ABSTRACT
BACKGROUND: Therapy of gastric varices (GV) is still challenging. Cyanoacrylate (CYA) injection is the recommended treatment for bleeding GV, but has a known adverse event rate, which could be reduced if EUS is used for guidance. Otherwise, EUS-guided coil application (ECA) may be an alternative. OBJECTIVES: To compare CYA and ECA embolization of feeding GV for feasibility, safety, and applicability. DESIGN: Retrospective analysis of a prospectively maintained database. SETTING: Multicenter study, tertiary referral centers. PATIENTS AND INTERVENTIONS: Thirty consecutive patients with localized GV who received either CYA injection or ECA were included with follow-up for 6 months after treatment. RESULTS: There were 11 patients in the coil group and 19 patients in the CYA group. The GV obliteration rate was 94.7% CYA versus 90.9% ECA; mean number of endoscopy sessions was 1.4 ± 0.1 (range 1-3). Adverse events occurred in 12 of 30 patients (40%) (CYA, 11/19 [57.9%]; ECA, 1/11 [9.1%]; P < .01); only 3 were symptomatic, and an additional 9 (CYA group) had glue embolism on a CT scan but was asymptomatic. No further adverse events occurred during follow-up. Six patients (20%) died unrelated to the procedures or bleeding. LIMITATIONS: Nonrandomized; EUS expertise necessary. CONCLUSIONS: EUS-guided therapy for GV by using CYA or ECA is effective in localized GV. ECA required fewer endoscopies and tended to have fewer adverse events compared with CYA injection. Larger comparative studies are needed to prove these data.
Subject(s)
Cyanoacrylates/therapeutic use , Embolization, Therapeutic/methods , Endosonography/methods , Esophageal and Gastric Varices/therapy , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/methods , Ultrasonography, Interventional/methods , Aged , Cohort Studies , Embolization, Therapeutic/instrumentation , Esophageal and Gastric Varices/complications , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
La unidad de atención continuada y hospital de día permite el manejo ambulatorio de los pacientes con una enfermedad digestiva. Objetivo: Disminuir los ingresos hospitalarios y el número de pacientes con una enfermedad digestiva que acude a urgencias. Material y métodos: Los pacientes se atienden según dos niveles asistenciales: a) atención continuada, en que se visitan de forma urgente los pacientes con una descompensación aguda de su enfermedad digestiva, y b) atención programada, en que se realizan procedimientos que por su complejidad requieren personal de enfermería, sin ser necesario el ingreso hospitalario. Resultados: En el período comprendido entre 1995 y 2005 se ha pasado de realizar 118 visitas en atención continuada en 1995 a 784 en 2005. En atención programada las paracentesis han aumentado de 237 en 1995 a 687 en 2006 y las infusiones de hierro intravenoso de 111 en 2004 a 519 en 2006. El número de ingresos hospitalarios pasó inicialmente de 605 en 1995 a 430 en 2000, para posteriormente aumentar. El número de pacientes con una enfermedad digestiva que acudió a urgencias disminuyó un 75% estos años. Conclusiones: La unidad de atención continuada y hospital de día permite una disminución inicial del número de ingresos en el área de hospitalización convencional y en el porcentaje de pacientes con patología digestiva que acuden a urgencias
The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. Aim: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. Material and methods: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. Results: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. Conclusions: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department
Subject(s)
Humans , Day Care, Medical/methods , Continuity of Patient Care/organization & administration , Gastrointestinal Diseases/therapy , Day Care, Medical/methods , Paracentesis/nursing , Nursing Care/methods , Patient Education as Topic/methods , Interferons/administration & dosage , Ribavirin/administration & dosageABSTRACT
UNLABELLED: The continuing care unit and day hospital allows ambulatory care of patients with digestive diseases. AIM: Reducing hospital admissions and the number of patients with digestive diseases that attend the emergency department. MATERIAL AND METHODS: Two types of care are provided: a) continuing care; patients are urgently visited when they show acute decompensation of their digestive disease, and b) scheduled care: procedures that, due to their complexity, require nursing care but not necessarily hospital admission. RESULTS: In the period 1995-2005, visits to the continuing care unit increased from 118 in 1995 to 784 in 2005. In scheduled care, the number of paracentesis increased from 237 in 1995 to 687 in 2006. Intravenous iron infusions increased from 111 in 2004 to 519 in 2006. The number of hospital admissions initially decreased from 605 in 1995 to 430 in 2000, and then increased. The number of patients with digestive diseases attending the emergency department decreased by 75% throughout the period studied. CONCLUSIONS: The continuing care unit and day hospital allowed an initial reduction in the number of conventional hospitalizations and in the percentage of patients with digestive diseases attending the emergency department.