No abstract available.
Acute Disease ; *Emergency Service, Hospital ; *Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/*diagnosis/mortality/therapy ; Humans ; Prognosis ; Risk Factors ; Time Factors ; Treatment Outcome

Transjugular intrahepatic portosystemic shunt (TIPSS) is a promising method of treatment for gastric or esophageal variceal bleeding. This study was performed to determine the prognostic factors contributing to the survival of patients after TIPSS for gastric or esophageal variceal bleeding. One hundred and fifty-five patients who underwent TIPSS between September 1991 and March 2001 were followed up by clinical examination, upper gastrointestinal endoscopy, and Duplex sonography. The mean portohepatic pressure gradient prior to TIPSS was 20.5 +/-9.93 mmHg and dropped to 10.7 +/-6.62 mmHg after TIPSS (p<0.001). The cumulative survival rate was 75.1% at 6 months, 66.6% at 1 yr, 58.4% at 2 yr, and 38.1% at 5 yr. Survival after TIPSS was inversely related to the Child-Pugh classification (p<0.05). The rebleeding rate was 18.3% at 6 months, 21.0% at 1 yr, 32.8% at 2 yr, and 53.1% at 5 yr. The causes of deaths were hepatic failure (53.5%), recurrent variceal bleeding (11.6%), pneumonia (4.6%), sepsis (3.5%), hepatic encephalopathy (2.3%), and unknown (17.4%). Multivariate analysis (Cox proportional hazard model) revealed that the Child-Pugh classification and age were statistically significant independent prognostic factors. In conclusion, TIPSS is an effective method of treatment for variceal bleeding in cases where other treatment modalities including endoscopic therapy are unsuccessful and the most important prognostic factors are preprocedural hepatic reserve (Child-Pugh class) and age.
Adolescent ; Adult ; Endoscopy ; Female ; Fibrosis/diagnosis ; Follow-Up Studies ; Gastrointestinal Hemorrhage/*diagnosis/*mortality/*therapy ; Humans ; Male ; Middle Aged ; *Portasystemic Shunt, Transjugular Intrahepatic ; Prognosis ; Recurrence ; Time Factors ; Treatment Outcome

OBJECTIVETo explore early diagnosis, treatment and prevention of gastrointestinal (GI) bleeding after cardiac surgery.

METHODSIn the last 13 years, cases complicated with GI bleeding after cardiac surgeries were analyzed retrospectively.

RESULTSFourty-four GI bleeding occurred post-operatively in (6 +/- 3) d. The mortality was 23% (10/44). Thirty-eight were located in upper GI tract, of them 26 underwent conservative therapy while 4 died of other than GI bleeding cause; six underwent laparotomy while 1 and 3 died of septicemia and multi-organ failure respectively; six underwent gastric endoscopic hemostasis by electrocautery or clipping the bleeding vessel while all survived. Six were located in lower GI tract, and 2 of them underwent laparotomy without finding bleeding section and died of multi-organ failure. By multivariable logistic regression analysis, deaths were highly related to the post-operative ventilator-dependence, acute renal insufficiency, intra-aortic balloon pump (IABP) assisting and laparotomy.

CONCLUSIONThe mortality of GI bleeding after cardiac surgeries is very high, early gastrointestinal endoscopic examination and minimally invasive intervention can treat this complication more effectively. GI bleeding must be prevented whenever complicating post-operative ventilator-dependence, acute renal insufficiency, and IABP assisting after cardiac surgery.

Adult ; Aged ; Cardiac Surgical Procedures ; adverse effects ; Early Diagnosis ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; mortality ; therapy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Factors

Mesenteric venous thrombosis has a low prevalence and nonspecific clinical symptoms, and it may cause bowel infarction and death. Early diagnosis and prompt surgical intervention with anticoagulants are important to patients. We examined a 27-year-old woman complaining of diffuse abdominal pain and hematochezia, and diagnosed extensive mesenteric venous thrombosis with intestinal infarction and pulmonary thromboembolism. In light of the patient's symptoms, an operation seemed necessary. However, because of the high risk of mortality, we decided to look for another option. The patient was successfully treated with intensive medical care and a radiological procedure in spite of intestinal infarction.
Abdominal Pain ; Adult ; Anticoagulants ; Early Diagnosis ; Female ; Gastrointestinal Hemorrhage ; Humans ; Infarction ; Mesenteric Ischemia ; Mesenteric Vascular Occlusion ; Mortality ; Prevalence ; Pulmonary Embolism ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator

BACKGROUND/AIMS: Gastrointestinal endoscopy is imperative for acute upper gastrointestinal bleeding (AUGIB) to find bleeding focus and stop bleeding. This study was designed to assess the necessity of emergency endoscopy and determine screening criteria for the patients who presented to emergency room (ER) with after-hours AUGIB. METHODS: The medical records of 383 patents with AUGIB who presented to ER at after-hours were reviewed. Patients were divided into 2 groups: emergency endoscopy (EE) group (<12 hours after arrival) or delayed endoscopy (DE) group (12-24 hours after arrival). We compared the severity, hemostatic procedures, rebleeding rate, length of hospitalization and 30-day mortality between the two groups. RESULTS: Ninety-eight patients in EE group and 137 patients in DE group were evaluated among patients with non-variceal upper gastrointestinal bleeding. No significant differences in clinical severity, finding the bleeding focus, hemostasis, 30-day mortality, hospital stay, and rebleeding rate were observed between the two groups. Among 148 patients with variceal upper gastrointestinal bleeding, 65 patients were in EE group and 83 patients in DE group. Most clinical severity index were not different between the groups. In EE group, the rate of finding bleeding foci was lower (p=0.043), and 30-day mortality was higher than in DE group (p=0.023). CONCLUSIONS: Emergency endoscopy within 12 hours after arrival at after-hours do not lead to better prognosis in AUGIB.
Acute Disease ; Adult ; Aged ; Clinical Competence ; *Emergency Service, Hospital ; *Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage/*diagnosis/mortality/therapy ; Humans ; Length of Stay ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: To evaluate the long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (NBC; Histoacryl) for treatment of bleeding gastric varices. METHODS: We retrospectively analyzed the records of 455 patients with gastric variceal hemorrhage (GVH) who were consecutively treated with NBC from January 2004 to July 2013, with a mean follow-up period of 582 days. The patients' endoscopic findings, initial hemostasis, complications, rebleeding rates, and bleeding-related death rates were reviewed. RESULTS: Hemostasis was achieved initially in 96.9% (441/455) of patients; rebleeding occurred in 35.2% (160/455), and the bleeding-related death rate was 6.8% (31/455) during follow-up. Complications included fever (6.8%), abdominal pain (3.7%), diarrhea (1.3%), spontaneous bacterial peritonitis (0.7%), bacteremia (0.4%), and embolism (0.2%). A red-color sign on concomitant esophageal varices (EVs) (p = 0.002) and previous history of variceal bleeding (p < 0.001) were significant risk factors for rebleeding within 1 year. The Child-Pugh score (p < 0.001), presence of hepatocellular carcinoma (p = 0.001), and failure of initial hemostasis (p < 0.001) were the risk factors most closely associated with bleeding-related death. CONCLUSIONS: This study provides a comprehensive overview of the outcomes and prognostic factors of patients with GVH. The results may help in the selection of effective treatment strategies for patients with GVH.
Adult ; Aged ; Aged, 80 and over ; Enbucrilate/adverse effects/*therapeutic use ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/diagnosis/mortality/*therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology/mortality/*therapy ; *Hemostatic Techniques/adverse effects/mortality ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

BACKGROUND: Small bowel tumors are relatively uncommon, accounting for only 3 to 6% of all gastrointestinal tumors. Their infrequency and the lack of specific symptoms can result in delayed diagnosis and poor prognosis. The purpose of this study was to find a relationship between the pathology and the clinical features of primary tumors of the jejunum and the ileum. METHODS: We analyzed the clinicopathological findings of 28 patients with primary tumors of the jejunum and the ileum who had undergone surgery at the Department of Surgery, Asan Medical Center, between June 1989 and December 1997. RESULTS: Among the 28 patients, there were 20 men and 8 women. The mean age was 54 years (13-76 years). The tumors consisted of 10 malignant gastrointestinal stromal tumors (GISTs), 7 lymphomas, 6 benign GISTs, 3 adenocarcinomas, and 2 lipomas. The clinical symptoms of these patients were abdominal pain (54%), GI bleeding (32%), nausea & vomiting (14%), weight loss (14%), palpation of abdominal mass (11%), and dizziness (11%). The preoperative complications were bleeding (32%), perforation (18%), intussusception (11%), and obstruction (7%). Bleeding was found in GISTs only and was more frequent in benign GISTs(100%) than in malignant GISTs (30%). Perforation was found in malignant tumors only (25%). Among the 20 patients with malignant tumors, chemotherapy was done in 13, and the 2-year survival rate was 75%. CONCLUSIONS: Early diagnosis of small bowel tumors is essential to prevent complications such as bleeding and perforation and to reduce mortality. Early diagnosis and surgery seem to be indispensable to a good outcome in symptomatic patients.
Abdominal Pain ; Adenocarcinoma ; Chungcheongnam-do ; Delayed Diagnosis ; Dizziness ; Drug Therapy ; Early Diagnosis ; Female ; Gastrointestinal Stromal Tumors ; Hemorrhage ; Humans ; Ileum* ; Intussusception ; Jejunum* ; Lipoma ; Lymphoma ; Male ; Mortality ; Nausea ; Palpation ; Pathology ; Prognosis ; Survival Rate ; Vomiting ; Weight Loss

BACKGROUND/AIMS: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common medical emergency that can be life threatening. This study evaluated predictive factors of 30-day mortality in patients with this condition. METHODS: A prospective observational study was conducted at a single hospital between April 2010 and November 2012, and 336 patients with symptoms and signs of gastrointestinal bleeding were consecutively enrolled. Clinical characteristics and endoscopic findings were reviewed to identify potential factors associated with 30-day mortality. RESULTS: Overall, 184 patients were included in the study (men, 79.3%; mean age, 59.81 years), and 16 patients died within 30 days (8.7%). Multivariate analyses revealed that comorbidity of diabetes mellitus (DM) or metastatic malignancy, age > or = 65 years, and hypotension (systolic pressure < 90 mmHg) during hospitalization were significant predictive factors of 30-day mortality. CONCLUSIONS: Comorbidity of DM or metastatic malignancy, age > or = 65 years, and hemodynamic instability during hospitalization were predictors of 30-day mortality in patients with NVUGIB. These results will help guide the management of patients with this condition.
Adult ; Age Factors ; Aged ; Chi-Square Distribution ; Comorbidity ; Diabetes Mellitus/mortality ; Endoscopy, Gastrointestinal ; Female ; Gastrointestinal Hemorrhage/diagnosis/*mortality/physiopathology/therapy ; Hemodynamics ; Hospital Mortality ; Hospitalization ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Metastasis ; Odds Ratio ; Predictive Value of Tests ; Prospective Studies ; Republic of Korea ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: To evaluate the efficacy of proton pump inhibitors (PPIs) in reducing rebleeding and bleeding-related death rates after endoscopic gastric variceal obliteration (GVO) using N-butyl-2-cyanoacrylate (NBC). METHODS: This study enrolled 341 patients who were consecutively diagnosed with and treated for bleeding gastric varices. The patients were divided into PPI and non-PPI groups, and their endoscopic findings, initial hemostasis outcomes, rebleeding and bleeding-related death rates, and treatment-related complications were analyzed. RESULTS: The rate of initial hemostasis was 97.1%. rebleeding occurred in 2.2% of patients within 2 weeks, 3.9% of patients within 4 weeks, 18.9% of patients within 6 months, and 27.6% of patients within 12 months of the GVO procedure. A previous history of variceal bleeding (relative risk [RR], 1.955; 95% confidence interval [CI], 1.263 to 3.028; p = 0.003) and use of PPIs (RR, 0.554; 95% CI, 0.352 to 0.873; p = 0.011) were associated with rebleeding. Child-Pugh class C (RR, 10.914; 95% CI, 4.032 to 29.541; p < 0.001), failure of initial hemostasis (RR, 13.329; 95% CI, 2.795 to 63.556; p = 0.001), and the presence of red-colored concomitant esophageal varices (RR, 4.096; 95% CI, 1.320 to 12.713; p = 0.015) were associated with bleeding-related death. CONCLUSIONS: The prophylactic use of PPIs reduces rebleeding after GVO using NBC in patients with gastric variceal hemorrhage. However, prophylactic use of PPIs does not reduce bleeding-related death.
Adult ; Aged ; Aged, 80 and over ; Chi-Square Distribution ; Enbucrilate/*administration & dosage/adverse effects ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/complications/diagnosis/mortality/*therapy ; Female ; Gastrointestinal Hemorrhage/diagnosis/etiology/mortality/*therapy ; Hemostasis, Endoscopic/adverse effects/*methods/mortality ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Proton Pump Inhibitors/adverse effects/*therapeutic use ; Recurrence ; Retrospective Studies ; Risk Factors ; Sclerosing Solutions/*administration & dosage/adverse effects ; Sclerotherapy/adverse effects/*methods/mortality ; Time Factors ; Treatment Outcome ; Young Adult

BACKGROUND/AIMS: Acute upper gastrointestinal bleeding (UGIB) is still responsible for significant morbidity in spite of various therapeutic advances. The aims of this study were to evaluate the success rate in managing UGIB and predicting factors that affected clinical courses. METHODS: From August 2003 to April 2005, medical data (registered in a standard database categories) of 318 patients who underwent endoscopic examination to evaluate UGIB were analyzed. Early and final treatment success rates were evaluated on the next day and 14 days after the initial endoscopic procedures respectively (or the day of discharge). RESULTS: Main causes of UGIB were peptic ulcer (50.9%), varices (28.3%), Mallory-Weiss syndrome (10.3%). Endoscopic treatments were tried in 200 patients (63.0%). Number of patients who underwent operation and deaths were 4 (1.3%) and 13 (4.1%), respectively. Early and final success rates were 86.2% and 94.0%. Independent prognostic factors related with early success rates were volume of transfusion (OR 0.80, 95% CI 0.72-0.89, p<0.001) and bleeding during the ventilator care (OR 0.03, 95% CI 0.01-0.31, p<0.001), whereas those factors related with final success rates were volume of transfusion (OR 0.79, 95% CI 0.69-0.90, p<0.001), bleeding during the stay in intensive care unit (ICU) (OR 0.12, 95% CI 0.13-0.49, p<0.001). CONCLUSIONS: Early and final success rates of bleeding control were 86.2% and 94.0% in acute UGIB. Volume of transfusion, bleeding during ICU state or ventilator state were important predictive factors of the treatment failure.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Transfusion ; Data Interpretation, Statistical ; Demography ; Esophageal and Gastric Varices/*diagnosis/therapy ; Female ; Gastrointestinal Hemorrhage/*diagnosis/mortality/therapy ; Humans ; Male ; Mallory-Weiss Syndrome/*diagnosis/therapy ; Middle Aged ; Peptic Ulcer/*diagnosis/therapy ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Treatment Outcome