BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or ga...BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.展开更多
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
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
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood require...Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges.In these patients,transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality.Moreover,ratio-based concepts do not stop bleeding;instead,they just give physicians more time to identify the bleeding source and plan management strategies.In clinical practice,standard laboratory coagulation tests(SLCT)are frequently used to assess various aspects of blood clotting.However,these tests may not always offer a comprehensive under-standing of clinically significant coagulopathy and the severity of blood loss.Furthermore,the SLCT have a considerable turnaround time,which may not be ideal for making prompt clinical decisions.In recent years,there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelast-ometry,which provide real-time,dynamic information about clot formation and dissolution.展开更多
BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establ...BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.METHODS Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research.Univariate analysis,least absolute shrinkage and selection operator regression,and multivariate analysis were employed to establish the nomogram model.Calibration curve,the area under the receiver operating characteristic curve(AUC),and decision curve analysis(DCA)were applied to assess the discrimination,accuracy,and clinical practicability of the nomogram,respectively.RESULTS A total of 1115 patients were enrolled in this study.The nomogram was established based on white blood cells(P<0.001),hemoglobin(P<0.001),fibrinogen(P<0.001),total bilirubin(P=0.007),activated partial thromboplastin time(P=0.002),total bile acid(P=0.012),and ascites(P=0.006).The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model.The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts,respectively,which were higher than that of the aspartate aminotransferase-to-platelet ratio index,fibrosis index based on 4 factors,and aspartate aminotransferase-to-alanine aminotransferase ratio.Additionally,DCA indicated that the net benefit value of the model was higher than that of the other models.CONCLUSION This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis,which could help clinicians with timely diagnosis,individualized treatment,and follow-up.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
Treatments for low degree hemorrhoids(I-III degree)are numerous and so are their counterparts for higher degrees.These treatments present nebulous diffe-rences in terms of indications and outcomes among techniques.Met...Treatments for low degree hemorrhoids(I-III degree)are numerous and so are their counterparts for higher degrees.These treatments present nebulous diffe-rences in terms of indications and outcomes among techniques.Methods previously abandoned due to side effects and long-term results have recently rejoined the mainstream due to recent peculiar modifications:Hemorrhoidal sclerotherapy is enjoying a new age of interest due to the use of the foam form of polidocanol,which is more effective than the liquid one.Various articles have already shown promising results and the logical next step is the combination of polidocanol foam with rubber-band ligation(the historical counterpart of sclero-therapy)in a technique called“sclerobanding”.In this article,we comment on the publication by Qu et al further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids,and present results compared with endoscopic rubber band ligation.The results achieved are promising.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
Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiolo...Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill patients.GI bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal failure.Managing GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical procedures.Even with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ failure.This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.展开更多
The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used ove...The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.展开更多
A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic...A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.展开更多
Gastrointestinal angiodysplasia(GIAD)is a common,acquired,vascular abnor-mality in the gastrointestinal tract that is commonly implicated in bleeding.Siro-limus,also known as rapamycin,is a mammalian target of rapamyc...Gastrointestinal angiodysplasia(GIAD)is a common,acquired,vascular abnor-mality in the gastrointestinal tract that is commonly implicated in bleeding.Siro-limus,also known as rapamycin,is a mammalian target of rapamycin pathway inhibitor that has shown significant potential in inhibiting abnormal angiogenesis that has demonstrated efficacy in inhibiting abnormal blood vessel formation in the skin,cornea,and tumors.Sun et al in their single centre prospective study aimed to evaluate the efficacy and safety of sirolimus in treating GIAD-associated bleeding.While their study does provide a sound platform for future studies to investigate the effects of sirolimus in the treatment of GIAD-associated bleeding in an evidence free zone,there are limitations to the study which are not addre-ssed.In this commentary,we summarise the significant highlights from the study performed by Sun et al along with its limitations.In addition to this,we provide an update on the current therapies utilised in the treatment of GIAD-associated bleeding.展开更多
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
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 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
BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleedi...BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.展开更多
BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenou...BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.展开更多
BACKGROUND 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 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
文摘BACKGROUND While varices and variceal bleeds are well-known and feared complications of advanced cirrhosis and portal hypertension,omental variceal bleed are a rare sequala even in patients with known esophageal or gastric varices.While rare,omental varices pose a risk for hemoperitoneum if ruptured,which is a lifethreatening complication with high mortality rates despite surgical intervention.CASE SUMMARY This report reviews the case of a patient 36-year-old female with alcohol related cirrhosis decompensated by ascites,but no history of varices admitted for hemorrhagic shock from spontaneous rupture of omental varices requiring emergency surgery.She underwent the first documented successful orthotopic liver transplantation the same admission.CONCLUSION This case report and literature review stresses the importance of early consideration and identification of intraabdominal variceal sources in cirrhotic patients with refractory shock.
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.
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.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
文摘Management of patients with acute hemorrhage requires addressing the source of bleeding,replenishing blood volume,and addressing any coagulopathy that may be present.Assessing coagulopathy and predicting blood requirements in real-time in patients experiencing ongoing bleeding can pose substantial challenges.In these patients,transfusion concepts based on ratios do not effectively address coagulopathy or reduce mortality.Moreover,ratio-based concepts do not stop bleeding;instead,they just give physicians more time to identify the bleeding source and plan management strategies.In clinical practice,standard laboratory coagulation tests(SLCT)are frequently used to assess various aspects of blood clotting.However,these tests may not always offer a comprehensive under-standing of clinically significant coagulopathy and the severity of blood loss.Furthermore,the SLCT have a considerable turnaround time,which may not be ideal for making prompt clinical decisions.In recent years,there has been a growing interest in point-of-care viscoelastic assays like rotational thromboelast-ometry,which provide real-time,dynamic information about clot formation and dissolution.
基金Supported by the National Natural Science Foundation of China,No.82270594the National Natural Science Foundation for Youths of China,No.82103151+1 种基金the Fundamental Research Funds for the Central Universities of Central South University,No.2022ZZTS0265the Graduate Research Innovation Project of Hunan Province,No.CX20220347.
文摘BACKGROUND Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding(EGVB)face high mortality.AIM To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.METHODS Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research.Univariate analysis,least absolute shrinkage and selection operator regression,and multivariate analysis were employed to establish the nomogram model.Calibration curve,the area under the receiver operating characteristic curve(AUC),and decision curve analysis(DCA)were applied to assess the discrimination,accuracy,and clinical practicability of the nomogram,respectively.RESULTS A total of 1115 patients were enrolled in this study.The nomogram was established based on white blood cells(P<0.001),hemoglobin(P<0.001),fibrinogen(P<0.001),total bilirubin(P=0.007),activated partial thromboplastin time(P=0.002),total bile acid(P=0.012),and ascites(P=0.006).The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model.The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts,respectively,which were higher than that of the aspartate aminotransferase-to-platelet ratio index,fibrosis index based on 4 factors,and aspartate aminotransferase-to-alanine aminotransferase ratio.Additionally,DCA indicated that the net benefit value of the model was higher than that of the other models.CONCLUSION This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis,which could help clinicians with timely diagnosis,individualized treatment,and follow-up.
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Treatments for low degree hemorrhoids(I-III degree)are numerous and so are their counterparts for higher degrees.These treatments present nebulous diffe-rences in terms of indications and outcomes among techniques.Methods previously abandoned due to side effects and long-term results have recently rejoined the mainstream due to recent peculiar modifications:Hemorrhoidal sclerotherapy is enjoying a new age of interest due to the use of the foam form of polidocanol,which is more effective than the liquid one.Various articles have already shown promising results and the logical next step is the combination of polidocanol foam with rubber-band ligation(the historical counterpart of sclero-therapy)in a technique called“sclerobanding”.In this article,we comment on the publication by Qu et al further modifying the use of sclerobanding through an endoscopic delivery for patients with grade II-III internal hemorrhoids,and present results compared with endoscopic rubber band ligation.The results achieved are promising.
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Gastrointestinal(GI)bleeding is a critical and potentially life-threatening condition frequently observed in the intensive care unit(ICU).This literature review consolidates current insights on the epidemiology,etiology,management,and outcomes of GI bleeding in critically ill patients.GI bleeding remains a significant concern,especially among patients with underlying risk factors such as coagulopathy,mechanical ventilation,and renal failure.Managing GI bleeding in the ICU requires a multidisciplinary approach,including resuscitation,endoscopic intervention,pharmacologic therapy,and sometimes surgical procedures.Even with enhanced management strategies,GI bleeding in the ICU is associated with considerable morbidity and mortality,particularly when complicated by multi-organ failure.This review reiterates the need for adequate resuscitation and interventions in managing GI bleeding in critically ill patients,aiming to enhance survival rates and improve the quality of care within the ICU setting.
文摘The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.
文摘A recent study by Peng et al developed a predictive model for first-instance secondary esophageal variceal bleeding in cirrhotic patients by integrating clinical and multi-organ radiomic features.The combined radiomic-clinical model demonstrated strong predictive capabilities,achieving an area under the curve of 0.951 in the training cohort and 0.930 in the validation cohort.The results highlight the potential of noninvasive prediction models in assessing esophageal variceal bleeding risk,aiding in timely clinical decision-making.Additionally,manual delineation of regions of interest raises the risk of observer bias despite efforts to minimize it.The study adjusted for clinical covariates,while some potential confounders,such as socioeconomic status,alcohol use,and liver function scores,were not included.Additionally,an imbalance in cohort sizes between the training and validation groups may reduce the statistical power of validation.Expanding the validation cohort and incorporating multi-center external validation would improve generalizability.Future studies should focus on incorporating long-term patient outcomes,exploring additional imaging modalities,and integrating automated segmentation techniques to refine the predictive model.
文摘Gastrointestinal angiodysplasia(GIAD)is a common,acquired,vascular abnor-mality in the gastrointestinal tract that is commonly implicated in bleeding.Siro-limus,also known as rapamycin,is a mammalian target of rapamycin pathway inhibitor that has shown significant potential in inhibiting abnormal angiogenesis that has demonstrated efficacy in inhibiting abnormal blood vessel formation in the skin,cornea,and tumors.Sun et al in their single centre prospective study aimed to evaluate the efficacy and safety of sirolimus in treating GIAD-associated bleeding.While their study does provide a sound platform for future studies to investigate the effects of sirolimus in the treatment of GIAD-associated bleeding in an evidence free zone,there are limitations to the study which are not addre-ssed.In this commentary,we summarise the significant highlights from the study performed by Sun et al along with its limitations.In addition to this,we provide an update on the current therapies utilised in the treatment of GIAD-associated bleeding.
文摘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.
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 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BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.
文摘BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.
基金Supported by 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 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.
