Objective:To investigate the impact of targeted nursing interventions based on frailty prediction models on peri-hospitalization clinical outcomes in middle-aged and elderly patients with upper gastrointestinal bleedi...Objective:To investigate the impact of targeted nursing interventions based on frailty prediction models on peri-hospitalization clinical outcomes in middle-aged and elderly patients with upper gastrointestinal bleeding(UGIB).Methods:A prospective cohort study was conducted,and 126 middle-aged and elderly patients with UGIB admitted from August 2024 to August 2025 were selected as the study subjects.The patients were divided into the intervention group(63 cases)and the control group(63 cases)based on whether they received nursing intervention based on frailty prediction models.The control group received routine care,while the intervention group,on the basis of routine care,used the FRAIL scale combined with laboratory indicators(albumin,hemoglobin,etc.)to establish a predictive model to evaluate patients within 24 hours of admission,and implemented multi-dimensional targeted nursing intervention for pre-frailty or frailty patients screened out.The incidence of frailty,rebleeding rate,average length of stay,hospitalization cost,and nursing satisfaction during hospitalization were compared between the two groups.Results:The incidence of frailty during hospitalization in the intervention group was 11.1%(7 cases/63 cases),significantly lower than 31.7%(20 cases/63 cases)in the control group,and the difference was statistically significant(p<0.05).The rebleeding rate of 4.8%vs 12.7%,the average length of stay of(7.2±1.5)days vs(9.1±2.2)days,and the average hospitalization cost of(23,000±6,000)yuan vs(28,000±7,000)yuan in the intervention group were all lower than those in the control group(all p<0.05).The nursing satisfaction score of the intervention group(93.5±4.2)points was higher than that of the control group(86.3±5.8)points(p<0.05).Conclusion:The frailty prediction model applied to the peri-hospitalization care of middle-aged and elderly patients with UGIB can effectively identify frailty risk.Through early targeted intervention,the incidence of frailty and rebleeding rate can be reduced,the length of hospital stay can be shortened,medical expenses can be reduced,and nursing satisfaction can be improved,which has clinical promotion value.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 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 Non variceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening condition requiring prompt and effective hemostasis.Various endoscopic inter-ventions,including novel hemostatic powders(HP),over-th...BACKGROUND Non variceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening condition requiring prompt and effective hemostasis.Various endoscopic inter-ventions,including novel hemostatic powders(HP),over-the-scope clips(OTSC),and traditional approaches,have been employed to manage upper gastroin-testinal bleeding(UGIB).Despite advancements,comparative efficacy and safety of these modalities remain uncertain.AIM To evaluate the efficacy and safety of novel hemostatic interventions compared to conventional endoscopic techniques for managing UGIB.METHODS Cochrane,MEDLINE,PubMed and Scopus libraries were searched for rando-mized controlled trials(RCTs)published up to October 2024.Only RCTs compa-ring novel interventions,such as HP or OTSC,with conventional endoscopic treatments computed tomography(CT)were included.The primary outcome was the 30-day rebleeding rate.Secondary outcomes included initial hemostasis,short-term rebleeding rates,need for salvage therapy(surgical/angiographic),30-day all-cause mortality,and bleeding-related mortality.We performed pairwise and network meta-analyses for all treatments.RESULTS Seventeen studies were included in this analysis.Regarding the 30-day rebleeding rate,OTSC and HP showed superior efficacy compared with CT[OTSC vs CT:Relative risk(RR):0.47,95%confidence interval(CI):0.33-0.65;HP vs CT:RR:0.73,95%CI:0.45-1.13],while OTSC and HP had comparable efficacy(RR:0.56,95%CI:0.30-1.05).OTSC ranked the highest in the network ranking estimate for this outcome.For the secondary outcomes,OTSC demonstrated superior efficacy for the short-term rebleeding rate(OTSC vs CT:RR:0.35,95%CI:0.14-0.74;HP vs CT:RR:0.62,95%CI:0.28-1.35;OTSC vs HP:RR:0.59,95%CI:0.17-1.67).Regarding the initial hemostasis rate,OTSC was slightly more effective than CT(OTSC vs CT:RR:1.20,95%CI:1.06-1.57)and comparable to HP(OTSC vs HP:RR:1.08,95%CI:0.89-1.40).There were no significant differences among treatments for all-cause mortality,bleeding-related mortality,or the necessity of surgical or angiographic salvage therapy.OTSC consistently ranked highest across most outcomes in the network ranking estimate.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
BACKGROUND Endoscopic therapy is the primary approach for treating Mallory-Weiss syndro-me,particularly under conditions of mucosal protection and gastric acid suppre-ssion.However,for a subset of patients who cannot ...BACKGROUND Endoscopic therapy is the primary approach for treating Mallory-Weiss syndro-me,particularly under conditions of mucosal protection and gastric acid suppre-ssion.However,for a subset of patients who cannot undergo endoscopic interven-tion or for whom such treatment proves ineffective,alternative measures like arterial embolization or surgical intervention may be required.While hyperbaric oxygen therapy(HBOT)has been applied across a range of medical conditions,its application in managing hemorrhage due to gastric tears remains undocumented.CASE SUMMARY A 52-year-old patient was admitted with symptoms of hematemesis and melena,and an endoscopy revealed a gastric fundus tear approximately 4 cm×5 cm in size.The lesion was considered unsuitable for endoscopic repair by the attending endoscopist.Despite conservative measures,including fasting and acid sup-pression,the patient experienced persistent bleeding and a substantial decrease in hemoglobin levels relative to admission values.Following a multidisciplinary consultation,HBOT was initiated,resulting in the cessation of bleeding and rapid wound healing.CONCLUSION For patients with gastric tears presenting with active hemorrhage,HBOT might offer an effective alternative when conventional endoscopic therapies are not viable or have been unsuccessful.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
AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combin...AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.展开更多
AIM:To investigate the effect of antiviral therapy with nucleoside analogs in hepatitis B virus(HBV)-related cirrhosis and esophageal varices.METHODS:Eligible patients with HBV-related cirrhosis and esophageal varices...AIM:To investigate the effect of antiviral therapy with nucleoside analogs in hepatitis B virus(HBV)-related cirrhosis and esophageal varices.METHODS:Eligible patients with HBV-related cirrhosis and esophageal varices who consulted two tertiary hospitals in Beijing,China,the Chinese Second Artillery General Hospital and Chinese PLA General Hospital,were enrolled in the study from January 2005 to December 2009. Of 117 patients,79 received treatment with different nucleoside analogs and 38 served as controls. Bleeding rate,change in variceal grade and non-bleeding duration were analyzed. Multivariate Cox proportional hazard regression was used to identify factors related to esophageal variceal bleeding.antiviral group compared to the control group(29.1%vs 65.8%,P < 0.001). Antiviral therapy was an independent factor related to esophageal bleeding in multivariate analysis(HR = 11.3,P < 0.001). The mean increase in variceal grade per year was lower in the antiviral group(1.0 ± 1.3 vs 1.7 ± 1.2,P = 0.003). Nonbleeding duration in the antiviral group was prolonged in the Kaplan-Meier model. Viral load rebound was observed in 3 cases in the lamivudine group and in 1 case in the adefovir group,all of whom experienced bleeding. Entecavir and adefovir resulted in lower bleeding rates(17.2% and 28.6%,respectively) than the control(P < 0.001 and P = 0.006,respectively),whereas lamivudine(53.3%) did not(P = 0.531).CONCLUSION:Antiviral therapy delays the progression of esophageal varices and reduces bleeding risk in HBV-related cirrhosis,however,high-resistance agents tend to be ineffective for long-term treatment.展开更多
Although relatively uncommon, Dieulafoy's lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent ...Although relatively uncommon, Dieulafoy's lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy's lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy's lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration(visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30% during the 1970's to 9%-13% currently with the advent of aggressive endoscopic therapy.展开更多
Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding compl...Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding complications such as gastrointestinal bleeding, which is one of the most common life-threatening complications. Early endoscopy is recommended for most patients with acute upper gastrointestinal bleeding. After successful endoscopic hemostasis, immediate resumption of antiplatelet therapy with proton-pump inhibitors(PPIs) is recommended to prevent further ischemic events. PPI prophylaxis during antiplatelet therapy reduces the risk of upper gastrointestinal bleeding. The potential negative metabolic interaction between PPIs and clopidogrel is still unclear.展开更多
Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to th...Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.展开更多
AIM: To compare the therapeutic effects of proton pump inhibitors vs H2 receptor antagonists for upper gastrointestinal bleeding in patients after successful endoscopy.METHODS: We searched the Cochrane library, MEDLIN...AIM: To compare the therapeutic effects of proton pump inhibitors vs H2 receptor antagonists for upper gastrointestinal bleeding in patients after successful endoscopy.METHODS: We searched the Cochrane library, MEDLINE, EMBASE and Pub Med for randomized controlled trials until July 2014 for this study. The risk of bias was evaluated by the Cochrane Collaboration's tool and all of the studies had acceptable quality. The main outcomes included mortality, re-bleeding, received surgery rate, blood transfusion units and hospital stay time. These outcomes were estimated using odds ratios(OR) and mean difference with 95% confidence interval(CI). Rev Man 5.3.3 software and Stata 12.0 software were used for data analyses. RESULTS: Ten randomized controlled trials involving 1283 patients were included in this review; 678 subjects were in the proton pump inhibitors(PPI) group and the remaining 605 subjects were in the H2 receptor antagonists(H2RA) group. The meta-analysis results revealed that after successful endoscopic therapy, compared with H2 RA, PPI therapy had statistically significantly decreased the recurrent bleeding rate(OR = 0.36; 95%CI: 0.25-0.51) and receiving surgery rate(OR = 0.29; 95%CI: 0.09-0.96). There were no statistically significant differences in mortality(OR = 0.46; 95%CI: 0.17-1.23). However, significant heterogeneity was present in both the numbers of patients requiring blood transfusion after treatment [weighted mean difference(WMD),-0.70 unit; 95%CI:-1.64- 0.25] and the time that patients remained hospitalized [WMD,-0.77 d; 95%CI:-1.87- 0.34]. The Begg's test(P = 0.283) and Egger's test(P = 0.339) demonstrated that there was no publication bias in our meta-analysis.CONCLUSION: In patients with upper gastrointestinal bleeding after successful endoscopic therapy, compared with H2 RA, PPI may be a more effective therapy.展开更多
AIM： To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy＇s lesion. METHODS： One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy＇s lesion were treated ...AIM： To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy＇s lesion. METHODS： One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy＇s lesion were treated with three endoscopic hemostasis methods： aethoxysklerol injection （46 cases）, endoscopic hemoclip hemostasis （31 cases）, and a combination of hemoclip hemostasis with aethoxysklerol injection （30 cases）. RESULTS： The rates of successful hemostasis using the three methods were 71.7% （33/46）, 77.4% （24/31） and 96.7% （29/30）, respectively, with significant differences between the methods （P 〈 0.05）. Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis,7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aeth- oxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no releeding was found during a 1-year follow-up. CONCLUSION： The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy＇s lesion.展开更多
AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective databas...AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.展开更多
We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 y...We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.展开更多
Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by l...Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by leading to discontinuation of treatment, permanent disability or death. The yearly incidence of bleeding during OAC is 2%-5% for major bleeding, 0.5%-1% for fatal bleeding, and 0.2%-0.4% for intracranial bleeding. While OAC interruption and/or antagonism, as well as administration of coagulation factors, represent the necessary measures for the management of bleeding, proper stratification of the individual risk of bleeding prior to start OAC is of paramount importance. Several factors, including advanced age, female gender, poor control and higher intensity of OAC, associated diseases and medications, as well as genetic factors, have been proven to be associated with an increased risk of bleeding. Most of these factors have been included in the development of bleeding prediction scores, which should now be used by clinicians when prescribing and monitoring OAC. Owing to the many limitations of OAC, including a narrow therapeutic window, cumber-some management, and wide interand intra-individual variability, novel oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, have been recently developed. These agents can be given in f ixed doses, have little interaction with foods and drugs, and do not require regular monitoring of anticoagulation. While the novel oral anticoagulants show promise for effective thromboprophylaxis in atrial f ibrillation and venous thromboembolism, def initive data on their safety and eff icacy are awaited.展开更多
AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that o...AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.展开更多
This study aims to introduce the diagnosis and treatment processes of traumatic splenic bleeding and explain its emergency,medical,interventional,and surgical treatments.Furthermore,this study aims to summarize the in...This study aims to introduce the diagnosis and treatment processes of traumatic splenic bleeding and explain its emergency,medical,interventional,and surgical treatments.Furthermore,this study aims to summarize the indications and contraindications of splenic artery embolization,interventional procedures,and precautions of complications.展开更多
基金Construction and Application of Frailty Trajectory Prediction Model for Middle-aged and Elderly Patients with Upper Gastrointestinal Bleeding,Project Source:Sichuan Vocational College of Nursing(Project No.:2024ZRY25)。
文摘Objective:To investigate the impact of targeted nursing interventions based on frailty prediction models on peri-hospitalization clinical outcomes in middle-aged and elderly patients with upper gastrointestinal bleeding(UGIB).Methods:A prospective cohort study was conducted,and 126 middle-aged and elderly patients with UGIB admitted from August 2024 to August 2025 were selected as the study subjects.The patients were divided into the intervention group(63 cases)and the control group(63 cases)based on whether they received nursing intervention based on frailty prediction models.The control group received routine care,while the intervention group,on the basis of routine care,used the FRAIL scale combined with laboratory indicators(albumin,hemoglobin,etc.)to establish a predictive model to evaluate patients within 24 hours of admission,and implemented multi-dimensional targeted nursing intervention for pre-frailty or frailty patients screened out.The incidence of frailty,rebleeding rate,average length of stay,hospitalization cost,and nursing satisfaction during hospitalization were compared between the two groups.Results:The incidence of frailty during hospitalization in the intervention group was 11.1%(7 cases/63 cases),significantly lower than 31.7%(20 cases/63 cases)in the control group,and the difference was statistically significant(p<0.05).The rebleeding rate of 4.8%vs 12.7%,the average length of stay of(7.2±1.5)days vs(9.1±2.2)days,and the average hospitalization cost of(23,000±6,000)yuan vs(28,000±7,000)yuan in the intervention group were all lower than those in the control group(all p<0.05).The nursing satisfaction score of the intervention group(93.5±4.2)points was higher than that of the control group(86.3±5.8)points(p<0.05).Conclusion:The frailty prediction model applied to the peri-hospitalization care of middle-aged and elderly patients with UGIB can effectively identify frailty risk.Through early targeted intervention,the incidence of frailty and rebleeding rate can be reduced,the length of hospital stay can be shortened,medical expenses can be reduced,and nursing satisfaction can be improved,which has clinical promotion value.
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.
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 Non variceal upper gastrointestinal bleeding(NVUGIB)is a life-threatening condition requiring prompt and effective hemostasis.Various endoscopic inter-ventions,including novel hemostatic powders(HP),over-the-scope clips(OTSC),and traditional approaches,have been employed to manage upper gastroin-testinal bleeding(UGIB).Despite advancements,comparative efficacy and safety of these modalities remain uncertain.AIM To evaluate the efficacy and safety of novel hemostatic interventions compared to conventional endoscopic techniques for managing UGIB.METHODS Cochrane,MEDLINE,PubMed and Scopus libraries were searched for rando-mized controlled trials(RCTs)published up to October 2024.Only RCTs compa-ring novel interventions,such as HP or OTSC,with conventional endoscopic treatments computed tomography(CT)were included.The primary outcome was the 30-day rebleeding rate.Secondary outcomes included initial hemostasis,short-term rebleeding rates,need for salvage therapy(surgical/angiographic),30-day all-cause mortality,and bleeding-related mortality.We performed pairwise and network meta-analyses for all treatments.RESULTS Seventeen studies were included in this analysis.Regarding the 30-day rebleeding rate,OTSC and HP showed superior efficacy compared with CT[OTSC vs CT:Relative risk(RR):0.47,95%confidence interval(CI):0.33-0.65;HP vs CT:RR:0.73,95%CI:0.45-1.13],while OTSC and HP had comparable efficacy(RR:0.56,95%CI:0.30-1.05).OTSC ranked the highest in the network ranking estimate for this outcome.For the secondary outcomes,OTSC demonstrated superior efficacy for the short-term rebleeding rate(OTSC vs CT:RR:0.35,95%CI:0.14-0.74;HP vs CT:RR:0.62,95%CI:0.28-1.35;OTSC vs HP:RR:0.59,95%CI:0.17-1.67).Regarding the initial hemostasis rate,OTSC was slightly more effective than CT(OTSC vs CT:RR:1.20,95%CI:1.06-1.57)and comparable to HP(OTSC vs HP:RR:1.08,95%CI:0.89-1.40).There were no significant differences among treatments for all-cause mortality,bleeding-related mortality,or the necessity of surgical or angiographic salvage therapy.OTSC consistently ranked highest across most outcomes in the network ranking estimate.
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BACKGROUND Endoscopic therapy is the primary approach for treating Mallory-Weiss syndro-me,particularly under conditions of mucosal protection and gastric acid suppre-ssion.However,for a subset of patients who cannot undergo endoscopic interven-tion or for whom such treatment proves ineffective,alternative measures like arterial embolization or surgical intervention may be required.While hyperbaric oxygen therapy(HBOT)has been applied across a range of medical conditions,its application in managing hemorrhage due to gastric tears remains undocumented.CASE SUMMARY A 52-year-old patient was admitted with symptoms of hematemesis and melena,and an endoscopy revealed a gastric fundus tear approximately 4 cm×5 cm in size.The lesion was considered unsuitable for endoscopic repair by the attending endoscopist.Despite conservative measures,including fasting and acid sup-pression,the patient experienced persistent bleeding and a substantial decrease in hemoglobin levels relative to admission values.Following a multidisciplinary consultation,HBOT was initiated,resulting in the cessation of bleeding and rapid wound healing.CONCLUSION For patients with gastric tears presenting with active hemorrhage,HBOT might offer an effective alternative when conventional endoscopic therapies are not viable or have been unsuccessful.
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AIM: To assess the efficacy of hemoclip application in combination with epinephrine injection in the treatment of bleeding peptic ulcers and to compare the clinical outcomes between patients treated with such a combination therapy and those treated with epinephrine injection alone.METHODS: A total of 293 patients (211 males, 82females) underwent endoscopic therapy for bleeding peptic ulcers. Of these, 202 patients (152 males, 50females) received epinephrine injection therapy while 91patients (59 males, 32 females) received combination therapy. The choice of endoscopic therapy was made by the endoscopist. Hemostatic rates, rebleeding rates, need for emergency surgery and 30-d mortality were the outcome measures studied.RESULTS: Patients who received combination therapy were significantly older (mean age 66±16 years, range24-90 years) and more suffered from chronic renal failure compared to those who received epinephrine injection therapy alone (mean age 61±17 years, range 21-89 years).Failure to achieve permanent hemostasis was 4% in the group who received epinephrine injection alone and 11%in the group who received combination therapy. When the differences in age and renal function between the two treatment groups were taken into account by multivariate analysis, the rates of initial hemostasis,rebleeding rates, need for surgery and 30-d mortality for both treatment options were not significantly different.CONCLUSION: Combination therapy of epinephrine injection with endoscopic hemoclip application is an effective method of achieving hemostasis in bleeding peptic ulcer diseases. However, superiority of combination therapy over epinephrine injection alone, could not be demonstrated.
文摘AIM:To investigate the effect of antiviral therapy with nucleoside analogs in hepatitis B virus(HBV)-related cirrhosis and esophageal varices.METHODS:Eligible patients with HBV-related cirrhosis and esophageal varices who consulted two tertiary hospitals in Beijing,China,the Chinese Second Artillery General Hospital and Chinese PLA General Hospital,were enrolled in the study from January 2005 to December 2009. Of 117 patients,79 received treatment with different nucleoside analogs and 38 served as controls. Bleeding rate,change in variceal grade and non-bleeding duration were analyzed. Multivariate Cox proportional hazard regression was used to identify factors related to esophageal variceal bleeding.antiviral group compared to the control group(29.1%vs 65.8%,P < 0.001). Antiviral therapy was an independent factor related to esophageal bleeding in multivariate analysis(HR = 11.3,P < 0.001). The mean increase in variceal grade per year was lower in the antiviral group(1.0 ± 1.3 vs 1.7 ± 1.2,P = 0.003). Nonbleeding duration in the antiviral group was prolonged in the Kaplan-Meier model. Viral load rebound was observed in 3 cases in the lamivudine group and in 1 case in the adefovir group,all of whom experienced bleeding. Entecavir and adefovir resulted in lower bleeding rates(17.2% and 28.6%,respectively) than the control(P < 0.001 and P = 0.006,respectively),whereas lamivudine(53.3%) did not(P = 0.531).CONCLUSION:Antiviral therapy delays the progression of esophageal varices and reduces bleeding risk in HBV-related cirrhosis,however,high-resistance agents tend to be ineffective for long-term treatment.
文摘Although relatively uncommon, Dieulafoy's lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy's lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy's lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration(visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30% during the 1970's to 9%-13% currently with the advent of aggressive endoscopic therapy.
文摘Antiplatelet therapy is the standard of care for the secondary prevention of acute coronary syndrome and ischemic stroke, especially after coronary intervention. However, this therapy is associated with bleeding complications such as gastrointestinal bleeding, which is one of the most common life-threatening complications. Early endoscopy is recommended for most patients with acute upper gastrointestinal bleeding. After successful endoscopic hemostasis, immediate resumption of antiplatelet therapy with proton-pump inhibitors(PPIs) is recommended to prevent further ischemic events. PPI prophylaxis during antiplatelet therapy reduces the risk of upper gastrointestinal bleeding. The potential negative metabolic interaction between PPIs and clopidogrel is still unclear.
文摘Non-variceal upper gastrointestinal bleeding(UGIB) is defined as bleeding proximal to the ligament of Treitz in the absence of oesophageal, gastric or duodenal varices. The clinical presentation varies according to the intensity of bleeding from occult bleeding to melena or haematemesis and haemorrhagic shock. Causes of UGIB are peptic ulcers, Mallory-Weiss lesions,erosive gastritis, reflux oesophagitis, Dieulafoy lesions or angiodysplasia. After admission to the hospital a structured approach to the patient with acute UGIB that includes haemodynamic resuscitation and stabilization as well as pre-endoscopic risk stratification has to be done. Endoscopy offers not only the localisation of the bleeding site but also a variety of therapeutic measures like injection therapy, thermocoagulation or endoclips. Endoscopic therapy is facilitated by acid suppression with proton pump inhibitor(PPI) therapy. These drugs are highly effective but the best route of application(oral vs intravenous) and the adequate dosage are still subjects of discussion. Patients with ulcer disease are tested for Helicobacter pylori and eradication therapy should be given if it is present. Non-steroidal antiinflammatory drugs have to be discontinued if possible. If discontinuation is not possible, cyclooxygenase-2 inhibitors in combination with PPI have the lowest bleeding risk but the incidence of cardiovascular events is increased.
基金Supported by National Natural Science Funds of China,No.81102784/H2803the key project in scientific research from ministry of education,No.212032Liaoning Innovative Research Team in University,No.LT2013022
文摘AIM: To compare the therapeutic effects of proton pump inhibitors vs H2 receptor antagonists for upper gastrointestinal bleeding in patients after successful endoscopy.METHODS: We searched the Cochrane library, MEDLINE, EMBASE and Pub Med for randomized controlled trials until July 2014 for this study. The risk of bias was evaluated by the Cochrane Collaboration's tool and all of the studies had acceptable quality. The main outcomes included mortality, re-bleeding, received surgery rate, blood transfusion units and hospital stay time. These outcomes were estimated using odds ratios(OR) and mean difference with 95% confidence interval(CI). Rev Man 5.3.3 software and Stata 12.0 software were used for data analyses. RESULTS: Ten randomized controlled trials involving 1283 patients were included in this review; 678 subjects were in the proton pump inhibitors(PPI) group and the remaining 605 subjects were in the H2 receptor antagonists(H2RA) group. The meta-analysis results revealed that after successful endoscopic therapy, compared with H2 RA, PPI therapy had statistically significantly decreased the recurrent bleeding rate(OR = 0.36; 95%CI: 0.25-0.51) and receiving surgery rate(OR = 0.29; 95%CI: 0.09-0.96). There were no statistically significant differences in mortality(OR = 0.46; 95%CI: 0.17-1.23). However, significant heterogeneity was present in both the numbers of patients requiring blood transfusion after treatment [weighted mean difference(WMD),-0.70 unit; 95%CI:-1.64- 0.25] and the time that patients remained hospitalized [WMD,-0.77 d; 95%CI:-1.87- 0.34]. The Begg's test(P = 0.283) and Egger's test(P = 0.339) demonstrated that there was no publication bias in our meta-analysis.CONCLUSION: In patients with upper gastrointestinal bleeding after successful endoscopic therapy, compared with H2 RA, PPI may be a more effective therapy.
基金Supported by Yantai City Science and Technology Development Plan, No. 2010148-13
文摘AIM： To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy＇s lesion. METHODS： One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy＇s lesion were treated with three endoscopic hemostasis methods： aethoxysklerol injection （46 cases）, endoscopic hemoclip hemostasis （31 cases）, and a combination of hemoclip hemostasis with aethoxysklerol injection （30 cases）. RESULTS： The rates of successful hemostasis using the three methods were 71.7% （33/46）, 77.4% （24/31） and 96.7% （29/30）, respectively, with significant differences between the methods （P 〈 0.05）. Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis,7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aeth- oxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no releeding was found during a 1-year follow-up. CONCLUSION： The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy＇s lesion.
基金Supported by A grant of the Korea Healthcare technology R&D Project,Ministry for Health,Welfare&Family Affairs,Republic of Korea NO.A091047 Medical Research Institute Grant (2009-1),Pusan National University
文摘AIM:To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding(NVUGIB).METHODS:We performed a retrospective analysis of a prospective database in a tertiary care university hospital.From October 2006 to October 2008,we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy.Within 24 h of hospital admission,all patients underwent endoscopic therapy.After successful endoscopic hemostasis,all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion(8 mg/h for 72 h).The somatostatin adjunct group(n=49)also received a 250-μg bolus of somatostatin,followed by continuous infusion (250μg/h for 72 h).Early rebleeding rates,disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined.RESULTS:Early rebleeding rates were not significantly different between treatment groups(12.2%vs 14.3%,P=0.766).Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups(94.2%vs 95.9%,P=0.696).Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding(P =0.044,OR:9.080,95%CI:1.062-77.595).CONCLUSION:The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.
文摘We report the case of a 17-year-old male admitted to our academic hospital with massive rectal bleeding.Since childhood he had reported recurrent gastrointestinal bleeding and had two exploratory laparotomies 5and 2 years previously.An emergency abdominal computed tomography scan,gastroscopy and colonoscopy,performed after hemodynamic stabilization,were considered normal.High-dose intravenous proton pump inhibitor(PPI)therapy was initiated and bleeding stopped spontaneously.Two other massive rectal bleeds occurred 8 h after each cessation of PPI which led to a hemostatic laparotomy after negative gastroscopy and small bowel capsule endoscopy.This showed long tubular duplication of the right colon,with fresh blood in the duplicated colon.Obscure lower gastrointestinal bleeding is a difficult medical situation and potentially life-threatening.The presence of ulcerated ectopic gastric mucosa in the colonic duplication explains the partial efficacy of PPI therapy.Obscure gastrointestinalbleeding responding to empiric anti-acid therapy should probably evoke the diagnosis of bleeding ectopic gastric mucosa such as Meckel’s diverticulum or gastrointestinal duplication,and gastroenterologists should be aware of this potential medical situation.
文摘Bleeding is the most important complication of oral anticoagulation (OAC) with vitamin K-antagonists. Whilst bleeding is unavoidably related to OAC, it may have a great impact on the prognosis of treated subjects by leading to discontinuation of treatment, permanent disability or death. The yearly incidence of bleeding during OAC is 2%-5% for major bleeding, 0.5%-1% for fatal bleeding, and 0.2%-0.4% for intracranial bleeding. While OAC interruption and/or antagonism, as well as administration of coagulation factors, represent the necessary measures for the management of bleeding, proper stratification of the individual risk of bleeding prior to start OAC is of paramount importance. Several factors, including advanced age, female gender, poor control and higher intensity of OAC, associated diseases and medications, as well as genetic factors, have been proven to be associated with an increased risk of bleeding. Most of these factors have been included in the development of bleeding prediction scores, which should now be used by clinicians when prescribing and monitoring OAC. Owing to the many limitations of OAC, including a narrow therapeutic window, cumber-some management, and wide interand intra-individual variability, novel oral anticoagulants, such as factor Xa inhibitors and direct thrombin inhibitors, have been recently developed. These agents can be given in f ixed doses, have little interaction with foods and drugs, and do not require regular monitoring of anticoagulation. While the novel oral anticoagulants show promise for effective thromboprophylaxis in atrial f ibrillation and venous thromboembolism, def initive data on their safety and eff icacy are awaited.
文摘AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P < 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P < 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.
文摘This study aims to introduce the diagnosis and treatment processes of traumatic splenic bleeding and explain its emergency,medical,interventional,and surgical treatments.Furthermore,this study aims to summarize the indications and contraindications of splenic artery embolization,interventional procedures,and precautions of complications.
