Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for...Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for massive bleeding.The present study aimed to explore risk factors for predicting massive bleeding in SAP patients and to develop a predictive nomogram,which could facilitate early prediction,and timely appropriate interventions.Methods:We conducted a multivariate logistic regression analysis to examine the relationship between massive bleeding and variables including patient demographics,disease severity,laboratory indexes and local pancreatic complications.A novel nomogram was constructed based on these factors,and was vali-dated both internally and externally assessing its discrimination,calibration,and clinical applicability.Results:The study involved 351 patients in the training cohort,104 patients in the internal validation cohort,and 123 patients in the external validation cohort.Logistic regression analysis identified several independent risk factors for massive bleeding,including computed tomography severity index score above 8 points,Acute Physiology and Chronic Health Evaluation II score greater than 16 points,abdominal com-partment syndrome,pancreatic fistula,and sepsis.The nomogram constructed from these factors yielded an area under the receiver operating characteristic curve(AUC)of 0.896 and a coefficient of determination(R²)of 0.093.The Hosmer-Lemeshow test indicated good model fitness(P=0.654).Furthermore,the nomogram demonstrated reliable performance in both validation cohorts.Conclusions:The nomogram showed strong predictive capability for massive bleeding and could be a valuable tool for clinicians in identifying SAP patients at high risk for this complication at an early stage.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
AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Thre...AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE fi ndings.RESULTS: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common fi nding in the entire cohort, these accounted for 30% of clinically signifi cant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleedinggroup, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.展开更多
Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case...Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.展开更多
To the Editor,Portal hypertension,which mostly results from liver cirrhosis,can lead to a number of complications,including portal hypertensive colopathy(PHC).PHC under endoscopy presents various changes in the colon ...To the Editor,Portal hypertension,which mostly results from liver cirrhosis,can lead to a number of complications,including portal hypertensive colopathy(PHC).PHC under endoscopy presents various changes in the colon mucosa including telangiectasia[1,2].Telangiectasia of PHC could account for lower gastrointestinal bleeding,but it was seldom reported that telangiectasia led to massive gastrointestinal bleeding.Herein,we report a patient with liver cirrhosis who experienced massive lower gastrointestinal bleeding due to colonic telangiectasia.展开更多
基金supported by grants from the National Nature Science Foundation of China(82370651 and 82070657).
文摘Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for massive bleeding.The present study aimed to explore risk factors for predicting massive bleeding in SAP patients and to develop a predictive nomogram,which could facilitate early prediction,and timely appropriate interventions.Methods:We conducted a multivariate logistic regression analysis to examine the relationship between massive bleeding and variables including patient demographics,disease severity,laboratory indexes and local pancreatic complications.A novel nomogram was constructed based on these factors,and was vali-dated both internally and externally assessing its discrimination,calibration,and clinical applicability.Results:The study involved 351 patients in the training cohort,104 patients in the internal validation cohort,and 123 patients in the external validation cohort.Logistic regression analysis identified several independent risk factors for massive bleeding,including computed tomography severity index score above 8 points,Acute Physiology and Chronic Health Evaluation II score greater than 16 points,abdominal com-partment syndrome,pancreatic fistula,and sepsis.The nomogram constructed from these factors yielded an area under the receiver operating characteristic curve(AUC)of 0.896 and a coefficient of determination(R²)of 0.093.The Hosmer-Lemeshow test indicated good model fitness(P=0.654).Furthermore,the nomogram demonstrated reliable performance in both validation cohorts.Conclusions:The nomogram showed strong predictive capability for massive bleeding and could be a valuable tool for clinicians in identifying SAP patients at high risk for this complication at an early stage.
文摘Intractable bleeding from gastric and duodenal ulcers is associated with significant morbidity and mortality. Aggressive treatment with early endoscopic hemostasis is essential for a favourable outcome. In as many as 12%-17% of patients,endoscopy is either not available or unsuccessful. Endovascular therapy with selective catheterization of the culprit vessel and injection of embolic material has emerged as an alternative to emergent operative intervention in high-risk patients. There has not been a systematic literature review to assess the role for embolotherapy in the treatment of acute upper gastrointestinal bleeding from gastroduo-denal ulcers after failed endoscopic hemostasis. Here,we present an overview of indications,techniques,and clinical outcomes after endovascular embolization of acute peptic-ulcer bleeding. Topics of particular relevance to technical and clinical success are also discussed. Our review shows that transcatheter arterial embolization is a safe alternative to surgery for massive gastroduodenal bleeding that is refractory to endoscopic treatment,can be performed with high technical and clinical success rates,and should be considered the salvage treatment of choice in patients at high surgical risk.
基金Supported by Science and Technology Fund,Department of Education, Zhejiang Province, China,No.20070230
文摘AIM: To investigate the diagnostic yield of capsule endoscopy (CE) in patients with obscure gastrointestinal bleeding (OGIB), and to determine whether the yield was affected by different bleeding status. METHODS: Three hundred and nine consecutive patients (all with recent negative gastric and colonic endoscopy results) were investigated with CE; 49 cases with massive bleeding and 260 cases with chronic recurrent overt bleeding. Data regarding OGIB were obtained by retrospective chart review and review of an internal database of CE fi ndings.RESULTS: Visualization of the entire small intestine was achieved in 81.88% (253/309) of cases. Clinically positive findings occurred in 53.72% (166/309) of cases. The positivity of the massive bleeding group was slightly higher than that of the chronic recurrent overt bleeding group but there was no significant difference (59.18% vs 52.69%, P > 0.05) between the two groups. Small intestinal tumors were the most common fi nding in the entire cohort, these accounted for 30% of clinically signifi cant lesions. In the chronic recurrent overt bleeding group angioectasia incidence reached more than 29%, while in the massive bleedinggroup, small intestinal tumors were the most common finding at an incidence of over 51%. Increasing patient age was associated with positive diagnostic yield of CE and the findings of OGIB were different according to age range. Four cases were compromised due to the capsule remaining in the stomach during the entire test, and another patient underwent emergency surgery for massive bleeding. Therefore, the complication rate was 1.3%. CONCLUSION: In this study CE was proven to be a safe, comfortable, and effective procedure, with a high rate of accuracy for diagnosing OGIB.
文摘Rectal bleeding is frequently seen in patients undergoing transrectal ultrasound(TRUS)-guided multiple biopsy of the prostate,but is usually mild and stops spontaneously.We report what is believed to be the first case of life-threatening rectal bleeding following this procedure,which was successfully treated by endoscopic intervention through placement of three clips on the sites of bleeding.This case emphasizes endoscopic intervention associated with endoclipping as a safe and effective method to achieve hemostasis in massive rectal bleeding after prostate biopsy.Additionally,current data on the complications of the TRUS-guided multiple biopsy of the prostate and the options for treating fulminant rectal bleeding, a consequence of this procedure,are described.
基金supported by the Natural Science Funds of China(No.81700539)the Sichuan Science and Technology Program(No.2020YFS0236).
文摘To the Editor,Portal hypertension,which mostly results from liver cirrhosis,can lead to a number of complications,including portal hypertensive colopathy(PHC).PHC under endoscopy presents various changes in the colon mucosa including telangiectasia[1,2].Telangiectasia of PHC could account for lower gastrointestinal bleeding,but it was seldom reported that telangiectasia led to massive gastrointestinal bleeding.Herein,we report a patient with liver cirrhosis who experienced massive lower gastrointestinal bleeding due to colonic telangiectasia.
