AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with ...AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.展开更多
BACKGROUND Carbon ion radiotherapy(CIRT)is currently used to treat prostate cancer.Rectal bleeding is a major cause of toxicity even with CIRT.However,to date,a correlation between the dose and volume parameters of th...BACKGROUND Carbon ion radiotherapy(CIRT)is currently used to treat prostate cancer.Rectal bleeding is a major cause of toxicity even with CIRT.However,to date,a correlation between the dose and volume parameters of the 12 fractions of CIRT for prostate cancer and rectal bleeding has not been shown.Similarly,the clinical risk factors for rectal bleeding were absent after 12 fractions of CIRT.AIM To identify the risk factors for rectal bleeding in 12 fractions of CIRT for prostate cancer.METHODS Among 259 patients who received 51.6 Gy[relative biological effectiveness(RBE)],in 12 fractions of CIRT,15 had grade 1(5.8%)and nine had grade 2 rectal bleeding(3.5%).The dose-volume parameters included the volume(cc)of the rectum irradiated with at least x Gy(RBE)(Vx)and the minimum dose in the most irradiated x cc normal rectal volume(Dx).RESULTS The mean values of D6cc,D2cc,V10 Gy(RBE),V20 Gy(RBE),V30 Gy(RBE),and V40 Gy(RBE)were significantly higher in the patients with rectal bleeding than in those without.The cutoff values were D6cc=34.34 Gy(RBE),D2cc=46.46 Gy(RBE),V10 Gy(RBE)=9.85 cc,V20 Gy(RBE)=7.00 cc,V30 Gy(RBE)=6.91 cc,and V40 Gy(RBE)=4.26 cc.The D2cc,V10 Gy(RBE),and V20 Gy(RBE)cutoff values were significant predictors of grade 2 rectal bleeding.CONCLUSION The above dose-volume parameters may serve as guidelines for preventing rectal bleeding after 12 fractions of CIRT for prostate cancer.展开更多
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
In this editorial we comment on the article by Wang et al,recently published on World Journal of Clinical Cases.Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a common and potentially serious ga...In this editorial we comment on the article by Wang et al,recently published on World Journal of Clinical Cases.Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a common and potentially serious gastroenterological emergency.Wang et al conducted a detailed study on the management of AN-VUGIB in a high-volume center in the Shaanxi region,China.Analyzing data from over 530 patients provided a comprehensive overview of clinical,epidemio-logical,and treatment characteristics.Results highlighted a younger patient population compared to European studies,with a higher prevalence of gastric and duodenal ulcers as the leading cause of bleeding.Endoscopic treatment is cur-rently the preferred therapeutic option,offering a variety of effective techniques.This study emphasizes the importance of implementing current guidelines in ANVUGIB management and highlights the crucial role of endoscopy in its management.展开更多
BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in rebleeding.However,the impact of epinephrine volume in patients treated with combination en...BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in rebleeding.However,the impact of epinephrine volume in patients treated with combination endoscopic therapy remains unclear.AIM To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or clipping.METHODS Data from 132 patients with Forrest class Ia,Ib,and IIa peptic ulcers were reviewed.The primary outcome was further bleeding at 7 d;secondary outcomes included further bleeding at 30 d,need for additional therapeutic interventions,post-endoscopy blood transfusions,and 30-day mortality.Logistic and linear regression and Cox proportional hazards analyses were performed.RESULTS There was no association between epinephrine volume and all primary and secondary outcomes in multivariable analyses.Increased odds for further bleeding at 7 d occurred in patients with elevated creatinine values(aOR 1.96,95%CI 1.30-3.20;P<0.01)or hypotension requiring vasopressors(aOR 6.34,95%CI 1.87-25.52;P<0.01).Both factors were also associated with all secondary outcomes.CONCLUSION Epinephrine maintains an important role in the management of bleeding ulcers,but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic therapy.Further bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of epinephrine.However,in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable,it is conceivable that increased volumes of epinephrine may still be beneficial.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
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
BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying ...BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying the stigmata of a recent hemorrhage(SRH)during colonoscopy enables targeted hemostasis and reduces rebleeding.However,no benchmark exists for an appropriate observation duration,resulting in operator-dependent variation.Short observation periods may lead to missed SRH,whereas unnecessarily prolonged procedures,particularly in older patients,can increase patient burden and limit endoscopy unit availability.METHODS We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital.The Observation time was measured from scope insertion to SRH detection(excluding therapeutic time)or withdrawal.The primary outcome,the“5%plateau time”,was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%.Computed tomography(CT)-based stratified analyses were performed by endoscopists who conducted≥10%of procedures.RESULTS Of the 1039 patients who underwent colonoscopy,845(mean age 77±11 years;64.5%male)were included.Nine board-certified endoscopists performed the procedures.SRH was detected in 286 patients(33.8%),with a median detection time of 19 minutes(interquartile range,12-28 minutes).The overall 5%plateau time was 40 minutes and varied according to the CT findings:40,35,and 30 minutes for no extravasation,right-sided extravasation,and left-sided extravasation,respectively.This time point corresponded to when 80%-90%of SRH cases were detected.De-spite variations in SRH detection rates and observation durations among endoscopists,the 5%plateau time was consistently approximately 40 minutes.CONCLUSION Although it varied according to the CT findings,the overall 5%plateau time was 40 minutes.This offers a practical benchmark for the minimum observation time without SRH detection.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
Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal trac...Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal tract,including the duodenum and jejunum,underscores the need for comprehensive understanding and management.In this minireview we analyzed the epidemiology,pathogenesis,clinical presentation,diagnosis,and management of DD with a specific focus on jejunal diverticulosis.Although the incidence of gastrointestinal DD increases with age,the male and female prevalence is the same.Clinical presentation is either asymptomatic or with unclear abdominal symptoms.However,complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment.Imaging alternatives,including CT and enteroscopy,play key roles in diagnosis.Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen.Jejunal diverticulosis(JD)is a less common condition and poses a unique diagnostic and therapeutic challenge.Bleeding has been reported as the most important complication in JD.Therefore,early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding,especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified.Therefore,current challenges in JD are better understanding the etiopathology and optimal management strategies.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
BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Altho...BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Although these modalities are widely used,their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.METHODS A systematic search was done on PubMed,EMBASE,Cochrane Library,and Web of Science(from database establishment to April 2025).Randomized controlled trial(RCT)quality was assessed via Cochrane RoB 2.0,and observational studies via the Critical Appraisal Skills Program.RevMan 5.4 was used for quantitative analysis;fixed/random-effects models were chosen through I^(2)-assessed heterogeneity.Publication bias was checked using funnel plots and sensitivity analysis via model switching.RESULTS Twenty-one studies(3 RCTs,12 single-group studies,and 6 retrospective cohort studies)with good quality were included.For single-group data,combined therapy had risk differences of 0.70(clinical success),0.24(mortality),and 0.22(rebleeding;all P<0.00001,I^(2)=0).Moreover,the≥60-year rebleeding risk difference was 0.43.Reintervention was found to differ by approach(Z=3.03,P=0.002,inter-subgroup I^(2)=99%).In the RCT and cohort studies,combined vs standard therapy had similar initial hemostasis(Z=0.04,P=0.97)and mortality(Z=1.56,P=0.12)but lower rebleeding(Z=3.26/P=0.001;Z=2.95/P=0.03).Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding,without differences in mortality.Age and vascular interventional methods may influence the therapeutic efficacy.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
文摘AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ulcer.METHODS:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the study.Patients were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the study.Secondary outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion requirements.RESULTS:Initial hemostasis was obtained in all patients.The rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the groups.CONCLUSION:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.
文摘BACKGROUND Carbon ion radiotherapy(CIRT)is currently used to treat prostate cancer.Rectal bleeding is a major cause of toxicity even with CIRT.However,to date,a correlation between the dose and volume parameters of the 12 fractions of CIRT for prostate cancer and rectal bleeding has not been shown.Similarly,the clinical risk factors for rectal bleeding were absent after 12 fractions of CIRT.AIM To identify the risk factors for rectal bleeding in 12 fractions of CIRT for prostate cancer.METHODS Among 259 patients who received 51.6 Gy[relative biological effectiveness(RBE)],in 12 fractions of CIRT,15 had grade 1(5.8%)and nine had grade 2 rectal bleeding(3.5%).The dose-volume parameters included the volume(cc)of the rectum irradiated with at least x Gy(RBE)(Vx)and the minimum dose in the most irradiated x cc normal rectal volume(Dx).RESULTS The mean values of D6cc,D2cc,V10 Gy(RBE),V20 Gy(RBE),V30 Gy(RBE),and V40 Gy(RBE)were significantly higher in the patients with rectal bleeding than in those without.The cutoff values were D6cc=34.34 Gy(RBE),D2cc=46.46 Gy(RBE),V10 Gy(RBE)=9.85 cc,V20 Gy(RBE)=7.00 cc,V30 Gy(RBE)=6.91 cc,and V40 Gy(RBE)=4.26 cc.The D2cc,V10 Gy(RBE),and V20 Gy(RBE)cutoff values were significant predictors of grade 2 rectal bleeding.CONCLUSION The above dose-volume parameters may serve as guidelines for preventing rectal bleeding after 12 fractions of CIRT for prostate cancer.
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In this editorial we comment on the article by Wang et al,recently published on World Journal of Clinical Cases.Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a common and potentially serious gastroenterological emergency.Wang et al conducted a detailed study on the management of AN-VUGIB in a high-volume center in the Shaanxi region,China.Analyzing data from over 530 patients provided a comprehensive overview of clinical,epidemio-logical,and treatment characteristics.Results highlighted a younger patient population compared to European studies,with a higher prevalence of gastric and duodenal ulcers as the leading cause of bleeding.Endoscopic treatment is cur-rently the preferred therapeutic option,offering a variety of effective techniques.This study emphasizes the importance of implementing current guidelines in ANVUGIB management and highlights the crucial role of endoscopy in its management.
基金Supported by the National Institutes of Health,No. T32 2T32DK007356-42
文摘BACKGROUND In monotherapy studies for bleeding peptic ulcers,large volumes of epinephrine were associated with a reduction in rebleeding.However,the impact of epinephrine volume in patients treated with combination endoscopic therapy remains unclear.AIM To assess whether epinephrine volume was associated with bleeding outcomes in individuals who also received endoscopic thermal therapy and/or clipping.METHODS Data from 132 patients with Forrest class Ia,Ib,and IIa peptic ulcers were reviewed.The primary outcome was further bleeding at 7 d;secondary outcomes included further bleeding at 30 d,need for additional therapeutic interventions,post-endoscopy blood transfusions,and 30-day mortality.Logistic and linear regression and Cox proportional hazards analyses were performed.RESULTS There was no association between epinephrine volume and all primary and secondary outcomes in multivariable analyses.Increased odds for further bleeding at 7 d occurred in patients with elevated creatinine values(aOR 1.96,95%CI 1.30-3.20;P<0.01)or hypotension requiring vasopressors(aOR 6.34,95%CI 1.87-25.52;P<0.01).Both factors were also associated with all secondary outcomes.CONCLUSION Epinephrine maintains an important role in the management of bleeding ulcers,but large volumes up to a range of 10-20 mL are not associated with improved bleeding outcomes among individuals receiving combination endoscopic therapy.Further bleeding is primarily associated with patient factors that likely cannot be overcome by increased volumes of epinephrine.However,in carefully-selected cases where ulcer location or size pose therapeutic challenges or when additional modalities are unavailable,it is conceivable that increased volumes of epinephrine may still be beneficial.
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BACKGROUND Colonic diverticular bleeding(CDB)is a leading cause of gastrointestinal blee-ding-related hospitalizations in Japan and is increasingly recognized as a signifi-cant burden in the United States.Identifying the stigmata of a recent hemorrhage(SRH)during colonoscopy enables targeted hemostasis and reduces rebleeding.However,no benchmark exists for an appropriate observation duration,resulting in operator-dependent variation.Short observation periods may lead to missed SRH,whereas unnecessarily prolonged procedures,particularly in older patients,can increase patient burden and limit endoscopy unit availability.METHODS We retrospectively analyzed patients with acute hematochezia who underwent an initial colonoscopy between January 2017 and December 2024 at a Japanese tertiary hospital.The Observation time was measured from scope insertion to SRH detection(excluding therapeutic time)or withdrawal.The primary outcome,the“5%plateau time”,was defined as the point when the proportion of patients newly identified with SRH in each 5-minute interval consistently dropped below 5%.Computed tomography(CT)-based stratified analyses were performed by endoscopists who conducted≥10%of procedures.RESULTS Of the 1039 patients who underwent colonoscopy,845(mean age 77±11 years;64.5%male)were included.Nine board-certified endoscopists performed the procedures.SRH was detected in 286 patients(33.8%),with a median detection time of 19 minutes(interquartile range,12-28 minutes).The overall 5%plateau time was 40 minutes and varied according to the CT findings:40,35,and 30 minutes for no extravasation,right-sided extravasation,and left-sided extravasation,respectively.This time point corresponded to when 80%-90%of SRH cases were detected.De-spite variations in SRH detection rates and observation durations among endoscopists,the 5%plateau time was consistently approximately 40 minutes.CONCLUSION Although it varied according to the CT findings,the overall 5%plateau time was 40 minutes.This offers a practical benchmark for the minimum observation time without SRH detection.
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.
文摘Diverticular disease(DD)represents a prevalent clinical challenge,especially in the aging population.The sigmoid colon is the most frequently affected area.However,the presence of DD in the upper gastrointestinal tract,including the duodenum and jejunum,underscores the need for comprehensive understanding and management.In this minireview we analyzed the epidemiology,pathogenesis,clinical presentation,diagnosis,and management of DD with a specific focus on jejunal diverticulosis.Although the incidence of gastrointestinal DD increases with age,the male and female prevalence is the same.Clinical presentation is either asymptomatic or with unclear abdominal symptoms.However,complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment.Imaging alternatives,including CT and enteroscopy,play key roles in diagnosis.Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen.Jejunal diverticulosis(JD)is a less common condition and poses a unique diagnostic and therapeutic challenge.Bleeding has been reported as the most important complication in JD.Therefore,early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality.This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding,especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified.Therefore,current challenges in JD are better understanding the etiopathology and optimal management strategies.
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BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening emergency.Endoscopic hemostasis and vascular interventional therapy are two major minimally invasive treatment strategies.Although these modalities are widely used,their comparative efficacy and safety across different patient populations and anatomical sites remain controversial.AIM To evaluate the clinical outcomes and safety of endoscopic hemostasis combined with vascular interventional therapy for NVUGIB.METHODS A systematic search was done on PubMed,EMBASE,Cochrane Library,and Web of Science(from database establishment to April 2025).Randomized controlled trial(RCT)quality was assessed via Cochrane RoB 2.0,and observational studies via the Critical Appraisal Skills Program.RevMan 5.4 was used for quantitative analysis;fixed/random-effects models were chosen through I^(2)-assessed heterogeneity.Publication bias was checked using funnel plots and sensitivity analysis via model switching.RESULTS Twenty-one studies(3 RCTs,12 single-group studies,and 6 retrospective cohort studies)with good quality were included.For single-group data,combined therapy had risk differences of 0.70(clinical success),0.24(mortality),and 0.22(rebleeding;all P<0.00001,I^(2)=0).Moreover,the≥60-year rebleeding risk difference was 0.43.Reintervention was found to differ by approach(Z=3.03,P=0.002,inter-subgroup I^(2)=99%).In the RCT and cohort studies,combined vs standard therapy had similar initial hemostasis(Z=0.04,P=0.97)and mortality(Z=1.56,P=0.12)but lower rebleeding(Z=3.26/P=0.001;Z=2.95/P=0.03).Symmetrical funnel plots and robust sensitivity analysis showed no publication bias.CONCLUSION Combined endoscopic hemostasis and vascular interventional therapy for acute NVUGIB can significantly reduce rebleeding,without differences in mortality.Age and vascular interventional methods may influence the therapeutic efficacy.
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.
