Clinical Medicine Insights. Gastroenterology最新文献

{"title":"Successful Endoscopic Treatment of Post-esophagectomy Refractory Reflux Using OverStitch: The First Clinical Case.","authors":"Hirotsugu Nagase,&nbsp;Makoto Yamasaki,&nbsp;Yoshitomo Yanagimoto,&nbsp;Takashi Kanemura,&nbsp;Shigeyoshi Higashi,&nbsp;Kota Momose,&nbsp;Ryo Kato,&nbsp;Yasuhiro Miyazaki,&nbsp;Tomoki Makino,&nbsp;Tsuyoshi Takahashi,&nbsp;Yukinori Kurokawa,&nbsp;Hiroshi Miyata,&nbsp;Shuji Takiguchi,&nbsp;Masaki Mori,&nbsp;Yuichiro Doki,&nbsp;Kiyokazu Nakajima","doi":"10.1177/1179552218784946","DOIUrl":"https://doi.org/10.1177/1179552218784946","url":null,"abstract":"<p><strong>Aims: </strong>The reflux of duodeno-gastric contents into the remnant esophagus (gastric tube-esophageal reflux: GTER) is a significant issues in long-term esophageal cancer survivors after radical esophagectomy. We attempted endoscopic valve (funnel) creation for prevention for GTER using OverStitch endoscopic suturing system.</p><p><strong>Methods: </strong>The OverStitch was mounted onto a standard double-channel endoscope. Under general anesthesia, the funnel creation was attempted by placing semi-full thickness sutures on the gastric wall, at 3 cm distal to the primary esophago-gastric anastomosis. The postoperative outcomes were also evaluated.</p><p><strong>Results: </strong>In total, 4 sutures were needed and the operating time was 62 minutes without complication. The endoscopic and swallowing studies, as well as pH profile, were all improved postoperatively. The patient's quality of life was dramatically improved with complete disappearance of night-time reflux in spine position.</p><p><strong>Conclusions: </strong>Endoscopic antireflux funnel creation was feasible and safe. This procedure may become a useful treatment for patients with severe GTER after esophagectomy.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":" ","pages":"1179552218784946"},"PeriodicalIF":0.0,"publicationDate":"2018-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552218784946","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36317715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Acute Severe Hepatotoxicity and Mild Constriction of Common Bile Duct Associated With Ingestion of Green Tea Extract: A Clinical Challenge.","authors":"Balarama Krishna Surapaneni,&nbsp;Michelle Le,&nbsp;Julian Jakobovits,&nbsp;Rakesh Vinayek,&nbsp;Sudhir Dutta","doi":"10.1177/1179552218779970","DOIUrl":"https://doi.org/10.1177/1179552218779970","url":null,"abstract":"<p><p>Consumption of herbal and dietary supplements (HDS) has increased worldwide as potential treatment for weight reduction and metabolic enhancement. However, it has been reported that HDS can cause liver injury which accounts for 20% of hepatotoxicity in the United States. Prevention of HDS induced liver injury remains a challenge due to difficulties in identifying the hepatotoxins in these preparations and lack of federal regulations for dietary supplements. We report a case of acute severe hepatic necrosis presumably due to consumption of nutritional supplement advertised to boost vitality and stem cells in human body.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":" ","pages":"1179552218779970"},"PeriodicalIF":0.0,"publicationDate":"2018-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552218779970","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36352358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal Lesions in African American Patients With Iron Deficiency Anemia.","authors":"Hassan Brim,&nbsp;Anahita Shahnazi,&nbsp;Mehdi Nouraie,&nbsp;Dilhana Badurdeen,&nbsp;Adeyinka O Laiyemo,&nbsp;Tahmineh Haidary,&nbsp;Ali Afsari,&nbsp;Hassan Ashktorab","doi":"10.1177/1179552218778627","DOIUrl":"https://doi.org/10.1177/1179552218778627","url":null,"abstract":"<p><strong>Background: </strong>Iron deficiency anemia (IDA) is a frequent disorder that is associated with many serious diseases. However, the findings of an evaluation of IDA-associated gastrointestinal disorders are lacking among African American patients.</p><p><strong>Aim: </strong>To determine the most prevalent gastrointestinal lesions among African American patients with IDA especially in young men.</p><p><strong>Methods: </strong>We reviewed medical records (n = 422) of patients referred for evaluation of IDA from 2008 to 2012. Iron deficiency anemia was diagnosed using clinical laboratory tests. The results of <i>esophagogastroduodenoscopy</i>, colonoscopy, and pathology specimens along with demographic data were abstracted and analyzed using Stata.</p><p><strong>Results: </strong>The mean age was 61.9 years, and 50.5% were women. In total, 189 patients (45%) had gross gastrointestinal (GI) bleeding. The most frequent diagnoses were gastritis (40%), benign colonic lesions (13%), esophagitis (9%), gastric ulcer (6%), and duodenitis (6%). GI bleeding was significantly more frequent in men (<i>P</i> = 0.001). Benign and malignant colonic lesions were significantly more present among older patients: 16% vs 6% (<i>P</i> = .005) and 5% vs 0% (<i>P</i> = .008), respectively. Colitis was more prevalent in younger patients (⩽50): 11% vs 2% (<i>P</i> = .001). In patients with gross lower GI bleeding, the top diagnoses were gastritis (25%), benign colon tumors (10%), and duodenitis (6%). Colon cancer was diagnosed among 15 patients, and all these patients were older than 50 years of age.</p><p><strong>Conclusions: </strong>Gastritis and colonic lesions are most common associated lesions with IDA among African Americans. So bidirectional endoscopy is required for unrevealing of the cause of IDA in asymptomatic patients.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":" ","pages":"1179552218778627"},"PeriodicalIF":0.0,"publicationDate":"2018-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552218778627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36127655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orbital Inflammatory Complications of Crohn's Disease: A Rare Case Series.","authors":"Tanya M Monaghan,&nbsp;Giorgio Albanese,&nbsp;Philip Kaye,&nbsp;James D Thomas,&nbsp;Lorraine C Abercrombie,&nbsp;Gordon W Moran","doi":"10.1177/1179552218757512","DOIUrl":"https://doi.org/10.1177/1179552218757512","url":null,"abstract":"<p><p>Orbital inflammatory disease is a rare ophthalmic manifestation of Crohn's disease. Inflammation is characteristically nonspecific, involving one or multiple structures of the orbit. Mechanisms of disease and optimal methods of treatment are poorly understood. The aim of this report is to present 3 cases of orbital involvement in Crohn's disease. A retrospective case note review of patients with orbital inflammatory disease and Crohn's disease was performed at our academic center to determine the clinical, imaging, and histopathologic features of this condition and its relationship to intestinal Crohn's disease. Three patients were identified with orbital inflammatory manifestations complicating Crohn's disease. All patients described were women with active intestinal disease and had a history of treatment with immunosuppressive therapies. Similarities were observed in clinical presentations with variance noted in radiologic and histopathologic findings. In all cases, symptoms improved with oral corticosteroids or nonsteroidal drugs in combination with anti-tumor necrosis factor agents. Inflammatory bowel disease-related orbital complications are rare but potentially vision-threatening. It is important to consider mimics of orbital inflammatory disease such as systemic inflammatory disease, malignancy, congenital malformations, infection, and trauma when formulating a comprehensive differential diagnosis. Therapeutic intervention is directed toward preservation of vision and orbital function and reducing the acute inflammatory process. Corticosteroids are typically the initial treatment of choice for moderate-to-severe disease, although several classes of immunomodulatory agents have been variably useful in treating this condition. Heightened awareness and close cooperation between gastroenterologists and ophthalmologists are mandatory.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":" ","pages":"1179552218757512"},"PeriodicalIF":0.0,"publicationDate":"2018-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552218757512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35875728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Saccharomyces boulardii</i> CNCM I-745 Improves Intestinal Enzyme Function: A Trophic Effects Review.","authors":"Margret I Moré,&nbsp;Yvan Vandenplas","doi":"10.1177/1179552217752679","DOIUrl":"https://doi.org/10.1177/1179552217752679","url":null,"abstract":"<p><p>Several properties of the probiotic medicinal yeast <i>Saccharomyces boulardii</i> CNCM I-745 contribute to its efficacy to prevent or treat diarrhoea. Besides immunologic effects, pathogen-binding and anti-toxin effects, as well as positive effects on the microbiota, <i>S boulardii</i> CNCM I-745 also has pronounced effects on digestive enzymes of the brush border membrane, known as trophic effects. The latter are the focus of this review. Literature has been reviewed after searching Medline and PMC databases. All relevant non-clinical and clinical studies are summarized. <i>S. boulardii</i> CNCM I-745 synthesizes and secretes polyamines, which have a role in cell proliferation and differentiation. The administration of polyamines or <i>S. boulardii</i> CNCM I-745 enhances the expression of intestinal digestive enzymes as well as nutrient uptake transporters. The signalling mechanisms leading to enzyme activation are not fully understood. However, polyamines have direct nucleic acid-binding capacity with regulatory impact. <i>S. boulardii</i> CNCM I-745 induces signalling via the mitogen-activated protein kinase pathway. In addition, effects on the phosphatidylinositol-3 kinase (PI3K) pathway have been reported. As an additional direct effect, <i>S. boulardii</i> CNCM I-745 secretes certain enzymes, which enhance nutrient acquisition for the yeast and the host. The increased availability of digestive enzymes seems to be one of the mechanisms by which <i>S. boulardii</i> CNCM I-745 counteracts diarrhoea; however, also people with certain enzyme deficiencies may profit from its administration. More studies are needed to fully understand the mechanisms of trophic activation by the probiotic yeast.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":" ","pages":"1179552217752679"},"PeriodicalIF":0.0,"publicationDate":"2018-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552217752679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35836103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial Comparing the Depth of Maximal Insertion Between Anterograde Single-Balloon Versus Spiral Enteroscopy.","authors":"Robert A Moran, Sindhu Barola, Joanna K Law, Stuart K Amateau, Daniil Rolshud, Erin Corless, Vandhana Kiswani, Vikesh K Singh, Anthony N Kalloo, Mouen A Khashab, Anne Marie Lennon, Patrick I Okolo, Vivek Kumbhari","doi":"10.1177/1179552218754881","DOIUrl":"10.1177/1179552218754881","url":null,"abstract":"<p><strong>Background: </strong>Three device-assisted deep endoscopic platforms presently exist and are available for clinical use: double-balloon enteroscopy, single-balloon enteroscopy (SBE), and spiral enteroscopy (SE). In a retrospective study, SE was associated with a greater depth of maximal insertion (DMI) with similar diagnostic yields and procedure time as compared with SBE.</p><p><strong>Aims: </strong>This was a prospective, randomized comparison of SE and SBE with respect to DMI, diagnostic yield, procedure time, and rate of adverse events.</p><p><strong>Methods: </strong>Patients were prospectively randomized to undergo either anterograde SE or SBE. Patient demographics, indication for procedure, DMI, procedure time, therapeutic procedure time, adverse event, diagnostic findings, and therapeutic interventions were prospectively recorded. The primary outcome was DMI. Secondary outcomes included: procedure time; diagnostic yield; therapeutic yield and adverse event rates.</p><p><strong>Results: </strong>During the study period, 30 patients underwent deep enteroscopy (SE 13, SBE 17). The most common indication was gastrointestinal bleeding in both groups. There was no significant difference in the DMI between SE and SBE (330.0 ± 88.2 cm vs 285.3 ± 80.8 cm, <i>P</i> = .16). There was no difference between SE and SBE in procedure time (37.0 ± 10.5 vs 38.3 ± 12.4, <i>P</i> = .76), diagnostic yield (SE = 9 [69%] vs SBE = 7 [41%], <i>P</i> = .16), or therapeutic yield (SE = 6 [46%] vs SBE = 4 [24%], <i>P</i> = .26). There were no major adverse events in either group.</p><p><strong>Conclusions: </strong>Spiral enteroscopy and SBE are similar with respect to DMI, diagnostic yield, therapeutic yield, procedure time, and rate of adverse events. Small numbers prevent giving a definitive judgment and future adequately powered prospective study is required to confirm these findings.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":" ","pages":"1179552218754881"},"PeriodicalIF":0.0,"publicationDate":"2018-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/aa/10.1177_1179552218754881.PMC5788085.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35792440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Morbidity and Mortality of Laparoscopic Appendectomy in Patients with Cirrhosis.","authors":"Yasir Al-Azzawi,&nbsp;Yasir Al-Abboodi,&nbsp;Matthew Fasullo,&nbsp;Tarek Najuib","doi":"10.1177/1179552217746645","DOIUrl":"https://doi.org/10.1177/1179552217746645","url":null,"abstract":"<p><strong>Introduction: </strong>The perioperative mortality is significantly higher in patients with cirrhosis undergoing certain surgical procedures. In this study, we examined the inpatient perioperative mortality and morbidities in cirrhotic people who underwent laparoscopic appendectomy.</p><p><strong>Methods: </strong>We performed a retrospective analysis using the National Inpatient Sample database for 2010. Inclusion criteria were all race and sex who are 18 years or older. Those who have laparoscopic appendectomy and have a history of liver cirrhosis were assigned to case group. An equal random number of appendectomy-related admissions and those who have no history of liver cirrhosis were selected and placed in the control group. A binary logistic regression statistical test was used to examine the odds ratio for the mortality difference and postoperative complication including pneumonia, urinary tract infection (UTI), surgical site infection, postoperative bleeding. IBM SPSS statistics was used to execute the analysis. A confidence interval of 95% and <i>P</i> value less than .05 were determined to define the statistical significance.</p><p><strong>Result: </strong>A total of 754 appendectomy-related admissions were identified-376 appendectomy-related admissions and history of cirrhosis and 378 admissions with appendectomy and no history of cirrhosis. Control group was not found to be statistically different from the case group when it comes to age, race, and sex. Of 754, 520 were white (73.5%), 334 (44.3%) were men. The mean age was 43.75 years for the case group and 46.68 years for the control group. Comparing cirrhotic with noncirrhotic group, the mean length of stay was 1.1 vs 1.52 days, inpatient mortality was 2 (0.5%) vs 1 (0.3%) (<i>P</i> = .56), pneumonia 8 (2.1%) vs 3 (0.8%) (<i>P</i> = .142), surgical site infection 3 (0.8%) vs 2 (0.5%) (<i>P</i> = .652), UTI 18 (4.8%) vs 12 (3.2%) (<i>P</i> = .26), and postoperative bleeding 3 (0.8%) vs 2 (0.5%) (<i>P</i> = .65).</p><p><strong>Conclusions: </strong>Appendectomy-related morbidity and mortality in cirrhotic patients are not different from noncirrhotic patients.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":"11 ","pages":"1179552217746645"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552217746645","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10354231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Gastric Ulcer With Mucosal Bridge.","authors":"Tomoyuki Kitagawa,&nbsp;Ryo Masaoka,&nbsp;Yasumi Katayama,&nbsp;Masaya Tamano","doi":"10.1177/1179552217749206","DOIUrl":"https://doi.org/10.1177/1179552217749206","url":null,"abstract":"<p><p>Endoscopic images of the mucosal bridge with gastric ulcer are unusual. The mucosal bridge is presumed to have changed to a special form based on repeated development of gastric ulcer. The clinical course of mucosal bridge is unclear.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":"10 ","pages":"1179552217749206"},"PeriodicalIF":0.0,"publicationDate":"2017-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552217749206","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35714546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Returns of Deficient Systemic Plasma Immunoglobulin G Levels as Rehabilitation Biomarker After Emergency Colectomy for Fulminant Ulcerative Colitis.","authors":"Alexander T Hawkins, Jun W Um, Amosy E M'Koma","doi":"10.1177/1179552217746692","DOIUrl":"10.1177/1179552217746692","url":null,"abstract":"<p><p>Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC. In addition, increased levels have been reported in colonic tissues of active UC compared with quiescent disease. We aimed to examine levels of p-IgG for clinical evaluation following emergency colectomies in patients with fulminant UC compared with patients with quiescent disease having elective RPC operations. In total 45 patients received an ileoanal pouch (IAP) due to UC. In all, 27 patients were men and 18 were women. The mean age was 34 years (range: 18-55). Because of fulminant UC, 26 patients had emergency subtotal colectomies with terminal ileostomy (TI). During second operation, the rectum was excised, and an IAP with diverting loop ileostomy (DLI) was performed. Nineteen patients had elective operations and had colectomies performed in conjunction with the pouch operation. Mucosectomy was performed in all groups. As a last procedure, the DLI was closed. Blood samples for immunoglobulin G (IgG) analyses were collected from each patient before the colectomy, after the colectomy with TI (before construction of the pouch), during the period with pouches (prior to DLI closure), and at 1, 2, and 3 years and at mean 13.7 years (range: 10-20) after DLI closure. Immunoglobulin G was determined by immunonephelometric assay technique. The statistics were analyzed by analysis of variance and linear regression. Preoperatively, p-IgG was significantly lower in the patients who had emergency operations compared with the group that had elective operations, 9.9 ± 3.0 vs 11.5 ± 3.3 g/L (<i>P</i> < .03). During the manipulative period with TI and/or DLI, the p-IgG levels were increased in both points, but the increase was not statistically significant (<i>P</i> = .26 and <i>P</i> = .19). During functional IAP at 1, 2, and 3 years and at mean 13.7 years (range: 10-20), there was a statistical increase in p-IgG levels (<i>P</i> < .002, <i>P</i> < .005, <i>P</i> < .005, and <i>P</i> < .0001) compared with preoperative levels. These changes did not correlate with episodes of pouchitis (<i>P</i> = .51). In patients having elective operations, p-IgG did not change preoperatively. After 12 months with functional pouches, the p-IgG levels were similar in both groups to the elective patient group preoperatively. In conclusion, p-IgG was found to be significantly lower in the emergency surgery patients compared with the elective surgery group preoperatively. This difference was probably due to increased losses and impaired gut lymphoid tissue production ","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":"10 ","pages":"1179552217746692"},"PeriodicalIF":0.0,"publicationDate":"2017-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/bb/10.1177_1179552217746692.PMC5734426.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35687082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should Emergency Endoscopy be Performed in All Patients With Suspected Colonic Diverticular Hemorrhage?","authors":"Takeshi Uehara,&nbsp;Satohiro Matsumoto,&nbsp;Hiroyuki Miyatani,&nbsp;Hirosato Mashima","doi":"10.1177/1179552217728906","DOIUrl":"https://doi.org/10.1177/1179552217728906","url":null,"abstract":"<p><strong>Objective: </strong>We attempted to develop a scoring system for facilitating decision making regarding the performance of emergency endoscopy in patients with colonic diverticular hemorrhage.</p><p><strong>Methods: </strong>This study involved analysis of the data of 178 patients who presented with hematochezia and were diagnosed as having colonic diverticular hemorrhage by colonoscopy. The patients were divided into 2 groups depending on whether the bleeding source was identified or not at the initial endoscopy (source-identified and source-not-identified groups), and on the basis of the results obtained, we established a scoring system for predicting successful identification of the bleeding source.</p><p><strong>Results: </strong>The percentages of patients on oral anticoagulant therapy or with a Charlson comorbidity index of ≥6, serum C-reactive protein level of ≥1 mg/dL, or extravasation of contrast medium visualized on contrast-enhanced computed tomographic (CT) images were all significantly higher in the identified than in the nonidentified group. Multivariate analysis identified extravasation of contrast medium on contrast-enhanced CT images (odds ratio [OR]: 10.6; 95% confidence interval [CI]: 2.7-42.2) and use of anticoagulants (OR: 4.5; 95% CI: 1.5-13.5) as independent predictors of successful identification of the bleeding source at the initial endoscopy in patients with colonic diverticular hemorrhage. On the basis of these results, we established a scoring system, which showed a sensitivity of 80% and specificity of 81% for successful identification of the bleeding source at the initial endoscopy.</p><p><strong>Conclusions: </strong>Herein, we propose a scoring system as a useful tool for determining whether emergency endoscopy is indicated in individual patients with suspected colonic diverticular hemorrhage.</p>","PeriodicalId":10382,"journal":{"name":"Clinical Medicine Insights. Gastroenterology","volume":"10 ","pages":"1179552217728906"},"PeriodicalIF":0.0,"publicationDate":"2017-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179552217728906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35355953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}