BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used ove...The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.展开更多
A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic...A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.展开更多
Gastrointestinal angiodysplasia(GIAD)is a common,acquired,vascular abnor-mality in the gastrointestinal tract that is commonly implicated in bleeding.Siro-limus,also known as rapamycin,is a mammalian target of rapamyc...Gastrointestinal angiodysplasia(GIAD)is a common,acquired,vascular abnor-mality in the gastrointestinal tract that is commonly implicated in bleeding.Siro-limus,also known as rapamycin,is a mammalian target of rapamycin pathway inhibitor that has shown significant potential in inhibiting abnormal angiogenesis that has demonstrated efficacy in inhibiting abnormal blood vessel formation in the skin,cornea,and tumors.Sun et al in their single centre prospective study aimed to evaluate the efficacy and safety of sirolimus in treating GIAD-associated bleeding.While their study does provide a sound platform for future studies to investigate the effects of sirolimus in the treatment of GIAD-associated bleeding in an evidence free zone,there are limitations to the study which are not addre-ssed.In this commentary,we summarise the significant highlights from the study performed by Sun et al along with its limitations.In addition to this,we provide an update on the current therapies utilised in the treatment of GIAD-associated bleeding.展开更多
Non-variceal upper gastrointestinal bleeding(GIB)remains a significant clinical challenge with a 30-day mortality of up to 11%.Peptic ulcers are the most common cause,followed by other conditions like Mallory-Weiss sy...Non-variceal upper gastrointestinal bleeding(GIB)remains a significant clinical challenge with a 30-day mortality of up to 11%.Peptic ulcers are the most common cause,followed by other conditions like Mallory-Weiss syndrome,Dieulafoy’s lesions,and gastric neoplasms.Treatment strategies include acid-suppressive therapy,endoscopic interventions,and surgical or radiological procedures.Endoscopic techniques such as over-the-scope clips,coagulation graspers,and endoscopic ultrasound-guided treatments have significantly improved outcomes,reducing rebleeding rates and the need for surgery.Injectable therapies,mechanical hemostasis via clips,and thermal modalities(e.g.,electrocoagulation,argon plasma coagulation)remain standard approaches for active bleeding.Newer hemostatic powders,such as TC-325,offer promising non-contact treatments,particularly in cases of refractory bleeding or malignancy.Doppler endoscopic probes aid in risk stratification by detecting residual arterial blood flow,improving the efficacy of endoscopic therapy and reducing rebleeding risks.For small bowel bleeding,endoscopic management with enteroscopy and thermal therapies remains key,though medical therapies are evolving.Lower GIB,which often involves conditions like diverticular disease and angioectasia,requires a comprehensive approach combining endoscopic,radiologic,and surgical interventions.Pharmacologic management focuses on balancing antithrombotic therapy with bleeding risks,with reversal agents playing a crucial role in life-threatening bleeding episodes.This review highlights advances in diagnostic tools and endoscopic therapies that have enhanced management outcomes for GIB across various etiologies.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is...BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is no consensus on the optimal platelet level that would be safe for endoscopic intervention,although a platelet level of>50×10^(9)/L was suggested based on expert opinion.There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.AIM To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.METHODS This is a single center retrospective study.The data was collected from the electronic health record from 2018 to 2020.Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count≤50×10^(9)/L were included in the study.Outcomes included mortality,transfusion requirements,length of stay,intensive care unit admission and recurrent bleeding.A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy>24 hours.RESULTS A total of 76 patients were identified.The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm.There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day(P=0.13)or 1 year(P=0.78)mortality,recurrent bleeding(P=0.68),transfusion of red blood cells(P=0.47),platelets(P=0.31),or length of stay(P=0.94).A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality(P=0.11 and 0.46,respectively)compared to routine endoscopy,but was associated with decreased recurrent bleeding in 30 days(P=0.01).CONCLUSION Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.展开更多
BACKGROUND Acute variceal bleeding(AVB)represents a life-threatening complication in hepatocellular carcinoma(HCC)patients undergoing systemic therapy,mainly including immune checkpoint inhibitors(ICIs)and antivascula...BACKGROUND Acute variceal bleeding(AVB)represents a life-threatening complication in hepatocellular carcinoma(HCC)patients undergoing systemic therapy,mainly including immune checkpoint inhibitors(ICIs)and antivascular drugs used alone or in combination.The pathogenesis of AVB in this population may involve tumor-related factors,treatment-induced effects,or progression of underlying portal hypertension.Identifying high-risk factors for AVB is crucial for the management of this patient population.AIM To develop and validate a risk prediction model for AVB occurrence in cirrhotic HCC patients receiving ICI-based systemic therapy.METHODS This retrospective study analyzed 286 HCC patients(2021-2022)receiving ICIs(mono-/combination therapy),randomly split into training(n=184)and validation(n=102)cohorts.In the training cohort,bleeding vs nonbleeding groups were compared for general information,etiological data,laboratory indicators,tumor staging,systemic treatment drugs,variceal bleeding history,and endoscopic treatment history.Risk factors for AVB were identified and used to establish a logistic regression model for predicting bleeding,which was further validated in the validation cohort.RESULTS The bleeding group had significantly higher proportions of patients with platelet count≥100×10^(9)/L,alphafetoprotein≥400 ng/mL,tumor diameter≥5 cm,portal vein tumor thrombosis,ascites,bleeding history,prior endoscopic treatment,albumin-bilirubin grade level 2-3,fibrosis-4 index(FIB-4)≥4.57,and prognostic nutritional index<45 compared to the non-bleeding group.Multivariate analysis identified tumor diameter≥5 cm,portal vein thrombosis,bleeding history,and elevated FIB-4 as independent risk factors for bleeding(P<0.05).A predictive model based on these factors showed good discrimination,with area under the receiver operating characteristic curve values of 0.861(training)and 0.816(validation).CONCLUSION A history of pre-ICI bleeding significantly increases recurrent bleeding risk,necessitating close monitoring.The FIB-4 fibrosis model,combined with tumor features,can also serve as a predictive factor for bleeding.展开更多
BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenou...BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.展开更多
BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospec...BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy(EIS)and subsequent interventional radiology(IR).AIM To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.METHODS This was a single tertiary care center before-after study,including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center.A retrospective review of the medical records was conducted.The management of these four patients involved the utilization of EIS followed by IR.The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches:Phase 1,from the initial occurrence of BEV-SB to the initial EIS;phase 2,from the initial EIS to the initial IR treatment;and phase 3,from the initial IR to December 2023.Descriptive statistics were performed to clarify the blood transfusions in each phase.RESULTS Four out of 519 patients diagnosed with PH were identified as having BEV-SB.The management duration of each phase was 20 person-months,42 personmonths,and 77 person-months,respectively.The four patients received a total of eight and five person-times of EIS and IR treatment,respectively.All patients exhibited recurrent gastrointestinal bleeding following the first EIS,while no further instances of gastrointestinal bleeding were observed after IR treatment.The transfusions administered during each phase were 34,31,and 3.5 units of red blood cells,and 13 units,14 units,and 1 unit of plasma,respectively.CONCLUSION EIS may be effective in achieving hemostasis for BEV-SB,but rebleeding is common,and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased morta...BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.展开更多
BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used ...BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used for hemostasis in patients with CDB.Endoscopic detachable snare ligation(EDSL)has also become an increasingly common treatment option.The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.AIM To study the effectiveness and complications of endoscopic clipping,EBL,and EDSL for CDB.METHODS We conducted a systematic search of PubMed/MEDLINE,Scopus,Web of Science,Embase,Google Scholar,and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping,EBL,or EDSL as treatment methods.The pooled estimates of initial hemostasis,early and late rebleeding,and the need for transarterial embolization or surgery between these groups were calculated.RESULTS We analyzed 28 studies with 5224 patients.Of these,4526 had active CDB and required one of the three endoscopic interventions.The pooled prevalence of early rebleeding was 23.5%,10.7%,and 10.6%in the endoscopic clipping,EBL,and EDSL groups,respectively.Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL[odds ratio(OR)=3.76(95%CI:2.13-6.63)]and EDSL(OR=3.30,95%CI:1.28-8.53).There was no difference in the initial hemostasis between the three groups.The pooled prevalence of late rebleeding was 27.2%in the clipping,followed by 13.8%in the EBL and 2.7%in the EDSL group.Compared to 2.6%in the EBL group,4.0%of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization.These results were consistent in the network meta-analysis.Based on the ranking of the indirect comparison of modalities,the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.CONCLUSION The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.展开更多
Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42...Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.展开更多
BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension,most commonly caused by cirrhosis of various etiologies.Although a considerable body of research has been condu...BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension,most commonly caused by cirrhosis of various etiologies.Although a considerable body of research has been conducted in this area,the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings,insufficient information,and a lack of systematic investigation.Bibliometric analysis can help clarify research trends,identify core topics,and reveal potential future directions.Therefore,this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field,with the expectation of providing new insights for both clinical practice and scientific research.AIM To evaluate research trends and advancements in esophagogastric variceal bleeding(EGVB)over the past twenty years.METHODS Relevant publications on EGVB were retrieved from the Web of Science Core Collection.VOSviewer,Pajek,CiteSpace,and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume,countries,institutions,journals,authors,keywords,and citation counts.RESULTS The analysis focused on original research articles and review papers.From 2004 to 2023,a total of 2097 records on EGVB were retrieved.The number of relevant publications has increased significantly over the past two decades,especially in China and the United States.The leading contributors in this field,in terms of countries,institutions,authors,and journals,were China,Assistance Publique-Hôpitaux de Paris,Bosch Jaime,and World Journal of Gastroenterology,respectively.Core keywords in this field include portal hypertension,management,liver cirrhosis,risk,prevention,and diagnosis.Future research directions may focus on optimizing diagnostic methods,personalized treatment,and multidisciplinary collaboration.CONCLUSION Using bibliometric methods,this study reveals the developmental trajectory and trends in research on EGVB,underscoring risk assessment and diagnostic optimization as the core areas of current focus.The study provides an innovative and systematic perspective for this field,indicating that future research could center on multidisciplinary collaboration,personalized treatment approaches,and the development of new diagnostic tools.Moreover,this work offers practical research directions for both the academic community and clinical practice,driving continued advancement in this domain.展开更多
Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evalua...Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evaluated the effectiveness and safety of systematic treatment in GC/GEJC patients presenting with OB.Using propensity score matching,the study balanced the comparison groups to investigate overall survival and treatment-related adverse events.The study's findings emphasize that systematic therapy can be safe and effective and contribute to the ongoing debate about the management of advanced GC/GEJC with OB,highlighting the complexities of treatment decisions in these high-risk patients.展开更多
BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat t...BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.展开更多
PuraStat®is a novel self-assembling peptide(SAP)used as a haemostatic agent in endoscopy,with widespread application in surgical settings.While the current evidence,though deserving further expansion,demonstrates...PuraStat®is a novel self-assembling peptide(SAP)used as a haemostatic agent in endoscopy,with widespread application in surgical settings.While the current evidence,though deserving further expansion,demonstrates a good haemostatic performance profile for this substance,there remains significant heterogeneity among studies,and an analysis of this SAP as monotherapy is not always available.The recent study by Bellester et al in the World Journal of Gastrointestinal Endoscopy provided an optimal effectiveness profile of this SAP in 45 patients treated for gastrointestinal(GI)bleeding,particularly highlighting data on its use as monotherapy in upper GI bleeding.This invited article outlines the current evidence on PuraStat®and offers a commentary on the recently published study.展开更多
BACKGROUND Gastrointestinal(GI)vascular bleeding disorders pose significant clinical challenges due to their complex pathogenesis and varied treatment responses.Despite advancements in diagnostic and therapeutic techn...BACKGROUND Gastrointestinal(GI)vascular bleeding disorders pose significant clinical challenges due to their complex pathogenesis and varied treatment responses.Despite advancements in diagnostic and therapeutic techniques,optimal mana-gement strategies remain elusive,necessitating further research.AIM To assess research trends and clinical advancements in GI vascular bleeding disorders,highlighting key themes and therapeutic progress.METHODS A bibliometric analysis was conducted using the Web of Science Core Collection database,reviewing publications from 2000 to 2024 to identify trends,highfrequency keywords,and key contributions from leading research institutions.In addition,a case study highlighted the effective application of sirolimus in managing colonic angioectasia in a patient with recurrent GI bleeding who had not responded to previous treatments.RESULTS The analysis reviewed 470 scholarly articles from 203 countries,involving 2817 authors across 1502 institutions.The United States led in publication contributions,with strong collaborations with countries like China,England,and Germany.A significant trend was observed in the shift from traditional endoscopic interventions to pharmacological therapies,particularly highlighting the successful use of sirolimus in treating colonic angioectasia. High-frequency keywords such as “angiodysplasia”,“colon”, and “management” were identified, indicating key research themes. The study also noted a growinginterest in drug therapies, as evidenced by the increasing prominence of keywords like “thalidomide” since 2018.CONCLUSIONThis study links bibliometric analysis and clinical insights, highlighting the shift to pharmacological managementin GI vascular bleeding disorders to improve patient outcomes.展开更多
BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emer...BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emerged to address these limitations,few models simultaneously perform small-bowel(SB)loca lization and abnormality detection.AIMTo develop an AI model that automatically distinguishes the SB from the stomach and colon and diagnoses SBabnormalities.METHODSWe developed an AI model using 87005 CE images (11925, 33781, and 41299 from the stomach, SB, and colon,respectively) for SB localization and 28405 SBCE images (1337 erosions/ulcers, 126 angiodysplasia, 494 bleeding,and 26448 normal) for abnormality detection. The diagnostic performances of AI-assisted reading and conventionalreading were compared using 32 SBCE videos in patients with suspicious SB bleeding.RESULTSRegarding organ localization, the AI model achieved an area under the receiver operating characteristic curve(AUC) and accuracy exceeding 0.99 and 97%, respectively. For SB abnormality detection, the performance was asfollows: Erosion/ulcer: 99.4% accuracy (AUC, 0.98);angiodysplasia: 99.8% accuracy (AUC, 0.99);bleeding: 99.9%accuracy (AUC, 0.99);normal: 99.3% accuracy (AUC, 0.98). In external validation, AI-assisted reading (8.7 minutes)was significantly faster than conventional reading (53.9 minutes;P < 0.001). The SB localization accuracies (88.6% vs72.7%, P = 0.07) and SB abnormality detection rates (77.3% vs 77.3%, P = 1.00) of the conventional reading and AIassistedreading were comparable.CONCLUSIONOur AI model decreased SBCE reading time and achieved performance comparable to that of experiencedendoscopists, suggesting that AI integration into SBCE reading enables efficient and reliable SB abnormalitydetection.展开更多
BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriat...BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.展开更多
Postoperative bleeding(POB)is a major complication following pancreaticoduodenectomy(PD),leading to significant morbidity and potential mortality.This minireview focuses on the prevention and management strategies for...Postoperative bleeding(POB)is a major complication following pancreaticoduodenectomy(PD),leading to significant morbidity and potential mortality.This minireview focuses on the prevention and management strategies for POB,synthesizing current evidence on surgical techniques,perioperative management,and postoperative interventions.Effective prevention strategies include the use of regional vessel wrapping,optimal pancreatic anastomosis,and meticulous intraoperative hemostasis.Postoperative management strategies,such as early detection using predictive models and advanced imaging,along with endovascular interventions like angiographic embolization and stent graft placement,are essential for timely intervention.Risk factors,including pancreatic texture,anticoagulation therapy,and patient comorbidities,further influence bleeding outcomes.The minireview also identifies gaps in current research and emphasizes the need for prospective randomized controlled trials to establish standardized protocols.Overall,a multidisciplinary approach combining surgical expertise,predictive analytics,and personalized care is essential to improving patient out comes and minimizing the risk of POB following PD.展开更多
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
文摘The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.
文摘A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.
文摘Gastrointestinal angiodysplasia(GIAD)is a common,acquired,vascular abnor-mality in the gastrointestinal tract that is commonly implicated in bleeding.Siro-limus,also known as rapamycin,is a mammalian target of rapamycin pathway inhibitor that has shown significant potential in inhibiting abnormal angiogenesis that has demonstrated efficacy in inhibiting abnormal blood vessel formation in the skin,cornea,and tumors.Sun et al in their single centre prospective study aimed to evaluate the efficacy and safety of sirolimus in treating GIAD-associated bleeding.While their study does provide a sound platform for future studies to investigate the effects of sirolimus in the treatment of GIAD-associated bleeding in an evidence free zone,there are limitations to the study which are not addre-ssed.In this commentary,we summarise the significant highlights from the study performed by Sun et al along with its limitations.In addition to this,we provide an update on the current therapies utilised in the treatment of GIAD-associated bleeding.
文摘Non-variceal upper gastrointestinal bleeding(GIB)remains a significant clinical challenge with a 30-day mortality of up to 11%.Peptic ulcers are the most common cause,followed by other conditions like Mallory-Weiss syndrome,Dieulafoy’s lesions,and gastric neoplasms.Treatment strategies include acid-suppressive therapy,endoscopic interventions,and surgical or radiological procedures.Endoscopic techniques such as over-the-scope clips,coagulation graspers,and endoscopic ultrasound-guided treatments have significantly improved outcomes,reducing rebleeding rates and the need for surgery.Injectable therapies,mechanical hemostasis via clips,and thermal modalities(e.g.,electrocoagulation,argon plasma coagulation)remain standard approaches for active bleeding.Newer hemostatic powders,such as TC-325,offer promising non-contact treatments,particularly in cases of refractory bleeding or malignancy.Doppler endoscopic probes aid in risk stratification by detecting residual arterial blood flow,improving the efficacy of endoscopic therapy and reducing rebleeding risks.For small bowel bleeding,endoscopic management with enteroscopy and thermal therapies remains key,though medical therapies are evolving.Lower GIB,which often involves conditions like diverticular disease and angioectasia,requires a comprehensive approach combining endoscopic,radiologic,and surgical interventions.Pharmacologic management focuses on balancing antithrombotic therapy with bleeding risks,with reversal agents playing a crucial role in life-threatening bleeding episodes.This review highlights advances in diagnostic tools and endoscopic therapies that have enhanced management outcomes for GIB across various etiologies.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a major cause of hospitalization worldwide.Patients with hematologic malignancies have a higher risk of GIB as a result of thrombocytopenia and platelet dysfunction.There is no consensus on the optimal platelet level that would be safe for endoscopic intervention,although a platelet level of>50×10^(9)/L was suggested based on expert opinion.There is a paucity of data on whether endoscopic intervention and the timing of endoscopy impacted the outcome of patients with hematologic malignancy and severe thrombocytopenia who experienced acute overt GIB.AIM To assess the safety of endoscopic intervention of inpatients with hematological malignancies and severe thrombocytopenia presenting with acute overt GIB.METHODS This is a single center retrospective study.The data was collected from the electronic health record from 2018 to 2020.Inpatients with hematologic malignancy who presented with acute overt GIB and platelet count≤50×10^(9)/L were included in the study.Outcomes included mortality,transfusion requirements,length of stay,intensive care unit admission and recurrent bleeding.A subgroup analysis was performed to compare the outcomes of urgent endoscopy within 24 hours of GIB vs endoscopy>24 hours.RESULTS A total of 76 patients were identified.The mean platelet count is 24.3 in the endoscopy arm and 14.6 in the conservative management arm.There was no statistically significant difference between patients who had endoscopy vs conservative management in 30-day(P=0.13)or 1 year(P=0.78)mortality,recurrent bleeding(P=0.68),transfusion of red blood cells(P=0.47),platelets(P=0.31),or length of stay(P=0.94).A subgroup analysis comparing urgent endoscopy within 24 hours compared with delayed endoscopy showed urgent endoscopy was not associated with improved 30-day or 1 year mortality(P=0.11 and 0.46,respectively)compared to routine endoscopy,but was associated with decreased recurrent bleeding in 30 days(P=0.01).CONCLUSION Medical supportive treatment without endoscopy could be considered as an alternative to endoscopic therapy for patients with hematologic malignancy complicated by severe thrombocytopenia and acute non-variceal GIB.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-034AHebei Province 2025 Traditional Chinese Medicine Scientific Research Project Plan,No.T2025008.
文摘BACKGROUND Acute variceal bleeding(AVB)represents a life-threatening complication in hepatocellular carcinoma(HCC)patients undergoing systemic therapy,mainly including immune checkpoint inhibitors(ICIs)and antivascular drugs used alone or in combination.The pathogenesis of AVB in this population may involve tumor-related factors,treatment-induced effects,or progression of underlying portal hypertension.Identifying high-risk factors for AVB is crucial for the management of this patient population.AIM To develop and validate a risk prediction model for AVB occurrence in cirrhotic HCC patients receiving ICI-based systemic therapy.METHODS This retrospective study analyzed 286 HCC patients(2021-2022)receiving ICIs(mono-/combination therapy),randomly split into training(n=184)and validation(n=102)cohorts.In the training cohort,bleeding vs nonbleeding groups were compared for general information,etiological data,laboratory indicators,tumor staging,systemic treatment drugs,variceal bleeding history,and endoscopic treatment history.Risk factors for AVB were identified and used to establish a logistic regression model for predicting bleeding,which was further validated in the validation cohort.RESULTS The bleeding group had significantly higher proportions of patients with platelet count≥100×10^(9)/L,alphafetoprotein≥400 ng/mL,tumor diameter≥5 cm,portal vein tumor thrombosis,ascites,bleeding history,prior endoscopic treatment,albumin-bilirubin grade level 2-3,fibrosis-4 index(FIB-4)≥4.57,and prognostic nutritional index<45 compared to the non-bleeding group.Multivariate analysis identified tumor diameter≥5 cm,portal vein thrombosis,bleeding history,and elevated FIB-4 as independent risk factors for bleeding(P<0.05).A predictive model based on these factors showed good discrimination,with area under the receiver operating characteristic curve values of 0.861(training)and 0.816(validation).CONCLUSION A history of pre-ICI bleeding significantly increases recurrent bleeding risk,necessitating close monitoring.The FIB-4 fibrosis model,combined with tumor features,can also serve as a predictive factor for bleeding.
文摘BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.
基金Supported by the Air Force Medical Center Outstanding Youth Program,No.2022YXQNNO36.
文摘BACKGROUND Bleeding ectopic varices located in the small bowel(BEV-SB)caused by portal hypertension(PH)are rare and life-threatening clinical scenarios.The current management of BEV-SB is unsatisfactory.This retrospective study analyzed four cases of BEV-SB caused by PH and detailed the management of these cases using enteroscopic injection sclerotherapy(EIS)and subsequent interventional radiology(IR).AIM To analyze the management of BEV-SB caused by PH and develop a treatment algorithm.METHODS This was a single tertiary care center before-after study,including four patients diagnosed with BEV-SB secondary to PH between January 2019 and December 2023 in the Air Force Medical Center.A retrospective review of the medical records was conducted.The management of these four patients involved the utilization of EIS followed by IR.The management duration of BEV-SB in each patient can be retrospectively divided into three phases based on these two approaches:Phase 1,from the initial occurrence of BEV-SB to the initial EIS;phase 2,from the initial EIS to the initial IR treatment;and phase 3,from the initial IR to December 2023.Descriptive statistics were performed to clarify the blood transfusions in each phase.RESULTS Four out of 519 patients diagnosed with PH were identified as having BEV-SB.The management duration of each phase was 20 person-months,42 personmonths,and 77 person-months,respectively.The four patients received a total of eight and five person-times of EIS and IR treatment,respectively.All patients exhibited recurrent gastrointestinal bleeding following the first EIS,while no further instances of gastrointestinal bleeding were observed after IR treatment.The transfusions administered during each phase were 34,31,and 3.5 units of red blood cells,and 13 units,14 units,and 1 unit of plasma,respectively.CONCLUSION EIS may be effective in achieving hemostasis for BEV-SB,but rebleeding is common,and IR aiming to reduce portal pressure gradient may lower the rebleeding rate.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a critical complication often seen in patients with acute coronary syndrome(ACS),especially those undergoing dual antiplatelet therapy.GIB is associated with increased mortality and prolonged hospitalization,particularly in ACS patients.Despite advancements in management strategies,the role of gastrointestinal endoscopy(GIE)in this population remains controversial,with concerns about timing,safety,and clinical outcomes.AIM To evaluate the safety and efficacy of GIE in patients with ACS and acute GIB,focusing on outcomes such as mortality,hospital length of stay(LOS),hemorrhage control,rebleeding,and blood transfusion requirements.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines,a systematic review was conducted using databases including PubMed,Cochrane,and EMBASE,up to December 2024.The protocol was registered with the International Prospective Register of Systematic Reviews(CRD42025630188).Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials(RCTs)and the Newcastle-Ottawa Scale for cohort studies.RESULTS Four studies met the inclusion criteria,comprising one RCT and three cohort studies with a total population of 1676130 patients.Most studies indicated that GIE was associated with improved survival in ACS patients with GIB.Three of our studies reported lower mortality rates in patients undergoing GIE compared to those managed without endoscopy,although this varied by study.While GIE demonstrated effectiveness in controlling hemorrhage and reducing rebleeding rates in one study.The rest of the studies did not evaluate these outcomes comprehensively.Hospital LOS outcomes were inconsistent,with two studies suggesting no significant difference,while only one study indicated potential reductions in LOS with GIE.Blood transfusion requirements were reported in one study to be higher in patients undergoing GIE,reflecting its frequent use in severe cases.The safety and effectiveness of GIE varied depending on patient characteristics,timing of the procedure,and type of intervention.CONCLUSION GIE has the potential to improve survival in certain patients with ACS complicated by GIB;however,determining the ideal timing and appropriate candidates necessitates careful individual assessment.While evidence suggests benefits,the limitations of observational studies warrant caution.Collaboration between cardiology and gastroenterology is essential to optimizing outcomes.Future randomized trials should focus on timing,severity,and diverse populations to refine guidelines and improve care for this high-risk group.
文摘BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence.The endoscopic clipping and endoscopic band ligation(EBL)methods are widely used for hemostasis in patients with CDB.Endoscopic detachable snare ligation(EDSL)has also become an increasingly common treatment option.The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.AIM To study the effectiveness and complications of endoscopic clipping,EBL,and EDSL for CDB.METHODS We conducted a systematic search of PubMed/MEDLINE,Scopus,Web of Science,Embase,Google Scholar,and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping,EBL,or EDSL as treatment methods.The pooled estimates of initial hemostasis,early and late rebleeding,and the need for transarterial embolization or surgery between these groups were calculated.RESULTS We analyzed 28 studies with 5224 patients.Of these,4526 had active CDB and required one of the three endoscopic interventions.The pooled prevalence of early rebleeding was 23.5%,10.7%,and 10.6%in the endoscopic clipping,EBL,and EDSL groups,respectively.Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL[odds ratio(OR)=3.76(95%CI:2.13-6.63)]and EDSL(OR=3.30,95%CI:1.28-8.53).There was no difference in the initial hemostasis between the three groups.The pooled prevalence of late rebleeding was 27.2%in the clipping,followed by 13.8%in the EBL and 2.7%in the EDSL group.Compared to 2.6%in the EBL group,4.0%of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization.These results were consistent in the network meta-analysis.Based on the ranking of the indirect comparison of modalities,the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.CONCLUSION The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.
文摘Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.
基金Supported by the National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Esophageal and gastric variceal bleeding is a catastrophic complication of portal hypertension,most commonly caused by cirrhosis of various etiologies.Although a considerable body of research has been conducted in this area,the complexity of the disease and the lack of standardized treatment strategies have led to fragmented findings,insufficient information,and a lack of systematic investigation.Bibliometric analysis can help clarify research trends,identify core topics,and reveal potential future directions.Therefore,this study aims to use bibliometric methods to conduct an in-depth exploration of research progress in this field,with the expectation of providing new insights for both clinical practice and scientific research.AIM To evaluate research trends and advancements in esophagogastric variceal bleeding(EGVB)over the past twenty years.METHODS Relevant publications on EGVB were retrieved from the Web of Science Core Collection.VOSviewer,Pajek,CiteSpace,and the bibliometrix package were then employed to perform bibliometric visualizations of publication volume,countries,institutions,journals,authors,keywords,and citation counts.RESULTS The analysis focused on original research articles and review papers.From 2004 to 2023,a total of 2097 records on EGVB were retrieved.The number of relevant publications has increased significantly over the past two decades,especially in China and the United States.The leading contributors in this field,in terms of countries,institutions,authors,and journals,were China,Assistance Publique-Hôpitaux de Paris,Bosch Jaime,and World Journal of Gastroenterology,respectively.Core keywords in this field include portal hypertension,management,liver cirrhosis,risk,prevention,and diagnosis.Future research directions may focus on optimizing diagnostic methods,personalized treatment,and multidisciplinary collaboration.CONCLUSION Using bibliometric methods,this study reveals the developmental trajectory and trends in research on EGVB,underscoring risk assessment and diagnostic optimization as the core areas of current focus.The study provides an innovative and systematic perspective for this field,indicating that future research could center on multidisciplinary collaboration,personalized treatment approaches,and the development of new diagnostic tools.Moreover,this work offers practical research directions for both the academic community and clinical practice,driving continued advancement in this domain.
文摘Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evaluated the effectiveness and safety of systematic treatment in GC/GEJC patients presenting with OB.Using propensity score matching,the study balanced the comparison groups to investigate overall survival and treatment-related adverse events.The study's findings emphasize that systematic therapy can be safe and effective and contribute to the ongoing debate about the management of advanced GC/GEJC with OB,highlighting the complexities of treatment decisions in these high-risk patients.
文摘BACKGROUND Colonic diverticular bleeding is a significant cause of acute overt lower gastrointestinal hemorrhage.Colonoscopy is commonly performed in patients with colonic diverticular bleeding to identify and treat the source of bleeding,which is crucial for effective management.CASE SUMMARY We present the case of a 70-year-old male with acute painless hematochezia.Colonoscopy showed active bleeding originating from a diverticulum,and the EyeMax direct visualization system was used in the treatment of the colonic diverticular bleeding.No further evidence of bleeding was observed at the end of the procedure.The patient was discharged from hospital on the seventh day.CONCLUSION The EyeMax system proved advantageous in localizing the bleeding diverticulum,thereby facilitating successful hemostatic measures.
文摘PuraStat®is a novel self-assembling peptide(SAP)used as a haemostatic agent in endoscopy,with widespread application in surgical settings.While the current evidence,though deserving further expansion,demonstrates a good haemostatic performance profile for this substance,there remains significant heterogeneity among studies,and an analysis of this SAP as monotherapy is not always available.The recent study by Bellester et al in the World Journal of Gastrointestinal Endoscopy provided an optimal effectiveness profile of this SAP in 45 patients treated for gastrointestinal(GI)bleeding,particularly highlighting data on its use as monotherapy in upper GI bleeding.This invited article outlines the current evidence on PuraStat®and offers a commentary on the recently published study.
基金Air Force Medical Center Youth Talent Program Project,No.22YXQN034Capital Health Development Research Special Project,No.2020-4-5123Beijing Haidian District Health and Wellness Development Scientific Research Cultivation Program,No.HP2021-03-80803.
文摘BACKGROUND Gastrointestinal(GI)vascular bleeding disorders pose significant clinical challenges due to their complex pathogenesis and varied treatment responses.Despite advancements in diagnostic and therapeutic techniques,optimal mana-gement strategies remain elusive,necessitating further research.AIM To assess research trends and clinical advancements in GI vascular bleeding disorders,highlighting key themes and therapeutic progress.METHODS A bibliometric analysis was conducted using the Web of Science Core Collection database,reviewing publications from 2000 to 2024 to identify trends,highfrequency keywords,and key contributions from leading research institutions.In addition,a case study highlighted the effective application of sirolimus in managing colonic angioectasia in a patient with recurrent GI bleeding who had not responded to previous treatments.RESULTS The analysis reviewed 470 scholarly articles from 203 countries,involving 2817 authors across 1502 institutions.The United States led in publication contributions,with strong collaborations with countries like China,England,and Germany.A significant trend was observed in the shift from traditional endoscopic interventions to pharmacological therapies,particularly highlighting the successful use of sirolimus in treating colonic angioectasia. High-frequency keywords such as “angiodysplasia”,“colon”, and “management” were identified, indicating key research themes. The study also noted a growinginterest in drug therapies, as evidenced by the increasing prominence of keywords like “thalidomide” since 2018.CONCLUSIONThis study links bibliometric analysis and clinical insights, highlighting the shift to pharmacological managementin GI vascular bleeding disorders to improve patient outcomes.
基金Supported by The Bio and Medical Technology Development Program of the National Research Foundation,No.NRF-2022R1C1C1010643.
文摘BACKGROUND Small-bowel capsule endoscopy(SBCE)is widely used to evaluate obscure gastrointestinal bleeding;however,its interpretation is time-consuming and reader-dependent.Although artificial intelligence(AI)has emerged to address these limitations,few models simultaneously perform small-bowel(SB)loca lization and abnormality detection.AIMTo develop an AI model that automatically distinguishes the SB from the stomach and colon and diagnoses SBabnormalities.METHODSWe developed an AI model using 87005 CE images (11925, 33781, and 41299 from the stomach, SB, and colon,respectively) for SB localization and 28405 SBCE images (1337 erosions/ulcers, 126 angiodysplasia, 494 bleeding,and 26448 normal) for abnormality detection. The diagnostic performances of AI-assisted reading and conventionalreading were compared using 32 SBCE videos in patients with suspicious SB bleeding.RESULTSRegarding organ localization, the AI model achieved an area under the receiver operating characteristic curve(AUC) and accuracy exceeding 0.99 and 97%, respectively. For SB abnormality detection, the performance was asfollows: Erosion/ulcer: 99.4% accuracy (AUC, 0.98);angiodysplasia: 99.8% accuracy (AUC, 0.99);bleeding: 99.9%accuracy (AUC, 0.99);normal: 99.3% accuracy (AUC, 0.98). In external validation, AI-assisted reading (8.7 minutes)was significantly faster than conventional reading (53.9 minutes;P < 0.001). The SB localization accuracies (88.6% vs72.7%, P = 0.07) and SB abnormality detection rates (77.3% vs 77.3%, P = 1.00) of the conventional reading and AIassistedreading were comparable.CONCLUSIONOur AI model decreased SBCE reading time and achieved performance comparable to that of experiencedendoscopists, suggesting that AI integration into SBCE reading enables efficient and reliable SB abnormalitydetection.
文摘BACKGROUND Postpancreatectomy hemorrhage is one of the most severe and life-threatening complications after pancreaticoduodenectomy.We present four cases of gastrointestinal bleeding patients to clarify its appropriate treatment and prevention.CASE SUMMARY The main symptoms included black stool,hematochezia,haematemesis,blood in the nasogastric tube,and hemorrhagic shock.The mean age was 66.25 years old and the median onset time was 340 d after the surgery.The bleeding location comprised gastrointestinal anastomosis,bile duct-jejunum anastomosis,and extraluminal bleeding.The possible causes included marginal ulcer,jejunal varix,and abdominal infection.Endoscopic hemostatic clips,as well as a covered stent using angiography,were utilized to stop the bleeding and three patients survived.Only one patient died of gastrointestinal bleeding,abdominal bleeding,abdominal infection,hypovolemic shock,and disseminated intravascular coagulation.CONCLUSION Early and effective endoscopic intervention is the key to successful hemostasis in patients with gastrointestinal bleeding after pancreatoduodenectomy.
文摘Postoperative bleeding(POB)is a major complication following pancreaticoduodenectomy(PD),leading to significant morbidity and potential mortality.This minireview focuses on the prevention and management strategies for POB,synthesizing current evidence on surgical techniques,perioperative management,and postoperative interventions.Effective prevention strategies include the use of regional vessel wrapping,optimal pancreatic anastomosis,and meticulous intraoperative hemostasis.Postoperative management strategies,such as early detection using predictive models and advanced imaging,along with endovascular interventions like angiographic embolization and stent graft placement,are essential for timely intervention.Risk factors,including pancreatic texture,anticoagulation therapy,and patient comorbidities,further influence bleeding outcomes.The minireview also identifies gaps in current research and emphasizes the need for prospective randomized controlled trials to establish standardized protocols.Overall,a multidisciplinary approach combining surgical expertise,predictive analytics,and personalized care is essential to improving patient out comes and minimizing the risk of POB following PD.
