinal neoplasms but have been increasingly recognized over the past few decades. Luminal NETs originate from the submucosa of the gastrointestinal tract and careful endoscopic exam is a key for accurate diagnosis. Despite their reputation as indolent tumors with a good prognosis,some NETs may have aggressive features with associated poor long-term survival. Management of NETs requires full understanding of tumor size,depth of invasion,local lymphadenopathy status,and location within the gastrointestinal tract. Staging with endoscopic ultrasound or cross-sectional imaging is important for determining whether endoscopic treatment is feasible. In general,small superficial NETs can be managed by endoscopic mucosal resection and endoscopic submucosal dissection(ESD). In contrast,NETs larger than 2 cm are almost universally treated with surgical resection with lymphadenectomy. For those tumors between 11-20 mm in size,careful evaluation can identify which NETs may be managed with endoscopic resection. The increasing adoption of ESD may improve the results of endoscopic resection for luminal NETs. However,enthusiasm for endoscopic resection must be tempered with respect for the more definitive curative results afforded by surgical treatment with more advanced lesions.展开更多
Endoscopic submucosal dissection (ESD) is a new endoluminal therapeutic technique involving the use of cutting devices to permit a larger resection of the tissue over the muscularis propria. The major advantages of th...Endoscopic submucosal dissection (ESD) is a new endoluminal therapeutic technique involving the use of cutting devices to permit a larger resection of the tissue over the muscularis propria. The major advantages of the technique in comparison with polypectomy and endoscopic mucosal resection are controllable resection size and shape and en bloc resection of a large lesion or a lesion with ulcerative findings. This technique is applied for the endoscopic treatment of epithelial neoplasms in the gastrointestinal tract from the pharynx to the rectum. Furthermore, some carcinoids and submucosal tumors in the gastrointestinal tract are treated by ESD. To determine the indication, two aspects should be considered. The first is a little likelihood of lymph node metastasis and the second is the technical resectability. In this review, practical guidelines of ESD for the gastrointestinal neoplasms are discussed based on the evidence found in the literature.展开更多
AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with ...AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with 123 colorectal lesions examined by NBI endoscopy in the Zhejiang Provincial People's Hospital from September 2008 to April 2010 were enrolled in this study.These lesions were classified by pit pattern and capillary pattern,and then assessed by histopathology.RESULTS:Ten lesions not meeting the diagnostic criteria were excuded,the overall diagnostic accuracy of NBI endoscopy in distinguishing neoplasia from non-neoplasia colorectal lesions was 91.2%(103/113),and that of NBI endoscopy with and without high magnification was 93.0%(40/43) and 90.0%(63/70),respectively.Both were significantly higher than that of conventional colonoscopy reported in the literature(P < 0.05),but there was no significant difference between the two groups(P > 0.05).CONCLUSION:Besides NBI magnifying endoscopy,NBI endoscopy without magnification may also be used to distinguish neoplasia from non-neoplasia colorectal lesions.展开更多
AIM： To analyze the results and complications of intraoperative enteroscopy （IOE） by investigating a series of selected patients with bleeding suspected to originate from the small intestine. METHODS： Eighty-one p...AIM： To analyze the results and complications of intraoperative enteroscopy （IOE） by investigating a series of selected patients with bleeding suspected to originate from the small intestine. METHODS： Eighty-one patients （mean age： 65 years） including 40 males （49.4%） and 41 females （50.6%） with obscure gastrointestinal bleeding underwent IOE between 1990 and 2004. The patients were identified from a database and data were selected from the patients＇ charts retrospectively. All the patients had undergone at least one non-diagnostic esophagogastroduodenoscopy, colonoscopy, standard enteroscopy and a negative abdominal ultrasound scan before IOE. RESULTS： The median minimal hemoglobin level in the patients was 59＋15g/L and 72.8% of the patients required transfusion of packed erythrOoltes previously. A bleeding source was detected in 68 （84%） of the patients during IOE. Angiodysplasiae were found in 44 patients （54.3%） and 9 patients （11.1%） were affected by ulcers in the small intestine. A tumor in the small intestine was detected in another 6 patients. The treatment consisted of argon-plasma-coagulation, surgical suture or limited resection in most of the patients. CONCLUSION： Intra-operative enteroscopy is still used for the diagnosis of suspected small bowel bleeding. Recent developments such as wireless capsule endoscopy and double balloon enteroscopy, may lead to the replacement of IOE in the future.展开更多
The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to impr...The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.展开更多
There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of th...There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.展开更多
AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without s...AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A) and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.展开更多
AIM: To assess the prevalence of clinically signifi cant lesions in patients with minimal bright red bleeding per rectum (BRBPR). METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim H...AIM: To assess the prevalence of clinically signifi cant lesions in patients with minimal bright red bleeding per rectum (BRBPR). METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defi ned as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflamma-tory bowel disease (IBD), positive fi rst degree family history of colorectal neoplasms, history of altered bow- el habits, recent signifi cant weight loss, and presence of iron defi ciency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were def ined as signif icant lesions. RESULTS: A total of 402 patients (183 female and 219 male, aged 43.6 ± 15.7 years) were studied. Hemorrhoids (54.2%), anal fi ssures (14.2%) and ul-cerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Signifi cant le-sions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with signifi cant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids. CONCLUSION: Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. Thechoice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.展开更多
AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHOD...AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.展开更多
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
Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity,a shorter treatment time,and similar outcomes.However,simultaneous laparoscopy-assisted low anterior...Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity,a shorter treatment time,and similar outcomes.However,simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature.Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort.He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected.The operation time was 270 min and the estimated blood loss was 120 mL.The patient required parenteral analgesia for less than 24 h.Flatus was passed on postoperative day 3,and a solid diet was resumed on postoperative day 7.He was discharged on postoperative day 13.With the advances in laparoscopic technology and experience,simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.展开更多
文摘Capsule endoscopy (CE) is a safe, non invasive diagnostic modality for the evaluation of small bowel lesions. Obscure gastrointestinal bleeding (OGIB) is one of the most important indications of capsule endoscopy. Capsule endoscopy has a very high diagnostic yield especially if the bleeding is ongoing. This technique appears to be superior to other techniques for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal (GI) bleed.
文摘Neuroendocrine tumors(NETs) are uncommon gastrointestinal neoplasms but have been increasingly recognized over the past few decades. Luminal NETs originate from the submucosa of the gastrointestinal tract and careful endoscopic exam is a key for accurate diagnosis. Despite their reputation as indolent tumors with a good prognosis,some NETs may have aggressive features with associated poor long-term survival. Management of NETs requires full understanding of tumor size,depth of invasion,local lymphadenopathy status,and location within the gastrointestinal tract. Staging with endoscopic ultrasound or cross-sectional imaging is important for determining whether endoscopic treatment is feasible. In general,small superficial NETs can be managed by endoscopic mucosal resection and endoscopic submucosal dissection(ESD). In contrast,NETs larger than 2 cm are almost universally treated with surgical resection with lymphadenectomy. For those tumors between 11-20 mm in size,careful evaluation can identify which NETs may be managed with endoscopic resection. The increasing adoption of ESD may improve the results of endoscopic resection for luminal NETs. However,enthusiasm for endoscopic resection must be tempered with respect for the more definitive curative results afforded by surgical treatment with more advanced lesions.
文摘Endoscopic submucosal dissection (ESD) is a new endoluminal therapeutic technique involving the use of cutting devices to permit a larger resection of the tissue over the muscularis propria. The major advantages of the technique in comparison with polypectomy and endoscopic mucosal resection are controllable resection size and shape and en bloc resection of a large lesion or a lesion with ulcerative findings. This technique is applied for the endoscopic treatment of epithelial neoplasms in the gastrointestinal tract from the pharynx to the rectum. Furthermore, some carcinoids and submucosal tumors in the gastrointestinal tract are treated by ESD. To determine the indication, two aspects should be considered. The first is a little likelihood of lymph node metastasis and the second is the technical resectability. In this review, practical guidelines of ESD for the gastrointestinal neoplasms are discussed based on the evidence found in the literature.
文摘AIM:To evaluate the diagnostic efficacies of narrowband imaging(NBI) endoscopy with and without high magnification in distinguishing neoplasia from nonneoplasia colorectal lesions.METHODS:A total of 118 patients with 123 colorectal lesions examined by NBI endoscopy in the Zhejiang Provincial People's Hospital from September 2008 to April 2010 were enrolled in this study.These lesions were classified by pit pattern and capillary pattern,and then assessed by histopathology.RESULTS:Ten lesions not meeting the diagnostic criteria were excuded,the overall diagnostic accuracy of NBI endoscopy in distinguishing neoplasia from non-neoplasia colorectal lesions was 91.2%(103/113),and that of NBI endoscopy with and without high magnification was 93.0%(40/43) and 90.0%(63/70),respectively.Both were significantly higher than that of conventional colonoscopy reported in the literature(P < 0.05),but there was no significant difference between the two groups(P > 0.05).CONCLUSION:Besides NBI magnifying endoscopy,NBI endoscopy without magnification may also be used to distinguish neoplasia from non-neoplasia colorectal lesions.
文摘AIM： To analyze the results and complications of intraoperative enteroscopy （IOE） by investigating a series of selected patients with bleeding suspected to originate from the small intestine. METHODS： Eighty-one patients （mean age： 65 years） including 40 males （49.4%） and 41 females （50.6%） with obscure gastrointestinal bleeding underwent IOE between 1990 and 2004. The patients were identified from a database and data were selected from the patients＇ charts retrospectively. All the patients had undergone at least one non-diagnostic esophagogastroduodenoscopy, colonoscopy, standard enteroscopy and a negative abdominal ultrasound scan before IOE. RESULTS： The median minimal hemoglobin level in the patients was 59＋15g/L and 72.8% of the patients required transfusion of packed erythrOoltes previously. A bleeding source was detected in 68 （84%） of the patients during IOE. Angiodysplasiae were found in 44 patients （54.3%） and 9 patients （11.1%） were affected by ulcers in the small intestine. A tumor in the small intestine was detected in another 6 patients. The treatment consisted of argon-plasma-coagulation, surgical suture or limited resection in most of the patients. CONCLUSION： Intra-operative enteroscopy is still used for the diagnosis of suspected small bowel bleeding. Recent developments such as wireless capsule endoscopy and double balloon enteroscopy, may lead to the replacement of IOE in the future.
文摘The purpose of this article is to review the evidence regarding transmission of infection during gastrointestinal endoscopy, factors important in endoscope reprocessing and infection control, areas to focus on to improve compliance, and recent developments and advances in the field.
基金Supported by the Italian Society of Pediatric Gastroenterology,Hepatology and Nutrition
文摘There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.
文摘AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy;BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A) and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.
文摘AIM: To assess the prevalence of clinically signifi cant lesions in patients with minimal bright red bleeding per rectum (BRBPR). METHODS: Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defi ned as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflamma-tory bowel disease (IBD), positive fi rst degree family history of colorectal neoplasms, history of altered bow- el habits, recent signifi cant weight loss, and presence of iron defi ciency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were def ined as signif icant lesions. RESULTS: A total of 402 patients (183 female and 219 male, aged 43.6 ± 15.7 years) were studied. Hemorrhoids (54.2%), anal fi ssures (14.2%) and ul-cerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Signifi cant le-sions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with signifi cant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids. CONCLUSION: Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. Thechoice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.
文摘AIM: To investigate in a prospective study whether a simplifi ed clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy. METHODS: All consecutive UGIB patients referred to a single endoscopic center during a 16 mo period were enrolled. Before endoscopy patients were strati- fied according to a simple clinical score (T-score), including T1 (high-risk), T2 (intermediate-risk) and T3 (low-risk). Endoscopy was performed in all cases within 2 h, and high-risk stigmata were considered for further analysis. RESULTS: Out of the 436 patients included into the study, 126 (29%) resulted to be T1, 135 (31%) T2, and 175 (40%) T3. Overall, stigmata of recent haem-orrhage (SRH) were detected in 118 cases (27%). SRH occurred more frequently in T1 patients than in T2/T3 cases (85% vs 3.2%; χ2 = 304.5309, P < 0.001). Older age (t=3.311; P < 0.01) and presence of comor-bidities (χ2 = 14.7458; P < 0.01) were more frequently detected in T1 than in T2/T3 patients. CONCLUSION: Our simplifi ed clinical score appeared to be associated with the detection of endoscopic findings which may deserve urgent endoscopy. A further,randomised study is needed to assess its accuracy in safely scheduling endoscopy in UGIB patients.
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.
文摘Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity,a shorter treatment time,and similar outcomes.However,simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature.Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort.He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected.The operation time was 270 min and the estimated blood loss was 120 mL.The patient required parenteral analgesia for less than 24 h.Flatus was passed on postoperative day 3,and a solid diet was resumed on postoperative day 7.He was discharged on postoperative day 13.With the advances in laparoscopic technology and experience,simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.
