Prevalence and Characteristics of Covert/Minimal Hepatic Encephalopathy in Patients With Liver Cirrhosis: A Systematic Review and Meta-Analysis.

INTRODUCTION: Covert/minimal hepatic encephalopathy (C/MHE) is the mildest form of hepatic encephalopathy (HE), but it is closely related to the quality of life and prognosis of patients with cirrhosis. Currently, the epidemiological data of C/MHE have not been well described. METHODS: We searched the PubMed, Embase, and Cochrane Library databases for relevant articles. We performed a random-effects meta-analysis of proportions to estimate the pooled prevalence of C/MHE in patients with cirrhosis. We also examined potential risk factors for C/MHE by comparing characteristics of patients with and without C/MHE. RESULTS: Finally, a total of 101 studies were included. The prevalence of C/MHE was 40.9% (95% confidence interval, 38.3%-43.5%) among patients with cirrhosis worldwide. The pooled C/MHE prevalence was 39.9% (95% confidence interval 36.7%-43.1%) based on studies using the psychometric HE score as a diagnostic tool. Meta-regression models showed that geographic region, sample size, mean age, sex ratio, and Child-Pugh classification were influencing factors for the heterogeneity of C/MHE prevalence. The presence of C/MHE was found to be associated with various factors including age, level of education, alcoholic etiology, Child-Pugh classification, MELD score, history of overt HE, presence of other complications, and laboratory tests related to impaired liver function. DISCUSSION: This study reports detailed data on the prevalence of C/MHE as well as clinical features associated with C/MHE, suggesting that C/MHE is one of the most common complications of liver cirrhosis.

Cold Snare Polypectomy With or Without Submucosal Injection for Endoscopic Resection of Colorectal Polyps: A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND AND AIMS: The impact of submucosal injection during cold snare polypectomy (CSP) remains uncertain. We conducted an evidence-based comparison of conventional CSP (C-CSP) and CSP with submucosal injection (SI-CSP) for colorectal polyp resection. METHODS: PubMed, Embase, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing C-CSP with SI-CSP. Major outcomes included the rates of complete resection, en bloc resection, polyp retrieval, and adverse events, as well as the duration of polypectomy. Data were analyzed by using a random-effects model. RESULTS: A total of seven RCTs were included. Complete resection rates for all polyps (RR 0.98; 95% CI 0.93-1.03), polyps ≤ 10 mm (RR 0.99; 95% CI 0.96-1.02) and polyps > 10 mm (RR 0.92; 95% CI 0.69-1.12) were not substantially different between C-CSP and SI-CSP groups. En bloc resection rate (RR 0.93; 95% CI 0.79-1.09) and polyp retrieval rate (RR 1.00; 95% CI 0.99-1.01) were also not significantly different between the two groups. The SI-CSP group required a prolonged polypectomy time than the C-CSP group (SMD - 0.89; 95% CI -1.29 to -0.49). Adverse events were rare in both groups. CONCLUSIONS: SI-CSP is not an optimal substitute for CSP in the resection of colorectal polyps, particularly diminutive and small polyps.

Atomically Dispersed Fe-N4 and Ni-N4 Independent Sites Enable Bidirectional Sulfur Redox Electrocatalysis.

Single-atom catalysts (SACs) with high atom utilization and outstanding catalytic selectivity are useful for improving battery performance. Herein, atomically dispersed Ni-N4 and Fe-N4 dual sites coanchored on porous hollow carbon nanocages (Ni-Fe-NC) are fabricated and deployed as the sulfur host for Li-S battery. The hollow and conductive carbon matrix promotes electron transfer and also accommodates volume fluctuation during cycling. Notably, the high d band center of Fe in Fe-N4 site demonstrates strong polysulfide affinity, leading to an accelerated sulfur reduction reaction. Meanwhile, Li2S on the Ni-N4 site delivers a metallic property with high S 2p electron density of states around the Femi energy level, enabling a low sulfur evolution reaction barrier. The dual catalytic effect on Ni-Fe-NC endows sulfur cathode high energy density, prolonged lifespan, and low polarization.

Unexpected submucosal lesion with malignant potential.

The inverted hyperplastic polyp (IHP) is known as hyperplastic gastric mucosa growth into submucosa and endoscopically presented as sessile or pedunculated submucosa lesion. It occurs in between 3.1% to 20.1% of cases, while its malignant transformation rate is just 0.02%. A male underwent esophagogastroduodenoscopy (EGD) and discovered a submucosal lesion with a pinhole-like orifice in the fundus. And endoscopic ultrasound (EUS) showed it was a heterogenous hypoechoic lesion located in the submucosa. After endoscopic resection, the pathological findings and immunohistochemical staining revealed it was inverted hyperplastic polyp (IHP) with adenocarcinoma. The measurement of the cancerous IHP depth of invasion is controversial. Thus, how to define the depth of lesion invasion in this patient needs to be seriously considered. To manage IHP with adenocarcinoma better, the depth of lesion invasion cancerous IHP needs to be seriously considered.

All-Round Ionic Liquids for Shuttle-Free Zinc-Iodine Battery.

The practical implementation of aqueous zinc-iodine batteries (ZIBs) is hindered by the rampant Zn dendrites growth, parasite corrosion, and polyiodide shuttling. In this work, ionic liquid EMIM[OAc] is employed as an all-round solution to mitigate challenges on both the Zn anode and the iodine cathode side. First, the EMIM+ embedded lean-water inner Helmholtz plane (IHP) and inert solvation sheath modulated by OAc- effectively repels H2 O molecules away from the Zn anode surface. The preferential adsorption of EMIM+ on Zn metal facilitates uniform Zn nucleation via a steric hindrance effect. Second, EMIM+ can reduce the polyiodide shuttling by hindering the iodine dissolution and forming an EMIM+ -I3 - dominated phase. These effects holistically enhance the cycle life, which is manifested by both Zn || Zn symmetric cells and Zn-I2 full cells. ZIBs with EAc deliver a capacity decay rate of merely 0.01 ‰ per cycle after over 18,000 cycles at 4 A g-1 , and lower self-discharge and better calendar life than the ZIBs without ionic liquid EAc additive.

In-Situ Spontaneous Electropolymerization Enables Robust Hydrogel Electrolyte Interfaces in Aqueous Batteries.

Hydrogels hold great promise as electrolytes for emerging aqueous batteries, for which establishing a robust electrode-hydrogel interface is crucial for mitigating side reactions. Conventional hydrogel electrolytes fabricated by ex situ polymerization through either thermal stimulation or photo exposure cannot ensure complete interfacial contact with electrodes. Herein, we introduce an in situ electropolymerization approach for constructing hydrogel electrolytes. The hydrogel is spontaneously generated during the initial cycling of the battery, eliminating the need of additional initiators for polymerization. The involvement of electrodes during the hydrogel synthesis yields well-bonded and deep infiltrated electrode-electrolyte interfaces. As a case study, we attest that, the in situ-formed polyanionic hydrogel in Zn-MnO2 battery substantially improves the stability and kinetics of both Zn anode and porous MnO2 cathode owing to the robust interfaces. This research provides insight to the function of hydrogel electrolyte interfaces and constitutes a critical advancement in designing highly durable aqueous batteries.

Clinical features, treatments and prognosis of appendiceal bleeding: a case series study.

BACKGROUND: Appendiceal bleeding is a rare cause of lower gastrointestinal bleeding, could be overlooked and diagnosed as obscure gastrointestinal bleeding. Due to limited real-world cases, the optimized management of appendiceal bleeding is unclear. We here shared our experiences in the past 20 years. METHODS: A retrospective study was conducted at West China Hospital of Sichuan University. We reviewed data of 28,175 colonoscopies from 43,095 gastrointestinal bleeding patients between June 2003 and June 2023. Six patients diagnosed as appendiceal bleeding were included. Data including symptoms, laboratory tests, imaging results, endoscopic findings, treatment and prognosis were collected and analyzed. RESULTS: Appendiceal bleeding accounts for 0.014% in gastrointestinal bleeding patients. Of the six patients, five were male, with a mean age of 48.5 years. Hematochezia was the most common symptom. The etiology included appendiceal angiodysplasia, appendicitis and appendectomy associated bleeding. Hemostasis was achieved by appendectomy, endoscopic therapy or medication according to different cases. One patient did not receive any treatment because of self-limiting bleeding. CONCLUSIONS: The diagnosis of appendiceal bleeding is challenging, repeated flushing during endoscopy is helpful. Appendectomy is the priority option for treatment as well as the etiology clarification, therapeutic endoscopy and medication could be considered case by case.

Development and validation of a model to determine the risk of esophageal strictures after endoscopic submucosal dissection for esophageal neoplasms.

BACKGROUND: Currently, endoscopic submucosal dissection (ESD) is widely used as therapeutic methods for superficial esophageal neoplasms (SENs). However, patients are likely to develop esophageal strictures after ESD. Our study aims to explore the possible risk factors for esophageal strictures after ESD and develop and validate a risk model for predicting the progression of postoperative esophageal strictures. METHODS: Clinical data of patients who underwent ESD in our hospital for suspected early esophageal squamous cell carcinoma were collected from January 2014 to March 2020. The possible risk factors for postoperative esophageal strictures were analyzed by univariate and multivariate logistic regression analysis. Eventually, a risk-scoring model was built, in which 70% of patients were used to develop the model and the remaining 30% were used for validation. RESULTS: A total of 553 patients who received ESD were involved, and the incidence of esophageal strictures after ESD was 16.6% (92/553). In our study, the operating time, circumferential range, lesion location, depth of infiltration, and R0 resection were independent risk factors for esophageal strictures after ESD. According to the risk of postoperative esophageal stenosis, a risk-scoring model for esophageal strictures prediction was developed. The risk score ranged from 0 to 11 points, and the risk scores were divided into low risk (0-3 points), intermediate risk (4-7 points), and high risk (8-11 points). The proportions of esophageal stenosis progression in the corresponding risk categories were 6.33%, 29.14%, and 100%. CONCLUSIONS: We developed a risk-scoring model based on factors including circumferential range, lesion location, depth of infiltration, and R0 resection. It stratified patients into low-, intermediate-, and high-risk groups for postoperative esophageal strictures development. This scoring model may have the potential to guide the management of patients after ESD in the future.

Boosting Polysulfide Catalytic Conversion and Facilitating Li+ Transportation by Ion-Selective COFs Composite Nanowire for LiS Batteries.

The large-scale application of lithium-sulfur batteries (LSBs) has been impeded by the shuttle effect of lithium-polysulfides (LiPSs) and sluggish redox kinetics since which lead to irreversible capacity decay and low sulfur utilization. Herein, a hierarchical interlayer constructed by boroxine covalent organic frameworks (COFs) with high Li+ conductivity is fabricated via an in situ polymerization method on carbon nanotubes (CNTs) (C@COF). The as-prepared interlayer delivers a high Li+ ionic conductivity (1.85 mS cm-1 ) and Li+ transference number (0.78), which not only acts as a physical barrier, but also a bidirectional catalyst for LiPSs redox process owing to the abundant heterointerfaces between the inner conductive CNTs and the outer COFs. After coupling such a catalytic interlayer with sulfur cathode, the LSBs exhibit a low decay rate of 0.07% per cycle over 500 cycles at 1 C, and long cycle life at 3 C (over 1000 cycles). More importantly, a remarkable areal capacity of around 4.69 mAh cm-2 can still be maintained after 50 cycles even under a high sulfur loading condition (6.8 mg cm-2 ). This work paves a new way for the design of the interlayer with bidirectional catalytic behavior in LSBs.

Retroflexed view for reexamination of the right colon after forward view examination: Systematic review and meta-analysis.

BACKGROUND: The effect of retroflexed view (RV) for the reexamination of the right colon after forward view (FV) examination has not been fully understood. METHODS: We searched multiple databases including PubMed, Embase, and the Cochrane Library for prospective studies exploring the role of RV for reexamination of the right colon. A meta-analysis was performed on outcomes including lesion detection rates, lesion miss rates, and withdrawal time. RESULTS: Four randomized controlled trials aimed to compare the impact of the second withdrawal from the right colon in RV vs. FV following a standard colonoscopy. Both the additional adenoma detection rate (AADR) and additional polyp detection rate (APDR) of the right colon were lower in the RV group compared with the FV group (risk ratio [RR] 0.73 for AADR; RR 0.76 for APDR); similar results were noted in comparisons of the adenoma miss rate and polyp miss rate. Six prospective cohort studies aimed to describe the effect of the RV examination of the right colon after one or two rounds of FV examination. Both the adenoma detection rate (ADR) and polyp detection rate (PDR) of the right colon were slightly higher in combined examinations with RV examination than single FV examination (RR 1.11 for ADR; RR 1.16 for PDR) or two FV examinations (RR 1.21 for ADR; RR 1.22 for PDR). CONCLUSIONS: FV may detect more adenomas and polyps than RV during the second withdrawal from the right colon. RV may detect additional adenomas and polyps in the right colon after two FV examinations.

[Lower Gastrointestinal Bleeding: Current State of Diagnosis and Treatment and Interpretation of the Clinical Guidelines].

Lower gastrointestinal bleeding (LGIB) is a common clinical emergency. However, most of the published findings on LGIB were of retrospective or observational studies, and the relevant clinical guidelines and consensuses were not published until quite recently. In clinical practice, LGIB treatment is not as standardized as the treatment of upper gastrointestinal bleeding. Herein, on the basis of the latest clinical research findings on and guidelines for LGIB, we summarized and analyzed the existent diagnosis and treatment of LGIB from the perspectives of patient assessment and endoscopic, interventional and medication treatment, intending to provide more references to support the clinical practice.

[Analysis and Treatment Experience of 25 Cases of Primary Gastric Lymphoma with Acute Upper Gastrointestinal Bleeding as the Primary Manifestation].

Objective: To summarize the clinical characteristics and treatment experience of gastric primary lymphoma with acute upper gastrointestinal bleeding as the primary manifestation, and to provide support for clinical treatment. Methods: Information on gastric primary lymphoma patients admitted to the Department of Gastroenterology, West China Hospital of Sichuan University between January 2010 and March 2021 for acute upper gastrointestinal bleeding was retrospectively collected. Data on endoscopic morphology, tumor staging, pathology typing, severity of bleeding, risks of rebleeding, treatment and inhospital prognosis were documented and analyzed. Results: A total of 25 patients with a mean age of 57.2 years were included in the study, all of whom presented clinically with melena (100%), 9 (36%) had hematemesis, and 6 (24%) was accompanied with abdominal pain. Twenty, or 80%, of the gastric lymphoma patients with bleeding as the primary manifestation showed endoscopically a tumor-forming phenotype (Yao Classification), mostly involving the middle and lower parts of the gastric body (44% and 32%, respectively). After conservative treatment with medication, rebleeding occurred in 4 patients during hospitalization. One of them required endoscopic hemostasis, two required surgical resection to stop the bleeding, and one decided not to undergo any further treatment. Only one patient died from infection and no death resulted directly from severe bleeding. Conclusion: Gastric primary lymphoma presenting acute upper gastrointestinal bleeding as the sole clinical manifestation rarely occurs, but when the condition does occur, it shows a wide range of endoscopic involvement. It has a higher risk of rebleeding, and endoscopic or surgical treatment may be attempted when conservative medication treatment for acute upper gastrointestinal bleeding fails.

[Clinical Value of White Light Image, Endoscopic Ultrasonography and Magnifying Endoscopy with Narrow Band Imaging in Evaluation of Indications for Endoscopic Treatment of Early Gastric Cancer].

OBJECTIVE: To explore the application value of white light image (WLI), endoscopic ultrasonography (EUS) and magnifying endoscopy with narrow band imaging (ME-NBI) in the endoscopic treatment of early gastric cancer (EGC), and to provide basis for decision-making in clinical diagnosis and treatment. METHODS: The clinicopathological data of EGC patients who underwent endoscopic submucosal dissection (ESD) at West China Hospital, Sichuan University between December 2013 and October 2020 were included. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EGC invasive depth were compared between WLI and EUS. The role of ME-NBI in predicting the differentiation types of EGC was analyzed. RESULTS: A total of 280 patients (291 lesions) were enrolled in the study. Among them, 199 patients (207 lesions) received EUS and 160 patients (168 lesions) received ME-NBI. The overall accuracy of WLI in diagnosing the invasive depth of EGC was 87.0%, significantly higher than that of EUS (46.4%, P<0.001). When WLI was combined with EUS, the diagnostic accuracy (87.4%) was not significantly improved. The overall accuracy of determining the differentiation degree of EGC with ME-NBI was 92.3% (155/168), and the accuracy of determining undifferentiated EGC with ME-NBI was significantly lower than that of differentiated EGC (41.2% vs. 98.0%, P<0.001). CONCLUSION: In the evaluation of indications for endoscopic treatment of EGC, WLI showed better performance in predicting the invasive depth of EGC, while EUS demonstrated limited value. ME-NBI showed better accuracy for predicting the differentiation degree of most EGC, especially for differentiated EGC.

[Mortality Risk Factors for Inpatients with Ischemic Heart Disease Complicated with Gastrointestinal Bleeding].

OBJECTIVE: To investigate the risk factors of in-hospital mortality in patients with combined ischemic heart disease (IHD) and gastrointestinal bleeding (GIB). METHODS: Patients who were hospitalized and received treatment for IHD combined with GIB at West China Hospital, Sichuan University between Jan. 2015 and Jan. 2018 were included in the study. Information concerning their baseline data, comorbidities, history of anticoagulant and antiplatelet medication, laboratory data on admission, and in-hospital treatments was collected. In-hospital death of all causes was taken as the primary endpoint event of the study, and multivariate logistic regression analysis was conducted to identify the independent risk factors of mortality during their hospital stay for this specific type of patients. Then, receiver operating characteristic ( ROC) curve was drawn and the area under curve ( AUC) was calculated accordingly. RESULTS: A total of 395 patients met the enrollment criteria and were included in the study. Among them, 342 patients were discharged after their condition improved, and 53 patients died during hospitalization. Analysis of the cause of death revealed that cardiogenic death was the leading cause of death (54.7%), which was followed by infection-caused death (24.5%). Logistic regression analysis revealed that patients with ST-segment elevation myocardial infarction (STEMI) had a 2.527-fold risk of mortality compared with patients with non-acute coronary syndrome (odds ratio [ OR]=2.527, 95% confidence interval [ CI]: 1.152-8.277, P=0.043), and patients with comorbidity of chronic renal disease (CKD) had a 2.89-fold risk of mortality ( OR=2.89, 95% CI:1.187-7.037, P=0.019). It was also shown the higher level of WBC count ( OR=1.123, 95% CI: 1.057-1.193, P<0.001) and lower hemoglobin ( OR=1.014, 95% CI: 1.003-1.025, P=0.013) on admission were related to in-hospital mortality. On the other hand, endoscopy ( OR=0.305, 95% CI: 0.103-0.881, P=0.029) was identified as a protective factor in hospital treatment that decreased the risk of in-hospital mortality. ROC curve was drawn by combining the aforementioned variables to predict in-hospital mortality, which had an AUC of 0.79. CONCLUSION: The actual type of IHD being STEMI, the patient's condition being complicated with chronic kidney disease, and having high white blood cells and low hemoglobin levels upon admission were considered independent risk factors for in-hospital death outcome of IHD patients complicated with GIB, while undergoing endoscopy during hospitalization was considered as a protective factor.

[Endoscopic Dilation to Treat One Case of Severe Intestinal Stenosis Caused by Endometriosis].

A 46-year-old woman was admitted for repeated abdominal distention and constipation for more than 10 years and further deterioration for 5 years. Colonoscopy showed, in the sigmoid colon, nodular neoplasm protruding into the cavity, resulting in local intestinal stenosis, through which the endoscopy could not pass. Pathological findings of the biopsy sample revealed changes caused by intestinal endometriosis. The patient underwent multiple endoscopic dilatation treatments in our hospital and the interval between recurrences of intestinal stenosis was extended from 6 months to 4 years. Intestinal endometriosis can cause repeated intractable stenosis caused by the infiltration of ectopic glands in the intestinal wall, which usually requires surgical intervention. Herein, we report a case of severe intestinal stenosis caused by endometriosis in the sigmoid colon. Good results have been achieved through endoscopic dilatation treatment. This case suggests that endoscopic dilation has good application value in the treatment of this kind of disease, which needs further exploration and promotion.

[Risk Factors for Adverse Outcomes in the Elderly Inpatients with Gastrointestinal Bleeding].

OBJECTIVE: To explore the factors affecting the adverse prognosis of elderly inpatients with gastrointestinal bleeding (GIB). METHODS: We retrospectively analyzed the clinical data of elderly patients aged 60 and over admitted with GIB to the Department of Gastroenterology, West China Hospital, Sichuan University between January 2016 and January 2021. The adverse outcome was defined as admission to the intensive care unit and/or in-hospital death during the patient's stay at the hospital. Univariate and multivariate logistic regression analyses were done to identify the risk factors associated with the adverse outcome of the elderly. RESULTS: A total of 885 elderly patients (median age: 72.00 years, 517 males and 368 females) with GIB were enrolled, including 436 cases of upper GIB (UGIB) and 449 cases of lower GIB (LGIB). The overall rate of adverse outcome was 13.22% (117/885), which was significantly higher in the UGIB patients than that in the LGIB patients ( P<0.001). Univariate logistic regression identified UGIB ( P<0.001), shock index>1 ( P<0.001), hemoglobin ( P<0.001), blood urea nitrogen ( P<0.001), creatinine ( P<0.001), and international normalized ratio (INR) ( P<0.001) on admission, as well as erythrocyte transfusion ( P<0.001), fresh frozen plasma (FFP) transfusion ( P<0.001), and platelet transfusion ( P<0.001) were associated with adverse outcome. Multivariate logistic analysis showed that UGIB ( P<0.001), shock index >1 on admission ( P=0.001), higher INR on admission ( P=0.015) and FFP transfusion during hospitalization ( P<0.001) were independent risk factors for adverse outcome of elderly patients with GIB. Further analysis showed that INR>1.5 on admission significantly increased the risks of adverse outcome ( P<0.001). CONCLUSION: Elderly patients with UGIB exhibited worse prognosis than those with LGIB. After adjusting for age and the location of bleeding, shock index>1, INR>1.5 on admission and FFP transfusion were considered independent risk factors for the adverse outcome of elderly inpatients with GIB.

The impact of albumin infusion on the risk of rebleeding and in-hospital mortality in cirrhotic patients admitted for acute gastrointestinal bleeding: a retrospective study of a single institute.

BACKGROUND: To investigate the effect of albumin infusion on cirrhotic patients admitted for acute gastrointestinal bleeding. METHODS: Medical records of cirrhotic patients who admitted due to acute gastrointestinal bleeding through January 2009 to December 2018 were reviewed. Clinical data and the total amount of albumin and red blood cell used during hospitalization were recorded. For patients with rebleeding, the amount of albumin and red blood cell used before rebleeding was also documented. The primary outcome was the occurrence of rebleeding, and the second outcome was in-hospital mortality. Univariate and multivariate logistic analysis was performed to identify risk factors associated with rebleeding and in-hospital mortality. RESULTS: A total of 1503 cirrhotic patients were included in the analysis. There were 146 episodes of in-patient rebleeding occurred, while 81 patients died. Overall, more red blood cells and albumin were prescribed to patients who suffered rebleeding. In terms of the amount before rebleeding, the red blood cell was higher in patients with rebleeding, but the albumin infusion was similar. In the multivariate model, the albumin infusion before rebleeding was an independent risk factor associated with rebleeding (adjusted OR for ≤40 g vs 0 g, 0.469 [0.269-0.793], p = 0.006; adjusted OR for > 40 g vs 0 g, 0.272 [0.115-0.576], p = 0.001). In Child-Pugh C class patients, the use of albumin more than 40 g during hospitalization associated with a lower risk of in-patient mortality (adjusted OR for > 40 g vs 0 g, 0.136 [0.019-0.741], p = 0.031). CONCLUSIONS: Albumin infusion was associated with a lower risk of rebleeding and in-hospital deaths in cirrhosis admitted for acute gastrointestinal bleeding.

[Role of Hemostatic Clips as Guidance during Transcatheter Arterial Embolization in Patients with Peptic Ulcer Bleeding after Endoscopic Treatment Failure].

OBJECTIVE: To investigate the feasibility and clinical efficacy of transcatheter arterial embolization using hemostatic clips as the guidance in the patients with peptic ulcer bleeding after endoscopic treatment failure. METHODS: From February 2009 to October 2018, 33 patients with peptic ulcer bleeding who were treated with transcatheter arterial embolization after endoscopic treatment failure were included in the study. Clinical success rate, 30-d mortality rate and complication rate were observed. RESULTS: According to Forrest grading of ulcer bleeding on endoscopy, 8 patients (24.2%) were defined as Ⅰa, 14 patients (42.5%) Ⅰb, 4 patients (12.1%) Ⅱa, and 7 patients (21.2%) Ⅱb. There were 8 patients not given endoscopic treatment due to poor vision. In 25 patients who received endoscopic treatment, 7 patients did not achieve primary endoscopic hemostasis and 18 patients had re-bleeding despite successful primary hemostasis. The mean interval time from endoscopic treatment failure to transcatheter arterial embolization was (35.42±67.54) h. All patients underwent arterial angiography, and 18 patients with positive angiographic findings were treated with embolization. Among the 15 patients with negative angiographic findings, hemostatic clip could be observed fluoroscopically in 8 patients and used as guidance for embolization. Prophylactic embolization was performed in 4 out of 7 patients without visualization of clip fluoroscopically. The clinical success rates in negative angiographic findings patients with and without clip guidance were 75.0% and 28.6% respectively. The clinical success rate with positive angiographic findings was 66.7%. The overall clinical success rate and 30-d mortality rate were 60.0% and 20.0% respectively. No complication related to embolization was observed. CONCLUSION: The preliminary clinical study demonstrates that transcatheter arterial embolization with the guidance of clips is effective and safe for patients with peptic ulcer bleeding after endoscopic treatment failure.

[Efficacy of Transcatheter Embolization for Gastrointestinal Stromal Tumor with Gastrointestinal Hemorrhage in 17 Cases].

OBJECTIVE: To evaluate the clinical efficacy of transcatheter embolization for patients with gastrointestinal stromal tumor and gastrointestinal hemorrhage. METHODS: From June 2006 to June 2019, 17 patients with gastrointestinal stromal tumor and who were gastrointestinal bleeding treated with transcatheter embolization due to gastrointestinal hemorrhage in our hospital were included in this study. The technical and clinical success rates and clinical success rate were analyzed retrospectively. RESULTS: Among 17 patients who underwent angiography before embolotherapy, 5 patients (29.4%) showed tumor staining and contrast extravasation, 9 patients (52.9%) showed tumor staining but no significant contrast extravasation, and 3 patients (17.6%) were negative. 14 patients had with positive angiographic findings and then underwent transcatheter embolization. Technical success was achieved in 13 patients (76.5%). Of the 13 technically successful patients, 12 patients (70.6%) achieved clinical success, one patient (5.9%) suffered from repeated gastrointestinal bleeding, which was improved after conservative treatment. No embolization-related complication occurred. The 30-day mortality rate was 0%. CONCLUSION: Transcatheter embolization for gastrointestinal stromal tumor with gastrointestinal hemorrhage is a safe and effective minimally invasive technique.