RESUMO
BACKGROUND: Acute gastric variceal bleeding (AGVB) is a potentially fatal consequence of portal hypertension, accounting for 10% to 30% of all variceal bleeding. Although endoscopic cyanoacrylate glue injection is a common treatment for acute hemostasis, it has been linked to significant side effects. In the treatment of AGVB, there is limited evidence of the efficacy and relative safety of endoscopic human thrombin injection over glue injection. MATERIALS AND METHODS: A total of 52 AGVB patients were randomized to receive either thrombin injection (25 patients) or glue injection (27 patients). The primary outcome was the incidence of any glue or thrombin injection-related post-therapy complications. Initial hemostasis, rebleeding, and mortality were all secondary end goals. RESULTS: Both groups had comparable baseline data. Hemostasis of active bleeding at endoscopy was 100.0% (10/10) in the thrombin group and 87.5% (7/8) in the glue group (P=0.44). Treatment failure after 5 days occurred in 2 patients (6.1%) in the glue group compared with none in the thrombin group (P=0.165). Between 6 and 42 days after index bleeding, rebleeding occurred in 4 patients in the thrombin group compared with 6 patients in the glue group (P=0.728). In the thrombin group, none of the patients had post-treatment ulcers on gastric varices compared with 14.81% (4/27) that occurred in the glue group (P=0.045), a statistically significant observation. Overall, complications occurred in 4 (20%) and 11 (40.7%) patients in the thrombin and glue groups, respectively (P=0.105). Two patients in the glue group died. CONCLUSION: To achieve successful AGVB hemostasis, endoscopic thrombin injection has been proven efficacious. However, glue injection may be linked to a higher rate of rebleeding and post-therapy gastric variceal ulceration compared with thrombin.
RESUMO
Primary hypothyroidism is a common clinical condition in which serous effusions are rare. Isolated cases have been reported in literature about presence of ascites, pleural effusion, pericardial effusion or combination of any two. But combination of all three is extremely rare. We hereby report a case of multiple body cavity effusions (ascites, pleural and pericardial effusions) and tissue edema (pedal and facial) in a hypothyroid male. He responded well to thyroid hormone replacement therapy.
Assuntos
Hipotireoidismo/complicações , Ascite/etiologia , Edema/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pleural/etiologiaRESUMO
Hepatic encephalopathy (HE), a morbid ordeal affecting chronic liver disease patients always insists for the search of a rational, superior & infallible agent beyond the time-proven standards i.e., Lactulose & Rifaximin. In this RCT, we compared the efficacy of intravenous (IV) L-ornithine-L-aspartate(LOLA) versus Oral LOLA in patients with chronic liver disease(CLD) enduring overt Hepatic Encephalopathy(OHE). 40 CLD patients with OHE were randomly assigned IV or oral LOLA in a 1:1 ratio. Patients were graded for HE and monitored for serum ammonia levels from day 1 to day 5. The aim was to compare IV versus oral LOLA efficacy in HE grades improvement and its correlation with ammonia levels. The study was registered with clinical trials registry-India, CTRI/2020/12/029943. Baseline characteristics of patients in both groups were similar. The mean difference in ammonia levels from day 1 to day 5 was 55.4 ± 32.58 µmol/L in the IV LOLA group and 60.75 ± 13.82 µmol/L in the oral LOLA group (p = 0.511). Significant reductions in ammonia levels were observed from day 1 to day 5 within each group (p < 0.001). HE grade & ammonia correlated positively in both groups. LOLA, regardless of administration route, has demonstrated efficacy in OHE.
Assuntos
Administração Intravenosa , Amônia , Dipeptídeos , Encefalopatia Hepática , Humanos , Encefalopatia Hepática/tratamento farmacológico , Encefalopatia Hepática/sangue , Masculino , Feminino , Pessoa de Meia-Idade , Administração Oral , Dipeptídeos/administração & dosagem , Dipeptídeos/uso terapêutico , Amônia/sangue , Adulto , Resultado do Tratamento , IdosoRESUMO
BACKGROUND: Pseudoaneurysm usually occurs after vascular injuries or erosions such as in trauma or inflammation like pancreatitis and is associated with high morbidity and mortality. AIM: The aim of study is to assess efficacy and safety of EUS-guided thrombin injection in pseudoaneurysm. MATERIALS AND METHODS: Prospective data collection was done at SMS Hospital, Jaipur, from January 2015 to March 2023. All patients with pseudoaneurysm were consecutively enrolled. RESULTS: Twenty patients (M/F, 18:2) with median age of 41 years (25-58 years), were studied. Underlying etiology of pseudoaneurysm was chronic pancreatitis in 75% of the patients, blunt trauma abdomen in 15% of the patients, recurrent acute pancreatitis in 5%, and idiopathic in 5% of the patients. At the time of admission, mean hemoglobin was 6.7 g/dL (3.4-8.2), with median blood transfusion requirement was 2 units (0-6 units). Hemoglobin values after 4-6 weeks showed a significant improvement ( t = 9.21, P < 0.05).Mean dose of human thrombin required for complete obliteration of pseudoaneurysm was 520 ± 188.6 IU per patient (300-800 IU). Amount of thrombin (IU) dose needed to achieve complete obliteration correlated well significantly with the dimension of pseudoaneurysm, P value less than 0.05 ( R = 0.80). Median follow-up duration in this study was 44 months (3-84 months), which was the longest follow-up period by far. CONCLUSIONS: Endoscopic ultrasound-guided thrombin injection in visceral artery pseudoaneurysm is a safe and effective alternative for patients not amenable for digital subtraction angiography-guided angioembolization.
Assuntos
Falso Aneurisma , Pancreatite , Humanos , Adulto , Trombina , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/tratamento farmacológico , Doença Aguda , Pancreatite/complicações , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos , Abdome , Hemoglobinas , ArtériasRESUMO
BACKGROUND: Amebic liver abscess is treated successfully with metronidazole or another nitroimidazole drug followed by a luminal amebicide. Metronidazole has long been preferred, but has been associated with several adverse effects including intolerance in certain clinical situations. Mechanisms of metronidazole resistance and mutagenic potential have been described. Effects of the use of drug in pregnant women and infants of lactating women are unknown. Nitazoxanide was proven to be efficacious in treating invasive intestinal amebiasis. Therefore, the present study was undertaken to assess the efficacy and safety of nitazoxanide as compared to metronidazole in patients with uncomplicated amebic liver abscess. METHODS: Patients with clinical and ultrasonography features suggestive of liver abscess, positive amebic serology, and/or anchovy sauce appearance on aspiration of the pus were included in the study and randomized into two parallel treatment groups. Group M received metronidazole, 2-2.5 g/day intravenous (IV), for inpatients, or 2-2.4 g/day oral, for outpatients in three divided doses for 14 days. Group N received nitazoxanide 500 mg BD per oral for 10 days. RESULTS: A total of sixty subjects fulfilling the inclusion criteria were randomized equally into two groups, group M and group N. Number of patients achieving symptomatic clinical response (SCR) was similar in the two groups (80% vs. 76.7%, p = 1.00), though time to achieve symptomatic clinical response was significantly lower in metronidazole group as compared to that in nitazoxanide group. Greater proportion of patients achieved early clinical response (ECR) in metronidazole group as compared to nitazoxanide group. Complete resolution of abscess, at 6 months, was noted in 18 (60%) patients in the M group and 22 (73.3%) patients in the N group (p = 0.273). Metronidazole was associated with significantly greater frequency of adverse effects than nitazoxanide. CONCLUSIONS: This study shows equivalent efficacy of nitazoxanide in uncomplicated amebic liver abscess as compared to metronidazole, with better tolerability and advantage of simultaneous luminal clearance, thus reducing chances of recurrence. TRIAL REGISTRATION: CTRI/2019/01/017249.
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Abscesso Hepático Amebiano , Feminino , Humanos , Lactação , Abscesso Hepático Amebiano/tratamento farmacológico , Metronidazol , Nitrocompostos , Gravidez , TiazóisAssuntos
Ampola Hepatopancreática/anormalidades , Doenças do Colo/diagnóstico , Antro Pilórico/anormalidades , Tuberculose Gastrointestinal/diagnóstico , Antituberculosos/uso terapêutico , Doenças do Colo/tratamento farmacológico , Endoscopia do Sistema Digestório , Feminino , Humanos , Achados Incidentais , Tuberculose Gastrointestinal/tratamento farmacológico , Adulto JovemRESUMO
AIM: To study the sensitivity, specificity and cost effectiveness of barium meal follow through with pneumocolon (BMFTP) used as a screening modality for patients with chronic abdominal pain of luminal origin in developing countries. METHODS: Fifty patients attending the Gastroenterology Unit, SMS Hospital, whose clinical evaluation revealed chronic abdominal pain of bowel origin were included in the study. After routine testing, BMFT, BMFTP, contrast enhanced computed tomography (CECT) of the abdomen, barium enema and colonoscopy were performed. The sensitivity, specificity and cost effectiveness of these imaging modalities in the detection of small and/or large bowel lesions were compared. RESULTS: Out of fifty patients, structural pathology was found in ten. Nine out of these ten patients had small bowel involvement while seven had colonic involvement alone or in combination with small bowel involvement. The sensitivity of BMFTP was 100% compared to 88.89% with BMFT when detecting small bowel involvement (BMFTP detected one additional patient with ileocecal involvement). The sensitivity and specificity of BMFTP for the detection of colonic pathology were 85.71% and 95.35% (41/43), respectively. Screening a patient with chronic abdominal pain (bowel origin) using a combination of BMFT and barium enema cost significantly more than BMFTP while their sensitivity was almost comparable. CONCLUSION: BMFTP should be included in the investigative workup of patients with chronic abdominal pain of luminal origin, where either multiple sites (small and large intestine) of involvement are suspected or the site is unclear on clinical grounds. BMFTP is an economical, quick and comfortable procedure which obviates the need for colonoscopy in the majority of patients.
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Dor Abdominal/diagnóstico , Ar , Sulfato de Bário/administração & dosagem , Doenças do Colo/diagnóstico , Dilatação/métodos , Programas de Rastreamento/métodos , Dor Abdominal/etiologia , Administração Oral , Adulto , Doenças do Colo/complicações , Colonoscopia/economia , Colonoscopia/métodos , Análise Custo-Benefício , Enema/economia , Enema/métodos , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Sensibilidade e Especificidade , EsfigmomanômetrosRESUMO
BACKGROUND: Human thrombin appears to be a new effective tool in the armamentarium of management of bleeding gastric varices, but there are paucity of data on its use. Thus, we share our experience with human thrombin in the treatment of bleeding gastric varices. METHODS: It was a prospective interventional study conducted between September 2015 and December 2017. Patients with upper gastrointestinal bleeding from gastric varices were included, while patients with previous history of cyanoacrylate glue injection or band ligation were excluded. RESULTS: A total of 20 patients including 13 males (mean age 32.65 [18-52] years) presenting with gastric variceal bleeding requiring endoscopic injection of human thrombin were studied. The underlying diagnosis was cirrhosis in 8 patients, and extrahepatic portal vein thrombosis, noncirrhotic portal fibrosis, and chronic pancreatitis in 6, 4, and 2 patients, respectively. Isolated gastric varices were found in 6 patients while 14 patients had gastroesophageal varices (GOV) (GOV1-3, GOV2-11). Patients received 1 to 3 sessions (mean = 1.3) of thrombin with a mean total dose of 700 IU (range = 500-2000 IU). Mean follow up was 16.8 months (range 3-28 months). Hemostasis in the acute setting was successfully managed in all the 20 patients on initial presentation. On serial follow up, 4 out of 20 patients required repeat endoscopic session for gastric varices. No thrombin injection-related complication was recorded. CONCLUSION: Endoscopic therapy with thrombin appears safe and effective in the management of bleeding gastric varices.
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Varizes Esofágicas e Gástricas/tratamento farmacológico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemostase Endoscópica/métodos , Hemostáticos/administração & dosagem , Trombina/administração & dosagem , Adolescente , Adulto , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Visceral artery pseudoaneurysm is a rare and potentially life-threatening vascular entity with a high mortality rate, conventionally managed with digital subtraction angiography with coil embolization or surgery. However, in cases where angiographic coil embolization is not possible due to technical reasons, computerized tomography (CT)/ultrasonography-guided thrombin injection remains a viable option as described in the literature. In this case series, we intend to highlight the role of endoscopic ultrasound-guided thrombin injection in the management of abdominal visceral artery pseudoaneurysm, which is either inaccessible by endovascular route or have high surgical risk of complication.
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Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Endossonografia , Trombina/administração & dosagem , Vísceras/irrigação sanguínea , Adulto , Humanos , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.
Assuntos
Doenças do Ducto Colédoco/diagnóstico , Tuberculose Hepática/diagnóstico , Antituberculosos/uso terapêutico , Biópsia por Agulha Fina , Colestase/etiologia , Doenças do Ducto Colédoco/complicações , Doenças do Ducto Colédoco/diagnóstico por imagem , Doenças do Ducto Colédoco/tratamento farmacológico , Constrição Patológica/complicações , Constrição Patológica/diagnóstico , Diagnóstico Diferencial , Humanos , Icterícia/etiologia , Masculino , Tuberculose Hepática/complicações , Tuberculose Hepática/tratamento farmacológico , Tuberculose Hepática/patologia , Adulto JovemRESUMO
BACKGROUND: Inflammatory bowel disease (IBD) has been associated with increased risk of osteopenia and osteoporosis. Several risk factors contribute to this; however, studies evaluating their association have conflicting results. METHODS: We conducted a cross-sectional study with prospective enrollment of adult ulcerative colitis patients attending the Gastroenterology Department of Sawai Man Singh Hospital, Jaipur Rajasthan between June 2015 and December 2015. Demographic data including age, gender, body mass index (BMI), disease duration, type of disease, prior steroid use and vitamin D levels were recorded and compared with bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). RESULTS: Of the 55 patients enrolled, 41 (74.5%) had abnormal BMD; out of this, 19 (34.5%) had osteopenia and 22 (40.0%) had osteoporosis. In univariate analysis, disease duration and history of steroid use were observed as statistically significant. However, on multivariate analysis, only duration of disease was found to be a significant independent predictor of low BMD. Age, gender, BMI, low levels of vitamin D and steroid usage were not associated with low BMD. CONCLUSION: Prevalence of low BMD is common in Indian ulcerative colitis patients. Prolonged disease duration appears to be the major risk factor.
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Densidade Óssea , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/etiologia , Colite Ulcerativa/complicações , Colite Ulcerativa/fisiopatologia , Osteoporose/epidemiologia , Osteoporose/etiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Glucocorticoides/efeitos adversos , Humanos , Índia/epidemiologia , Masculino , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Deficiência de Vitamina DRESUMO
A 40-year-old man, resident of a rural area of Rajasthan state of India presented with recurrent biliary colic and fever since last 2 years. Examination was normal and investigations revealed a dilated common bile duct with elevated alkaline phosphatase. Magnetic resonance cholangiopancreatography revealed a dilated biliary system without any evident cause. Patient was subjected to endoscopic retrograde cholangioancreatography and it demonstrated biliary dilatation with a linear filling defect in lower common bile duct, further sphinicterotomy was done and a live Fasciola hepatica was extracted using a biliary basket.