Bleeding from gastric varices is generally more severe than bleeding from esophageal varices, although it occurs less frequently. Recently, new endoscopic treatment options and interventional radiological procedures have broadened the therapeutic armamentarium for gastric varices. This review provides an overview of the classification and pathophysiology of gastric varices, an introduction to current endoscopic and interventional radiological management options for gastric varices, and details of a practical approach to endoscopic variceal obturation using N-butyl-2-cyanoacrylate.
Enbucrilate/*therapeutic use ; Endoscopy, Gastrointestinal/*methods ; Esophageal and Gastric Varices/*diagnosis/physiopathology/*therapy ; Gastrointestinal Hemorrhage/*diagnosis/physiopathology/*therapy ; Hemostasis, Endoscopic/*methods ; Humans ; Sclerotherapy/methods

Acute Kidney Injury ; blood ; etiology ; therapy ; Anti-Retroviral Agents ; administration & dosage ; CD4 Lymphocyte Count ; Disease Progression ; Embolization, Therapeutic ; methods ; Fatal Outcome ; Gastrointestinal Hemorrhage ; diagnostic imaging ; etiology ; physiopathology ; therapy ; Glucocorticoids ; administration & dosage ; HIV Infections ; complications ; diagnosis ; immunology ; HIV-1 ; drug effects ; isolation & purification ; Humans ; Male ; Middle Aged ; Purpura, Schoenlein-Henoch ; complications ; diagnosis ; physiopathology ; Radiography ; Renal Dialysis ; methods

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery

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

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.
Anastomosis, Surgical ; adverse effects ; Anticoagulants ; therapeutic use ; Bariatric Surgery ; adverse effects ; Catheterization ; China ; Conservative Treatment ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Endoscopy, Gastrointestinal ; methods ; Extracorporeal Membrane Oxygenation ; Gastrectomy ; adverse effects ; Gastric Bypass ; adverse effects ; Gastric Mucosa ; pathology ; Gastric Stump ; physiopathology ; surgery ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; surgery ; Hemostasis, Surgical ; adverse effects ; methods ; Hemostatic Techniques ; Heparin ; therapeutic use ; Humans ; Intermittent Pneumatic Compression Devices ; Intestine, Small ; pathology ; Laparoscopy ; adverse effects ; Margins of Excision ; Peptic Ulcer ; etiology ; therapy ; Postoperative Complications ; diagnosis ; prevention & control ; therapy ; Pulmonary Embolism ; etiology ; therapy ; Stents ; Stockings, Compression ; Thrombectomy ; Thrombolytic Therapy ; Venous Thrombosis ; etiology ; prevention & control ; therapy