AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospecti...AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy.RESULTS: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding.CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding.展开更多
BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with wide...BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori infection.AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani population.METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022.Data on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was collected.RESULTS The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting symptoms.Most patients(73.2%)were discharged within five days.The mortality rates at one week and one month were 10.6%and 14.8%,respectively.Re-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,respectively.Most ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed rates.NSAID use was associated with more FCⅢulcers.Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.展开更多
目的比较单独使用经颈内静脉肝内门体分流术(TIPS)与TIPS联合胃冠状静脉栓塞术(TIPS联合GCVE)治疗胃静脉曲张出血术后的再出血率与支架功能障碍发生率。确定胃冠状静脉栓塞术在治疗胃静脉曲张的价值。方法回顾性分析我院2011年1月~2016...目的比较单独使用经颈内静脉肝内门体分流术(TIPS)与TIPS联合胃冠状静脉栓塞术(TIPS联合GCVE)治疗胃静脉曲张出血术后的再出血率与支架功能障碍发生率。确定胃冠状静脉栓塞术在治疗胃静脉曲张的价值。方法回顾性分析我院2011年1月~2016年12月期间使用TIPS或TIPS联合GCVE治疗的143例胃静脉曲张出血的患者(其中TIPS组64例、TIPS联合GCVE组79例)。术后随访1年,采用Kaplan-Meier法比较两组间术后再出血率和生存率,采用Log-rank检验比较两组间生存曲线差异,生存时间以月为单位。结果单纯TIPS组与TIPS+GCVE组手术前后平均脉压差分别为11.57±0.92、17.35±1.08 cm H2O(P<0.01)。术后支架功能障碍率分别为4.77%、1.85%(P=0.82)。TIPS组与TIPS联合GCVE组术后1年累计生存率分别为85.94%、91.14%(P=0.32);TIPS组与TIPS联合GCVE组术后1年累计胃静脉曲张再出血率分别为28.12%、15.19%(P=0.048)。结论 TIPS联合GCVE治疗胃静脉曲张出血的术后1年累计生存率与单纯TIPS组无统计学差异,但TIPS联合GCVE组在术后降低门静脉压力与预防术后胃静脉曲张再出血更优于单纯TIPS组。展开更多
文摘AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy(ES) bleeding.METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, comorbidities, endoscopic diagnosis, presence of periampullary diverticulum, occurrence of immediate postES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy.RESULTS: A total of 35 patients(21.7%) had rebleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/d L, initial bleeding severity, and bleeding diathesis were significant predictors of rebleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/d L and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single(n = 23) or multiple(range, 2-7; n = 6) sessions in 29 of the 35 patients(82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding.CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/d L are predictors of re-bleeding.
文摘BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori infection.AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani population.METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022.Data on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was collected.RESULTS The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting symptoms.Most patients(73.2%)were discharged within five days.The mortality rates at one week and one month were 10.6%and 14.8%,respectively.Re-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,respectively.Most ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed rates.NSAID use was associated with more FCⅢulcers.Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.
文摘目的比较单独使用经颈内静脉肝内门体分流术(TIPS)与TIPS联合胃冠状静脉栓塞术(TIPS联合GCVE)治疗胃静脉曲张出血术后的再出血率与支架功能障碍发生率。确定胃冠状静脉栓塞术在治疗胃静脉曲张的价值。方法回顾性分析我院2011年1月~2016年12月期间使用TIPS或TIPS联合GCVE治疗的143例胃静脉曲张出血的患者(其中TIPS组64例、TIPS联合GCVE组79例)。术后随访1年,采用Kaplan-Meier法比较两组间术后再出血率和生存率,采用Log-rank检验比较两组间生存曲线差异,生存时间以月为单位。结果单纯TIPS组与TIPS+GCVE组手术前后平均脉压差分别为11.57±0.92、17.35±1.08 cm H2O(P<0.01)。术后支架功能障碍率分别为4.77%、1.85%(P=0.82)。TIPS组与TIPS联合GCVE组术后1年累计生存率分别为85.94%、91.14%(P=0.32);TIPS组与TIPS联合GCVE组术后1年累计胃静脉曲张再出血率分别为28.12%、15.19%(P=0.048)。结论 TIPS联合GCVE治疗胃静脉曲张出血的术后1年累计生存率与单纯TIPS组无统计学差异,但TIPS联合GCVE组在术后降低门静脉压力与预防术后胃静脉曲张再出血更优于单纯TIPS组。
