Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.030
Filtrar
1.
Gastroenterology ; 158(1): 168-175.e6, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31563627

RESUMO

BACKGROUND & AIMS: We performed a large, multicenter, randomized controlled trial to determine the efficacy and safety of early colonoscopy on outcomes of patients with acute lower gastrointestinal bleeding (ALGIB). METHODS: We performed an open-label study at 15 hospitals in Japan of 170 patients with ALGIB randomly assigned (1:1) to groups that underwent early colonoscopy (within 24 hours of initial visit to the hospital) or elective colonoscopy (24-96 hours after hospital admission). The primary outcome was identification of stigmata of recent hemorrhage (SRH). Secondary outcomes were rebleeding within 30 days, endoscopic treatment success, need for transfusion, length of stay, thrombotic events within 30 days, death within 30 days, and adverse events. RESULTS: SRH were identified in 17 of 79 patients (21.5%) in the early colonoscopy group vs 17 of 80 patients (21.3%) in the elective colonoscopy group (difference, 0.3; 95% confidence interval, -12.5 to 13.0; P = .967). Rebleeding within 30 days of hospital admission occurred in 15.3% of patients in the early colonoscopy group and 6.7% of patients in the elective colonoscopy group (difference, 8.6; 95% confidence interval, -1.4 to 18.7); there were no significant differences between groups in successful endoscopic treatment rate, transfusion rate, length of stay, thrombotic events, or death within 30 days. The adverse event of hemorrhagic shock occurred during bowel preparation in no patient in the early group vs 2 patients (2.5%) in the elective colonoscopy group. CONCLUSIONS: In a randomized controlled study, we found that colonoscopy within 24 hours after hospital admission did not increase SRH or reduce rebleeding compared with colonoscopy at 24-96 hours in patients with ALGIB. ClinicalTrials.gov, Numbers: UMIN000021129 and NCT03098173.


Assuntos
Doenças do Colo/cirurgia , Colonoscopia/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hemorragia Gastrointestinal/cirurgia , Tempo para o Tratamento , Doença Aguda/mortalidade , Doença Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Doenças do Colo/mortalidade , Feminino , Hemorragia Gastrointestinal/mortalidade , Mortalidade Hospitalar , Humanos , Japão , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(51): e18303, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860979

RESUMO

RATIONALE: Aortoesophageal fistula (AEF) is the direct communication between the aorta and esophagus, which can cause fatal hemorrhage, and its incidence increased with the use of an esophageal stent (ES). PATIENT CONCERNS: A 79-year-old man was admitted due to hemodynamic shock with massive hematemesis caused by AEF 1 month after the implantation of an ES. DIAGNOSES: Computed tomography angiography visualized an AEF with an ulcer-like projection on the aortic arch where the ES was placed. Angiography of the aorta revealed extravasation of contrast media from the aortic arch into the stented esophagus, which confirmed the diagnosis. INTERVENTIONS: Thoracic endovascular aortic repair (TEVAR) was performed for massive hematemesis caused by ES-related, AEF but did not solve the underlying problem, leading to the second fatal hemorrhage. LESSONS: TEVAR for the unique treatment of ES-related AEF is feasible in certain cases but may lead to collapse after a specific period.


Assuntos
Doenças da Aorta/complicações , Fístula Esofágica/complicações , Hemorragia Gastrointestinal/etiologia , Implantação de Prótese/efeitos adversos , Stents/efeitos adversos , Fístula Vascular/complicações , Idoso , Doenças da Aorta/etiologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Fístula Esofágica/etiologia , Fístula Esofágica/cirurgia , Evolução Fatal , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Fístula Vascular/etiologia , Fístula Vascular/cirurgia
3.
Braz J Cardiovasc Surg ; 34(5): 630-632, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719016

RESUMO

Heyde syndrome manifests as aortic stenosis associated with gastrointestinal bleeding. We describe the case of a 64-year-old man who came to the emergency room due to acute heart failure and intermittent gastrointestinal bleeding. Treatment involves initial correction of anemia and heart failure followed by aortic valve replacement. The prosthesis used depends on the characteristics of each patient and valve replacement allows the resolution of bleeding in most cases. Gastrointestinal bleeding in patients with aortic stenosis is associated with severity of the valve obstruction. A mechanical prosthesis was used with no recurrent bleeding even with the need for lifelong anticoagulation therapy.


Assuntos
Estenose da Valva Aórtica/cirurgia , Hemorragia Gastrointestinal/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome , Resultado do Tratamento
4.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676053

RESUMO

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Assuntos
Colectomia/métodos , Hemorragia Gastrointestinal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Anastomose Cirúrgica , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Perfuração Intestinal/fisiopatologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Prognóstico , Medição de Risco , Resultado do Tratamento
5.
Rev Med Suisse ; 15(667): 1859-1864, 2019 Oct 16.
Artigo em Francês | MEDLINE | ID: mdl-31617973

RESUMO

Upper gastrointestinal bleeding is an urgent entity associated with a high mortality of about 10 %. Its urgent management includes medical interventions such as volume repletion, blood transfusions, the use of proton pump inhibitors, as well as upper gastrointestinal endoscopy. Whilst the benefit of esophago-gastro-duodenoscopy is clearly demonstrated, the ideal timing for this intervention is less well established. Initial management and pharmacological interventions are important and well-integrated into protocols.


Assuntos
Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirurgia , Transfusão de Sangue , Duodenoscopia , Esofagoscopia , Gastroscopia , Humanos , Inibidores da Bomba de Prótons/uso terapêutico
6.
Cochrane Database Syst Rev ; 9: CD010546, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31550050

RESUMO

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including haemorrhage from oesophageal and gastrointestinal varices. Variceal haemorrhage commonly occurs in children with chronic liver disease or portal vein obstruction. Prevention is therefore important. Following numerous randomised clinical trials demonstrating efficacy of non-selective beta-blockers and endoscopic variceal ligation in decreasing the incidence of variceal haemorrhage, primary prophylaxis of variceal haemorrhage in adults has become the established standard of care. Hence, band ligation and beta-blockers have been proposed to be used as primary prophylaxis of oesophageal variceal bleeding in children. OBJECTIVES: To determine the benefits and harms of band ligation compared with any type of beta-blocker for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (February 2019), CENTRAL (December 2018), PubMed (December 2018), Embase Ovid (December 2018), LILACS (Bireme; January 2019), and Science Citation Index Expanded (Web of Science; December 2018). We scrutinised the reference lists of the retrieved publications and performed a manual search from the main paediatric gastroenterology and hepatology conferences (NASPGHAN and ESPGHAN) abstract books from 2009 to 2018. We searched ClinicalTrials.gov for ongoing clinical trials. There were no language or document type restrictions. SELECTION CRITERIA: We planned to include randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. We planned to also include quasi-randomised and other observational studies retrieved with the searches for randomised clinical trials for report of harm. DATA COLLECTION AND ANALYSIS: We planned to summarise data from randomised clinical trials using standard Cochrane methodologies. MAIN RESULTS: We found no randomised clinical trials assessing band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. AUTHORS' CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis are lacking. There is a need for well-designed, adequately powered randomised clinical trials to assess the benefits and harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. Those randomised clinical trials should include patient-relevant clinical outcomes such as mortality, failure to control bleeding, and adverse events.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/cirurgia , Ligadura/métodos , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Antifibrinolíticos/uso terapêutico , Doença Hepática Terminal/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Veia Porta , Prevenção Primária , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose Venosa/complicações
7.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(4): 452-456, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31484605

RESUMO

To analyze the clinical features and prognosis of ulcerative colitis(UC)complicated with acute massive lower gastrointestinal bleeding(LGIB). Methods Eleven patients hospitalized in Peking Union Medical College Hospital from January 2006 to December 2017 for treatment of UC,suffering from acute massive LGIB,were enrolled and descriptively analyzed. Results The proportion of UC patients with acute massive LGIB was 0.7% among all 1486 UC patients hospitalized during the study period.The disease was moderately or severely active in these 11 patients,among whom 9 patients(81.8%)had chronic relapsing pancolitis.Cytomegalovirus infection was present in 5 patients,among whom 4 patients received antiviral treatments.All the 11 patients received treatments including food and water fasting,rehydration,blood transfusion,and use of somatostatin.Four patients received emergency surgical treatment after the first episode of massive bleeding,and 3 of them suffered from re-bleeding after the surgery.Among the remaining seven patients,two underwent emergency total colectomy+subtotal rectectomy+ileostomy and three received elective total resection of colon and rectum or total colectomy+subtotal rectectomy+ileostomy.Thus,9 patients underwent emergency surgery,1 patient did not receive surgey during follow-up,and 1 patient was lost to follow-up. Conclusions Acute massive LGIB is a manifestation of active UC and can be associated with poor prognosis.Optimized perioperative management is important for improving the outcomes of such patients.


Assuntos
Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Hemorragia Gastrointestinal/complicações , Colectomia , Colite Ulcerativa/cirurgia , Hemorragia Gastrointestinal/cirurgia , Humanos , Ileostomia , Prognóstico
8.
Chirurg ; 90(8): 607-613, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31392464

RESUMO

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (UGIB) has a high mortality. Hematemesis sometimes with melena are the leading clinical symptoms. Peptic ulcers and (erosive) inflammation are common, whereas Mallory-Weiss syndrome, neoplasms, angiodysplasia and diffuse UGIB are less common. PROBLEM: A risk stratification is based on the medical history, clinical presentation and laboratory tests, which are considered in the Glasgow-Blatchford score; however, which treatment approach is optimal? RESULTS: After stabilisation under restricted transfusion indications, temporary stoppage of anticoagulants and optimized coagulation is beneficial and proton pump inhibitors (PPI) should be started. Prokinetics improve the endoscopic conditions in UGIB. The use of an endoscopic Doppler probe optimizes localization of the bleeding site. The use of the Forrest classification and Helicobacter pylori diagnostics are recommended. Mechanical (clips, injection), thermal (argon plasma coagulation, APC) and topical (hemostatic powder) endoscopic treatment procedures are available. Endoluminal hemostasis is very effective. Only clip application is suitable as monotherapy whereas all other endoscopic options should be combined. Angiography followed by transarterial embolization (TAE) can be used for therapy. Despite the high primary success rate, the risk of rebleeding is high. Surgery as the primary treatment is rarely necessary, although effective. Compared to TAE complications are higher, but there is no difference regarding mortality. CONCLUSION: Endoscopy remains the gold standard for the initial diagnostics and treatment of UGIB. In cases of rebleeding repeated endoscopy is recommended. With persistent UGIB an endovascular procedure should be evaluated. Surgery remains an important salvage option.


Assuntos
Hemostase Endoscópica , Anticoagulantes , Transfusão de Sangue , Endoscopia Gastrointestinal , Hemorragia Gastrointestinal/cirurgia , Humanos , Inibidores da Bomba de Prótons
10.
Pediatr Surg Int ; 35(11): 1197-1210, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31300851

RESUMO

PURPOSE: This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed. METHODS: Patients aged ≤ 18 years treated surgically for NVGIB were analysed. RESULTS: Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc99m pertechnetate scan, computed tomography enterography-angiography, and capsule endoscopy; remaining 18% were diagnosed at laparotomy with intra-operative enteroscopy (IOE). Surgical management was tailored to bleed site, severity, and etiology. Indications of IOE and approach to management challenges are detailed. CONCLUSIONS: The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Adolescente , Algoritmos , Falso Aneurisma/complicações , Endoscopia por Cápsula , Criança , Pré-Escolar , Coristoma/complicações , Doença de Crohn/complicações , Úlcera Duodenal/complicações , Feminino , Mucosa Gástrica , Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Gastrointestinais/complicações , Artéria Hepática , Humanos , Lactente , Masculino , Divertículo Ileal/complicações , Compostos Radiofarmacêuticos , Pertecnetato Tc 99m de Sódio , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações
11.
Zhonghua Er Ke Za Zhi ; 57(7): 526-531, 2019 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-31269552

RESUMO

Objective: To investigate the effect of the endoscopic selective varices devascularization (ESVD) for the esophageal gastric varices bleeding (EGVB) in children. Methods: The clinical data of the patients diagnosed with EGVB and treated with ESVD from January 2018 to March 2018 were retrospectively analyzed. The effects, safety and complications of ESVD were evaluated. Results: There were five patients (including 2 males and 3 females, age ranged from 4 to 7 years) in the study. No rebleeding was found at the first follow-up on one week post operation. Three patients were treated with the endo-therapy at the twice follow-up (3 months after surgery): 2 patients had ESVD again and 1 patient had resection under endoscopy due to stenosis caused by surgical scar. After the second procedure, there was no rebleeding but one patient had abdominal pain caused by mesenteric thrombosis, cured with low molecular weight heparin. Conclusion: The ESVD for EGVB is safe and effective, but the long-term curative effect should be further studied.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Esôfago/cirurgia , Hemorragia Gastrointestinal/cirurgia , Veias/cirurgia , Criança , Pré-Escolar , Endoscopia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Esôfago/irrigação sanguínea , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
12.
Chirurgia (Bucur) ; 114(3): 409-413, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264580

RESUMO

Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old male patient who is admitted to the emergency room with the following complaints: upper GI tract bleeding manifested through hematemesis and melena, epigastric pain, lack of bowel movements. A contrast computed tomograohy is performed showing the presence of a hyper-dense stomach content, gastric wall thickening, abdominal fluid but with no signs of intestinal occlusion. A laparotomy is performed and ollowing an anterior gastrotomy a large quantity of pebbles is found along with a hemorrhagic and stenotic tumor of the lesser curvature. Taking into account the intraoperative aspect the decision was made to perform an end-to-side stapled esophago-jejunal anastomosis on an omega loop with a Braun entero-entero anastomosis following total gastric resection and D1 lymphadenectomy. Postoperative course is uneventful. A barium swallow carried out on the 10th day following surgery shows a functional anastomosis without leakage. On day 11, the patient is discharged. Pica is usually discovered by accident, most frequently on the operating table which is why thorough preoperative examination and investigations are required.


Assuntos
Esôfago/cirurgia , Hemorragia Gastrointestinal/etiologia , Jejuno/cirurgia , Pica/complicações , Anastomose Cirúrgica , Gastrectomia , Hemorragia Gastrointestinal/cirurgia , Hematemese/etiologia , Hematemese/cirurgia , Humanos , Masculino , Melena/etiologia , Melena/cirurgia , Pessoa de Meia-Idade , Pica/diagnóstico por imagem , Pica/cirurgia , Estômago/diagnóstico por imagem , Estômago/cirurgia
13.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164378

RESUMO

Type 1 neurofibromatosis (NF1) is a hereditary disorder with an incidence of approximately 1:3000 at birth. Gastrointestinal (GI) lesions occur in approximately one-third of the patients, with most being asymptomatic and diagnosed incidentally. Symptomatic lesions leading to GI bleeding are uncommon. We share our experience of an elderly man with NF1, who presented with massive recurrent GI bleeding secondary to jejunal neurofibromas. The lesions were identified on CT scan of abdomen, and the patient was managed with resection of the involved bowel segment.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Neoplasias do Jejuno/diagnóstico , Neurofibromatose 1/diagnóstico , Idoso , Colonoscopia , Diagnóstico Diferencial , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/cirurgia , Humanos , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Masculino , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia , Recidiva , Tomografia Computadorizada por Raios X
14.
Medicine (Baltimore) ; 98(18): e15464, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045824

RESUMO

There have been few studies comparing percutaneous transhepatic variceal embolization (PTVE) and transjugular intrahepatic portosystemic shunt (TIPS) for the prevention of recurrent gastric variceal bleeding (GVB).Compare the outcomes of these 2 procedures in patients with GVB.A total of 74 cirrhosis patients with GVB who underwent TIPS and modified PTVE were enrolled. The rebleeding and mortality rates, portal vein pressure (PVP) variation, and rates of hepatic encephalopathy (HE) were compared between the 2 groups.A total of 43 PTVE and 31 TIPS patients were enrolled in this study. The difference of rebleeding rate in the 2 groups was not statistically significant (P = .190). The difference of early rebleeding rates and cumulative rebleeding-free rates were all not statistically significant (P = .256, P = .200). The difference of mortality rates in the 2 groups was not statistically significant (χ = 1.206, P = .272). The rate of HE in TIPS group was statistically higher than that in PTVE group (P < .0001).Both PTVE and TIPS were effective for preventing rebleeding of GVs. There were no significant differences in rebleeding and mortality rates. The incidence of HE after TIPS was higher than PTVE.


Assuntos
Embolização Terapêutica/efeitos adversos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Fígado/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Adulto , Idoso , Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Humanos , Incidência , Fígado/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
BMJ Case Rep ; 12(5)2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068354

RESUMO

A 78-year-old man attended for outpatient capsule endoscopy, to investigate a recent history of unexplained small bowel bleeding. His previous medical history included an abdominal aortic aneurysm repair 6 years ago. Soon after capsule ingestion, he experienced sudden onset abdominal pain and collapsed on hospital grounds. He was rapidly transferred to the emergency department as he was haemodynamically unstable, and a significant per rectum (PR) bleed was found on examination. The patient was quickly stabilised following fluid resuscitation. CT angiography was performed which did not show active bleeding. However, use of the real-time capsule viewer indicated a profuse active jejunal bleed originating from the aortic graft, suggestive of an aortoenteric fistula. The patient underwent emergency endovascular cuff placement, and subsequent endovascular abdominal aortic stent grafting, to good effect.


Assuntos
Dor Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Endoscopia por Cápsula/efeitos adversos , Hemorragia Gastrointestinal/diagnóstico por imagem , Fístula Intestinal/patologia , Fístula Vascular/patologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Tratamento de Emergência , Hemorragia Gastrointestinal/patologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Stents , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia , Procedimentos Cirúrgicos Vasculares
16.
Arq Gastroenterol ; 56(1): 22-27, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31141063

RESUMO

BACKGROUND: There are several therapeutic options for symptomatic hemorrhoids, from hygienic and dietary measures to conventional surgery. The best technique adopted for alternative and non-surgical treatment for intermediate grade (II and III) hemorrhoidal disease is rubber band ligation. More recently, the technique has been used with the aid of a gastroscope and a kit of elastic rubber bands for esophageal varices. This technique was called Endoscopic Rubber Band Ligation of hemorrhoids (ERBL). OBJECTIVE: The objective is Compare the results and the incidence of the immediate and late complications in patients undergoing ERBL. The satisfaction with the treatment of patients undergoing different number of rubber band ligatures were also analyzed. METHODS: This is a cohort study included patients undergoing ERBL from 2007 to 2014 at the hospital. The incidence of early and late complications and the satisfaction with the treatment of patients undergoing until two ligatures and patients undergoing three or more ligatures in the same procedure were compared. RESULTS: The study included 116 patients. The most frequently reported symptom was anal bleeding (n=72; 62.1%). The number of rubber band ligatures performed during the ERBL procedure varied from one to six; 84 (72,4%) patients had three or more rubber band ligatures performed during the procedure. No significant associations were observed between the incidence of early or late complications and satisfaction with ERBL among the group subjected until two rubber band ligatures or three or more rubber band ligatures. CONCLUSION: The endoscopic elastic ligation method proved to be a feasible, safe and efficient for the treatment of symptomatic hemorrhoidal disease grades II and III. The technique had moderate rates of immediate and late complications, but most of the complications are considered of low magnitude, easily resolved and without clinical repercussions, no matter how much ligations were performed in the same procedure.


Assuntos
Endoscopia/métodos , Hemorragia Gastrointestinal/cirurgia , Hemorroidas/cirurgia , Ligadura/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorroidas/complicações , Humanos , Ligadura/efeitos adversos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Expert Rev Med Devices ; 16(6): 493-501, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31109217

RESUMO

INTRODUCTION: The most commonly used treatment for advanced colorectal adenomas is endoscopic mucosal resection (EMR). The increased number of EMRs since the introduction of the screening program for colorectal cancer has resulted in an increase in EMR-related complications. This review summarizes the current knowledge for the use of clips for the treatment and prevention of complications after EMR. AREAS COVERED: The historical development of clips is summarized and their properties are evaluated. An overview is presented of the evidence for therapeutic and prophylactic clipping for bleeding or perforation after EMR in the colon. Several clipping techniques are discussed in relation to the efficacy of wound closure. Furthermore, new techniques that will likely influence the use of clips in the future endoscopic practice, such as endoscopic full-thickness resection (eFTR) are also highlighted. EXPERT COMMENTARY: Most research focuses on prophylactic clipping for delayed bleeding after EMR of large adenomas. We advocate a distance of 0.5-1.0 cm between aligning clips. This focus may likely shift from bleeding to perforation. Here, endoscopic treatment with through-the-scope clips and large-diameter clips may well replace surgery. The future role of clips will also depend on the further development of new endoscopic technologies, such as eFTR.


Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/efeitos adversos , Ressecção Endoscópica de Mucosa/efeitos adversos , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Instrumentos Cirúrgicos , Humanos
18.
Khirurgiia (Mosk) ; (4): 30-36, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120444

RESUMO

AIM: To optimize surgical care for the hemorrhagic colorectal cancer. MATERIAL AND METHODS: 77 patients diagnosed with hemorrhagic colorectal cancer were reviewed: 9 patients of them were efficaciously treated with conservative therapy (I group); 47 - underwent successful endoscopic coagulation (I); 4 - arterial embolization (I), 2 - ligation of internal iliac arteries (I), 15 - acute resection (II group). 20 of 62 patients I group underwent plan surgery and radiation or chemotherapy during 7-10 days after hemostasis and normalization hemoglobin. The 3-year cumulative survival after resections (acute versus plan) was plotted on a Kaplan-Meier chart in 31 patients. RESULTS: Complications and postoperative mortality was significantly higher after acute resection (II group) compared with plan resection (I): 33,3% vs 20%; 15% vs 5%, respectively. The survival rate was higher after plan than acute resections: 0,8882 and 0,3571, respectively. CONCLUSION: Acute surgery for hemorrhagic colorectal cancer should only be carried out by appropriately trained surgeons in multi-specialty hospital. Endoscopy and arterial embolization are the most effective means of successfully controlling hemorrhage while minimizing potential complications. A bridging strategy may be a valid alternative in some of patients with hemorrhagic colorectal cancer, because a significantly lower postoperative mortality rate.


Assuntos
Neoplasias Colorretais/cirurgia , Hemorragia Gastrointestinal/terapia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/mortalidade , Embolização Terapêutica , Endoscopia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/cirurgia , Humanos , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 98(21): e15716, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124950

RESUMO

The Glasgow-Blatchford scores (GBS) and Rockall scores (RS) are commonly used for stratifying patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH). Although predictive value of these scoring methods has been extensively validated, their clinical effectiveness remains unclear. The following study evaluated the GBS and RS scoring system with reference to bleeding, needs for further surgery, endoscopic intervention and death, in order to verify their effectiveness and accuracy in clinical application.Patients who presented with NVUGIH, or who were consequently diagnosed with the disease (by endoscopy examination) between January 1, 2008, and December 31, 2012 were enrolled in the study. GBS and RS scores were compared to predict bleeding, the needs for further surgery, endoscopic intervention, death by ROC curves and AUC value.Among 2977 patients, the pre-endoscopic RS and complete RS score (CRS) were superior to the GBS score (AUC: 0.842 vs 0.804 vs 0.622, respectively) for predicting the mortality risk in patients. The pre-endoscopic RS score predicting re-bleeding was significantly higher than the CRS and the GBS score (AUC: 0.658 vs 0.548 vs 0.528, respectively). In addition, the 3 scoring systems revealed to be poor predictors of surgical operation effectiveness (AUC: 0.589 vs 0.547 vs 0.504, respectively).Our data demonstrated that the GBS and RS scoring systems could be used to predict outcomes in patients with nonvariceal upper gastrointestinal bleeding.


Assuntos
Hemorragia Gastrointestinal/patologia , Índice de Gravidade de Doença , Adulto , Fatores Etários , Idoso , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Curva ROC , Medição de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA