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Early endoscopy in upper gastrointestinal bleeding

Václav Hejda
Cirrhosis is the end stage of progressive development of different liver diseases and is associated with significant morbidity and mortality rates. Cirrhosis is associated with a number of potential complications, in particular with development of portal hypertension. Portal hypertension with the production of ascites, hepatic and gastric varices bleeding in the upper part of the gastrointestinal tract, presents the breakpoint in the natural course of cirrhosis, and it is associated with a considerably worse prognosis of patients, with a dramatically increased risk of mortality...
2016: Vnitr̆ní Lékar̆ství
Gautam Sharma, Jessica Ardila-Gatas, Mena Boules, Matthew Davis, James Villamere, John Rodriguez, Stacy A Brethauer, Jeffrey Ponsky, Matthew Kroh
BACKGROUND: Surgeons may be reluctant to perform upper gastrointestinal (UGI) endoscopy in the early post-operative period due to concern for anastomotic disruption. The aim of this study was to determine the safety and feasibility of early (≤ 30 days) post-operative UGI endoscopy after roux-en-y gastric bypass (RYGB). METHODS: A retrospective data analysis of a prospectively maintained database was completed between May 2002 and March 2015 for patients that had undergone UGI endoscopy within 30 days of their RYGB...
October 2016: Surgery
Ding-Yun Liu, Tao Gan, Ni-Ni Rao, Yao-Wen Xing, Jie Zheng, Sang Li, Cheng-Si Luo, Zhong-Jun Zhou, Yong-Li Wan
The gastrointestinal endoscopy in this study refers to conventional gastroscopy and wireless capsule endoscopy (WCE). Both of these techniques produce a large number of images in each diagnosis. The lesion detection done by hand from the images above is time consuming and inaccurate. This study designed a new computer-aided method to detect lesion images. We initially designed an algorithm named joint diagonalisation principal component analysis (JDPCA), in which there are no approximation, iteration or inverting procedures...
August 2016: Medical Image Analysis
Yidan Lu, Viviane Adam, Vanessa Teich, Alan Barkun
OBJECTIVES: High-dose intravenous proton pump inhibitors (PPIs) post endoscopy are recommended in non-variceal upper gastrointestinal bleeding (UGIB), as they improve outcomes of patients with high-risk lesions. Determine the budget impact of using different PPI regimens in treating non-variceal UGIB, including pre- and post-endoscopic use, continuous infusion (high dose), and intermittent bolus (twice daily) dosing. METHODS: A budget impact analysis using a decision model informed with data from the literature adopting a US third party payer's perspective with a 30-day time horizon was used to determine the total cost per patient (US$2014) presenting with acute UGIB...
May 3, 2016: American Journal of Gastroenterology
Nicoleta Gimiga, Claudia Olaru, Smaranda Diaconescu, Ingrith Miron, Marin Burlea
BACKGROUND: The aim of this study was to investigate the common etiologies, clinical and biological patterns of upper gastrointestinal bleeding (UGIB) in children from a hospital center in Northeast Romania. METHODS: This seven-year retrospective study was performed from 2007 to 2013 in St. Mary Children's Emergency Hospital, Jassy, Romania and included all children who referred to our center with UGIB exteriorized by hematemesis or melena. Endoscopy was performed under conscious sedation/general anesthesia after the informed consent was obtained...
June 2016: Minerva Pediatrica
Carla Senosiain Lalastra, Julia Arribas Anta, Víctor Moreira Vicente, Javier Martínez González, Maite Maroto Castellanos, María Concepción García Sánchez, Celia Zaera de la Fuente, Sergio López Durán, Ángel Cañete Ruiz, Agustín Albillos Martínez
INTRODUCTION: Variceal upper gastrointestinal bleeding (UGIB) can trigger acute hypoxic hepatitis (AHH). The aim of this study was to analyse the incidence, associated risk factors and mortality of AHH after variceal UGIB. PATIENTS AND METHODS: Retrospective study of cirrhotic patients with variceal UGIB, classified into 2 groups according to the development of AHH. AHH was diagnosed when AST and ALT reached levels 10 times above the upper limit of normal, after ruling out other causes of hepatitis...
November 2016: Gastroenterología y Hepatología
Dong-Won Ahn, Young Soo Park, Sang Hyub Lee, Cheol Min Shin, Jin-Hyeok Hwang, Jin-Wook Kim, Sook-Hyang Jeong, Nayoung Kim, Dong Ho Lee
BACKGROUND/AIMS: This study was performed to investigate the clinical role of urgent esophagogastroduodenoscopy (EGD) for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) performed by experienced endoscopists after hours. METHODS: A retrospective analysis was performed for consecutively collected data of patients with ANVUGIB between January 2009 and December 2010. RESULTS: A total of 158 patients visited the emergency unit for ANVUGIB after hours...
May 2016: Korean Journal of Internal Medicine
Tomoki Wada, Akiyoshi Hagiwara, Tatsuki Uemura, Naoki Yahagi, Akio Kimura
Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation...
August 2016: Internal and Emergency Medicine
Gonzalo Latorre S, Jorge Álvarez O, Danisa Ivanovic-Zuvic S, Gonzalo Valdivia C, Paula Margozzini M, José Chianale B, Juan Francisco Miquel P
BACKGROUND: In Chile, gastric cancer (GC) is a major cause of cancer related deaths. The current screening strategy consists of an upper gastrointestinal endoscopy (UGE) for people aged 40 years or more with epigastric pain. AIM: To evaluate the diagnostic coverage of the use of UGE for early detection of GC in Chile. MATERIAL AND METHODS: As part of the digestive module of the 2009-10 National Health Survey, 5293 adults over 15 years were asked about the presence of epigastric pain, possible upper gastrointestinal bleeding (PUGB), use of proton pump inhibitors (PPIs) or histamine H2-receptor antagonists (H2RAs), family history of GC and having performed an UGE...
September 2015: Revista Médica de Chile
Ángel Lanas
In the Digestive Disease Week in 2015 there have been some new contributions in the field of gastrointestinal bleeding that deserve to be highlighted. Treatment of celecoxib with a proton pump inhibitor is safer than treatment with nonselective NSAID and a proton pump inhibitor in high risk gastrointestinal and cardiovascular patients who mostly also take acetylsalicylic acid. Several studies confirm the need to restart the antiplatelet or anticoagulant therapy at an early stage after a gastrointestinal hemorrhage...
September 2015: Gastroenterología y Hepatología
Marcus Robertson, Avik Majumdar, Ray Boyapati, William Chung, Tom Worland, Ryma Terbah, James Wei, Steve Lontos, Peter Angus, Rhys Vaughan
BACKGROUND AND AIMS: The American College of Gastroenterology recommends early risk stratification in patients presenting with upper GI bleeding (UGIB). The AIMS65 score is a risk stratification score previously validated to predict inpatient mortality. The aim of this study was to validate the AIMS65 score as a predictor of inpatient mortality in patients with acute UGIB and to compare it with established pre- and postendoscopy risk scores. METHODS: ICD-10 (International Classification of Diseases, Tenth Revision) codes identified patients presenting with UGIB requiring endoscopy...
June 2016: Gastrointestinal Endoscopy
T Tagata, T Hamano, H Teramoto, A Mitsunaga, A Mitsunaga, Y Mitsunaga, Y Ikarashi, I Shirato, S Yoshida, M Shimada, M Shirato, T Nishino
Aberrant pancreas is used to describe ectopic pancreatic tissue lying outside its normal location with no anatomic or vascular connection to the pancreas proper. Patients with aberrant pancreas are usually asymptomatic, so aberrant pancreas are typically discovered incidentally during endoscopy, surgery, or autopsy. This time, we report a case of gastric aberrant pancreas bleeding was repeated and endoscopic hemostasis was difficult. A 22-year-old man was admitted to a hospital with a complaint of epigastric pain and melena...
April 2014: Endoscopic Ultrasound
Ian M Gralnek, Jean-Marc Dumonceau, Ernst J Kuipers, Angel Lanas, David S Sanders, Matthew Kurien, Gianluca Rotondano, Tomas Hucl, Mario Dinis-Ribeiro, Riccardo Marmo, Istvan Racz, Alberto Arezzo, Ralf-Thorsten Hoffmann, Gilles Lesur, Roberto de Franchis, Lars Aabakken, Andrew Veitch, Franco Radaelli, Paulo Salgueiro, Ricardo Cardoso, Luís Maia, Angelo Zullo, Livio Cipolletta, Cesare Hassan
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Main Recommendations MR1. ESGE recommends immediate assessment of hemodynamic status in patients who present with acute upper gastrointestinal hemorrhage (UGIH), with prompt intravascular volume replacement initially using crystalloid fluids if hemodynamic instability exists (strong recommendation, moderate quality evidence)...
October 2015: Endoscopy
Kelvin L Y Lam, John C T Wong, James Y W Lau
Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. Bleeding peptic ulcers account for the majority of causes in patients presenting with AUGIB, whereas variceal bleeding in cirrhotic patients represents a more severe form of bleeding. Endoscopic therapy is the mainstay of treatment in patients with active bleeding, as it achieves hemostasis and improves patient outcomes. Pharmacotherapy is an important adjunct to endoscopic hemostasis. In the management of patients with bleeding peptic ulcers, acid suppression after endoscopic hemostasis reduces rates of further bleeding and interventions...
December 2015: Current Treatment Options in Gastroenterology
Amandeep Singh, Anwaar A Khan, Robert Krall, Zafar K Mirza
Background. Gastric antral vascular ectasia (GAVE) also known as "watermelon stomach" (WS) is an uncommon cause of gastrointestinal (GI) blood loss. It typically presents in middle aged females. We are presenting a case of GAVE at an unusually early age with atypical symptoms. Case. A previously healthy 16 y/o Caucasian female presented to the ER with a one-month history of upper abdominal pain. Physical examination was benign except tenderness in the epigastric region. There were no significant findings on laboratory data...
2015: Case Reports in Medicine
Ann Joo Lee, Lacie Brenner, Bashar Mourad, Carmela Monteiro, Kenneth J Vega, Juan Carlos Munoz
Kaposi's sarcoma (KS) of the gastrointestinal tract is not an uncommon disease among individuals with acquired immunodeficiency syndrome (AIDS). The majority is asymptomatic, and for this reason, gastrointestinal KS (GI-KS) remains undiagnosed. With continued tumor growth, considerable variation in clinical presentation occurs including abdominal pain, nausea, vomiting, iron deficiency anemia (either chronic or frank gastrointestinal bleeding), and rarely mechanical obstruction alone or combined with bowel perforation...
August 6, 2015: World Journal of Gastrointestinal Pharmacology and Therapeutics
Supannee Rassameehiran, Kenneth Nugent, Ariwan Rakvit
Nonvariceal upper gastrointestinal hemorrhage is a common cause for admission to the intensive care unit. Most patients are prohibited from oral or enteral feeding for 72 hours despite different risks for rebleeding. Fasting is believed to improve the ability to control intragastric pH, stabilize clots, and reduce the risk of rebleeding; however, studies have shown no difference in intragastric pH and complications in patients who received early feeding. Approximately 50% of patients are classified as low risk for rebleeding and can be safely fed immediately and discharged early, even on the same day as endoscopy...
July 2015: Southern Medical Journal
Jesse M Civan, Christina C Lindenmeyer, Maureen Whitsett, Steven K Herrine
BACKGROUND: Optimal management of acute upper gastrointestinal bleeding (UGIB) depends on identifying a variceal versus nonvariceal etiology. An objective measure predicting etiology could guide early management pending endoscopy. The AST-to-platelet ratio index (APRI) score has been studied as a marker of cirrhosis and portal hypertension, but has not been evaluated in the setting of acute UGIB. METHODS: In this single-center retrospective cohort study, we reviewed endoscopy reports and other data for patients with acute UGIB, and classified episodes as variceal bleeds or other...
August 2015: Journal of Clinical Gastroenterology
Dušan Grujić, Aleksandar Knežević, Svetlana Vojvodić, Bojana Grujić
BACKGROUND: Arteriovenous fistulas (AVFs) of the superior mesenteric vasculature are rarely encountered. We present a case of an iatrogenic superior mesenteric AVF in a patient who had undergone a small bowel resection 14 years previously. CASE REPORT: The 45-year-old male was admitted with bloody diarrhea, fatigue, weight loss and moderate ascites. On the fifth hospital day, while being evaluated for suspected liver cirrhosis, the patient developed severe gastrointestinal (GI) bleeding...
April 2015: Balkan Medical Journal
Cristina Bucci, Gianluca Rotondano, Riccardo Marmo
Upper gastrointestinal bleeding remains one of the most common challenges faced by gastroenterologists and endoscopists in daily clinical practice. Endoscopic management of nonvariceal bleeding has been shown to improve clinical outcomes, with significant reduction of recurrent bleeding, need for surgery, and mortality. Early upper gastrointestinal endoscopy is recommended in all patients presenting with upper gastrointestinal bleeding within 24 hours of presentation, although appropriate resuscitation, stabilization of hemodynamic parameters, and optimization of comorbidity before endoscopy are essential...
July 2015: Gastrointestinal Endoscopy Clinics of North America
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