Endoscopic polypectomy was firstly introduced by Tsuneoka in 1969, and till now this method has been widely used for the treatment of benign and malignant polyps with the advent of technical improvement. This method is a very important modality as secondary prevention of malignancy because polyps in gastraintestinal tract are now being considered as precancerous lesion. Polypectomy with snare and electrocautery is mainly used for pedunclated polyps (eg. Yamada Class III, IV), but sessile polyps pose technical difficulty and occasionally cause serious gastrointestinal hemorrhage when resection margin adjacent polyp base. We performed polypectomy with "O"-ring used in endocopic variceal ligation (EVL) to make sessile polyp as semipedunclated form, and also to control bleeding, and then successfully remove it with conventional snare polypectomy. We report these 5 cases with the review of the literature.
Electrocoagulation ; Gastrointestinal Hemorrhage ; Hemorrhage ; Ligation* ; Polyps ; Secondary Prevention ; SNARE Proteins

Esophageal and Gastric Varices ; complications ; prevention & control ; surgery ; Gastrointestinal Hemorrhage ; complications ; prevention & control ; surgery ; Humans

Adhesiveness ; Gastrointestinal Hemorrhage ; prevention & control ; surgery ; Hand ; Humans ; Surgical Instruments ; Surgical Procedures, Operative ; methods

Gastrointestinal Hemorrhage ; drug therapy ; etiology ; prevention & control ; Humans ; Hypertension, Portal ; complications

Gastric acid suppressants, such as proton pump inhibitors, are one of the most widey used drugs worldwide. There is a very high frequency of abuse of gastric acid suppressants, leading huge waste of medical resources. Moreover, numerous studies have showed that acid suppressants were associated with a variety of adverse events, such as fractures and intestinal infections. Increasing guidelines and consensuses have been made to guide the appropriate use of acid suppressants. Gastrointestinal surgery is one of the fields with the largest prescriptions of acid suppressants. Acid suppressants are widely used for preventing anastomotic bleeding after upper gastrointestinal surgery, treating gastrointestinal bleeding and etc. However, most of these prescriptions are off-label uses lacking adequate evidentiary basis. Thus far, there is no guideline specific for appropriate use of acid suppressants in digestive surgeries. Therefore, Chinese Society of Upper Gastrointestinal Surgeons (CSUGS) and Chinese Gastric Cancer Association (CGCA) developed this clinical practice guideline based on the best research evidence and clinical expertise. The aim is to guide the appropriate use of gastric acid suppressants in gastrointestinal surgery, which in turn, increase the benefits of patients.
Humans ; Digestive System Surgical Procedures ; Gastric Acid ; Gastrointestinal Hemorrhage/prevention & control* ; Proton Pump Inhibitors/therapeutic use*

OBJECTIVE: To compare the expected population impact of benefit and risk of aspirin treatment strategies for the primary prevention of cardiovascular diseases recommended by different guidelines in the Chinese Electronic Health Records Research in Yinzhou (CHERRY) study. METHODS: A decision-analytic Markov model was used to simulate and compare different strategies of aspirin treatment, including: Strategy ①: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk, recommended by the 2020 Chinese Guideline on the Primary Prevention of Cardiovascular Diseases; Strategy ②: Aspirin treatment for Chinese adults aged 40-59 years with a high 10-year cardiovascular risk, recommended by the 2022 United States Preventive Services Task Force Recommendation Statement on Aspirin Use to Prevent Cardiovascular Disease; Strategy ③: Aspirin treatment for Chinese adults aged 40-69 years with a high 10-year cardiovascular risk and blood pressure well-controlled (< 150/90 mmHg), recommended by the 2019 Guideline on the Assessment and Management of Cardio-vascular Risk in China. The high 10-year cardiovascular risk was defined as the 10-year predicted risk over 10% based on the 2019 World Health Organization non-laboratory model. The Markov model simulated different strategies for ten years (cycles) with parameters mainly from the CHERRY study or published literature. Quality-adjusted life year (QALY) and the number needed to treat (NNT) for each ischemic event (including myocardial infarction and ischemic stroke) were calculated to assess the effectiveness of the different strategies. The number needed to harm (NNH) for each bleeding event (including hemorrhagic stroke and gastrointestinal bleeding) was calculated to assess the safety. The NNT for each net benefit (i.e., the difference of the number of ischemic events could be prevented and the number of bleeding events would be added) was also calculated. One-way sensitivity analysis on the uncertainty of the incidence rate of cardiovascular diseases and probabilistic sensitivity analysis on the uncertainty of hazard ratios of interventions were conducted. RESULTS: A total of 212 153 Chinese adults, were included in this study. The number of people who were recommended for aspirin treatment Strategies ①-③ was 34 235, 2 813, and 25 111, respectively. The Strategy ③ could gain the most QALY of 403 [95% uncertainty interval (UI): 222-511] years. Compared with Strategy ①, Strategy ③ had similar efficiency but better safety, with the extra NNT of 4 (95%UI: 3-4) and NNH of 39 (95%UI: 19-132). The NNT per net benefit was 131 (95%UI: 102-239) for Strategy ①, 256 (95%UI: 181-737) for Strategy ②, and 132 (95%UI: 104-232) for Strategy ③, making Strategy ③ the most favorable option with a better QALY and safety, along with similar efficiency in terms of net benefit. The results were consistent in the sensitivity analyses. CONCLUSION The aspirin treatment strategies recommended by the updated guidelines on the primary prevention of cardiovascular diseases showed a net benefit for high-risk Chinese adults from developed areas. However, to balance effectiveness and safety, aspirin is suggested to be used for primary prevention of cardiovascular diseases with consideration for blood pressure control, resulting in better intervention efficiency.
Adult ; Humans ; Aspirin/therapeutic use* ; Cardiovascular Diseases/epidemiology* ; Gastrointestinal Hemorrhage ; Myocardial Infarction/prevention & control* ; Primary Prevention/methods* ; Middle Aged ; Aged

OBJECTIVETo investigate the causes and treatment of postoperative gastrointestinal bleeding after orthotopic liver transplantation (OLT).

METHODSClinical data of 776 patients after OLT between January 2000 and December 2006 were analyzed retrospectively.The experiences in diagnosis and treatment of postoperative gastrointestinal bleeding after OLT were reviewed.

RESULTSGastrointestinal bleeding occurred in 18 patients (2.3%) after OLT, among whom 8 (44.5%) were from peptic ulcer, 3 (16.7%) from gastric and esophageal varices, 3 (16.7%) from gastroduodenitis, 3 (16.7%) from hemobilia, and 1 (5.6%) had diverticular bleeding in the jejunum. These 18 patients with gastrointestinal bleeding were managed with conservative treatment, endoscopic treatment, radiological interventional embolism,or exploratory laparotomy. Five patients died of gastrointestinal bleeding and the gastrointestinal bleeding-related mortality rate was 27.8%. After a mean follow up of 3.5 years, only 1 patient died of recurrence of hepatic cellular carcinoma while others survived disease-free.

CONCLUSIONSGastrointestinal bleeding may occur from different sites after OLT and the mortality is high. Prompt identification of the source of bleeding and correct management are required to improve the prognosis.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Gastrointestinal Hemorrhage ; etiology ; prevention & control ; Humans ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Postoperative Hemorrhage ; prevention & control ; Retrospective Studies ; Young Adult

BACKGROUND: Portosystemic shunts, including surgical portosystemic shunts and transjugular intra-hepatic portosystemic shunt (TIPS), may have benefit over endoscopic therapy (ET) for treatment of variceal bleeding in patients with cirrhotic portal hypertension; however, whether there being a survival benefit among them remains unclear. This study was to compare the effect of three above-mentioned therapies on the short-term and long-term survival in patient with cirrhosis. METHODS: Using the terms "variceal hemorrhage or variceal bleeding or variceal re-bleeding" OR "esophageal and gastric varices" OR "portal hypertension" and "liver cirrhosis," the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the references of identified trials were searched for human randomized controlled trials (RCTs) published in any language with full texts or abstracts (last search June 2017). Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated using random effects model by Review Manager. The quality of the included studies was evaluated using the Cochrane Collaboration's tool for the assessment of the risk of bias. RESULTS: Twenty-six publications comprising 28 RCTs were included in this analysis. These studies included a total of 2845 patients: 496 (4 RCTs) underwent either surgical portosystemic shunts or TIPS, 1244 (9 RCTs) underwent either surgical portosystemic shunts or ET, and 1105 (15 RCTs) underwent either TIPS or ET. There was no significant difference in overall mortality and 30-day or 6-week survival among three interventions. Compared with TIPS and ET, separately, surgical portosystemic shunts were both associated with a lower bleeding-related mortality (RR = 0.07, 95% CI = 0.01-0.32; P < 0.001; RR = 0.17, 95% CI = 0.06-0.51, P < 0.005) and rate of variceal re-bleeding (RR = 0.23, 95% CI = 0.10-0.51, P < 0.001; RR = 0.10, 95% CI = 0.04-0.24, P < 0.001), without a significant difference in the rate of postoperative hepatic encephalopathy (RR = 0.52, 95% CI = 0.25-1.00, P = 0.14; RR = 1.09, 95% CI = 0.59-2.01, P = 0.78). TIPS showed a trend toward lower variceal re-bleeding (RR = 0.46, 95% CI = 0.36-0.58, P < 0.001), but a higher incidence of hepatic encephalopathy than ET (RR = 1.78, 95% CI = 1.34-2.36, P < 0.001). CONCLUSIONS The overall analysis revealed that there seem to be no short-term and long-term survival advantage, but surgical portosystemic shunts are with the lowest bleeding-related mortality among the three therapies. Surgical portosystemic shunts may be the most effective without an increased risk of hepatic encephalopathy and TIPS is superior to ET but at the cost of a higher incidence of hepatic encephalopathy. However, some of findings should be interpreted with caution due to the lower level of evidence and the existence of significant heterogeneity.
Confidence Intervals ; Esophageal and Gastric Varices ; pathology ; Gastrointestinal Hemorrhage ; prevention & control ; Humans ; Portasystemic Shunt, Transjugular Intrahepatic ; Randomized Controlled Trials as Topic

No abstract available.
Aspirin/*adverse effects/therapeutic use ; Cardiovascular Diseases/prevention & control ; Drug Therapy, Combination ; Drug-Eluting Stents ; Endoscopy, Gastrointestinal ; Gastrointestinal Hemorrhage/*chemically induced/mortality/prevention & control ; Humans ; Platelet Aggregation Inhibitors/*adverse effects/therapeutic use ; Risk Factors ; Ticlopidine/analogs & derivatives/therapeutic use

Endoscopic submucosal dissection (ESD) has been reported to have a higher bleeding rate than conventional methods. However, there are few reports on whether a proton pump inhibitor or a histamine2-receptor antagonist is the more effective treatment for preventing bleeding after ESD. In a prospective trial, patients undergoing ESD due to gastric adenoma or adenocarcinoma were randomly assigned to pantoprazole or famotidine. Both drugs were given intravenously for the first 2 days, thereafter by mouth. Eighty-five in the pantoprazole group and 79 in the famotidine group were included for analysis. Primary outcome measure was the delayed bleeding rate. Clinical characteristics were not different between the two groups. The delayed bleeding rate was significantly lower in the pantoprazole group compared with the famotidine group (3.5% vs. 12.7%, p=0.031). On multivariate analysis, the preventive use of pantoprazole (relative hazard: 0.220, 95% CI: 0.051- 0.827, p=0.026) and the specimen size (> or =34 mm, relative hazard: 4.178, 95% CI: 1.229-14.197, p=0.022) were two independent factors predictive of delayed bleeding. There were no significant differences in en bloc and complete resection rate between the two groups. In conclusion, pantoprazole is more effective than famotidine for the prevention of delayed bleeding after ESD.
2-Pyridinylmethylsulfinylbenzimidazoles/*therapeutic use ; Aged ; Anti-Ulcer Agents/*therapeutic use ; Dissection ; Famotidine/*therapeutic use ; Female ; Gastric Mucosa/*surgery ; Gastrointestinal Hemorrhage/*prevention & control ; *Gastroscopy ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage/*prevention & control ; Prospective Studies ; Single-Blind Method ; Stomach Neoplasms/*surgery