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Italian survey on non-steroidal anti-inflammatory drugsand gastrointestinal bleeding in children

World Journal of Gastroenterology 2016年第5期22卷 1877-1883页

作者： Sabrina Cardile Massimo Martinelli Arrigo Barabino Paolo Gandullia Salvatore Oliva Giovanni Di Nardo Luigi Dall'Oglio Francesca Rea Gian Luigi de'Angelis Barbara Bizzarri Graziella Guariso enzo masci Annamaria Staiano Erasmo Miele Claudio Romano Gastroenterology and Endoscopic Unit Department of PediatricsUniversity of Messina98100 MessinaItaly Department of Translational Medical Science Section of PediatricsUniversity of Naples“Federico II”80131 NaplesItaly Department of Pediatric Gastroenterology Gaslini Institute16148 GenoaItaly Department of Pediatrics and Infantile Neuropsychiatry Pediatric Gastroenterology and Liver UnitSapienza University of Rome00185 RomeItaly Digestive Surgery and Endoscopy Unit Bambino GesùChildren’s Hospital00165 RomeItaly Gastroenterology and Endoscopy Service University of Parma43126 ParmaItaly Unit of Paediatric Gastroenterology Digestive EndoscopyHepatologyand Care of Children with Liver TransplantationDepartment of Women’s and Children’s HealthUniversity Hospital of Padova35128 PadovaItaly Gastrointestinal Endoscopy Azienda Ospedaliera San Paolo University HospitalUniversity of Milan20142 MilanItaly

AIM: To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug(NSAIDs) use in children.METHODS: A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber(physician or selfmedication) were examined. RESULTS: Fifty-one patients, including 34 males, were enrolled(median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients(68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients(56.9%)]. Seven patients had positive family history of Helicobacter pylori(H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four(47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom(33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51(62%) patients, duodenal lesions in 17(33%) and esophageal lesions in 8(15%). In 10/51(19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight(94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51(6%) patients, an endoscopic hemostasis was needed.CONCLUSION: The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in

关键词： Hematemesis Gastrointestinal bleeding non-steroidal anti-inflammatory drug Melena Pediatrics

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Over-the-scope clips in the treatment of gastrointestinal tract iatrogenic perforation: A multicenter retrospective study and a classification of gastrointestinal tract perforations

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World Journal of Gastrointestinal Surgery 2016年第4期8卷 315-320页

作者： Benedetto Mangiavillano Angelo Caruso Raffaele Manta Roberto Di Mitri Alberto Arezzo Nico Pagano Giuseppe Galloro Filippo Mocciaro Massimiliano Mutignani Carmelo Luigiano Enrico Antonucci Rita Conigliaro enzo masci Gastroenterology and Gastrointestinal Endoscopy Borea Hospital Gastroenterology and Gastroin-testinal Endoscopy Sant’Agostino Estense Gastrointestinal Endoscopy Operative Endoscopy Unit Niguarda-Ca Granda Hospital Gastroenterology and Endo-scopy Unit ARNAS Civico Hospital Department of Surgical Sciences University of Torino Unit of Gastroenterology S.Orsola-Malpighi Univer-sity Hospital Department of Clinical Medicine and Surgery Special Unit of Surgical Digestive Endoscopy University of Naples Federico Ⅱ - School of Medicine Gastrointestinal Endoscopy San Paolo Univer-sitary Hospital Division of Surgical and Gastrointetsinal Products Euromedical s.r.l Gastroenterology and Gastrointestinal Endoscopy National Tumori Institute

AIM: To determine the outcome of the management of iatrogenic gastrointestinal tract perforations treated by over-the-scope clip(OTSC) placement.METHODS: We retrospectively enrolled 20 patients(13 female and 7 male; mean age: 70.6 ± 9.8 years) in eight high-volume tertiary referral centers with upper or lower iatrogenic gastrointestinal tract perforation treated by OTSC placement. Gastrointestinal tract perforation could be with oval-shape or with round-shape. Ovalshape perforations were closed by OTSC only by suction and the round-shape by the "twin-grasper" plus suction. RESULTS: Main perforation diameter was 10.1 ± 4.3 mm(range 3-18 mm). The technical success rate was 100%(20/20 patients) and the clinical success rate was 90%(18/20 patients). Two patients(10%) who did not have complete sealing of the defect underwent surgery. Based upon our observations we propose two types of perforation: Round-shape "type-1 perforation" and oval-shape "type-2 perforation". Eight(40%) out of the 20 patients had a type-1 perforation and 12 patients a type-2(60%). CONCLUSION: OTSC placement should be attempted after perforation occurring during diagnostic or therapeutic endoscopy. A failed closure attempt does not impair subsequent surgical treatment.

关键词： Over-the-scope clip OVESCO Perforation Gastrointestinal tract

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