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Comparative study of endoscopy *** intrahepatic portosystemic shunt in the management of gastric variceal bleeding

Gastroenterology Report 2015年第1期3卷 75-82页

作者： Gursimran Singh Kochhar Udayakumar Navaneethan Jason Hartman Jose Mari Parungao Rocio Lopez Ranjan Gupta Baljendra Kapoor Paresh Mehta madhu sanaka Department of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOHUSA Case Western School of Medicine ClevelandOHUSA Department of Vascular and Interventional Radiology Cleveland Clinic FoundationClevelandOHUSA

Background and Aim:Gastric varices are associated with high *** have been conflicting reports on whether endoscopic treatment with cyanoacrylate or the placement of a transjugular intrahepatic portosystemic shunt(TIPS)is more effective in the treatment of gastric *** compared the outcomes of patients treated with cyanoacrylate glue or TIPS for the management of acute gastric variceal ***:The study was designed as a retrospective cohort analysis of patients undergoing either TIPS or endoscopic treatment with cyanoacrylate for acute gastric variceal bleeding at our institution from 2001 to *** compared to studied between the two treatment modalities were the short-term treatment outcomes,including re-bleeding within 30 days,length of hospital stay and in-hospital ***-Meier survival analysis was performed to assess factors associated with in-hospital ***:A total of 169 patients were included in the *** TIPS arm contained 140 patients and the cyanoacrylate arm contained 29 *** was no evidence to suggest any significant differences in demographics or disease *** were no differences between the TIPS arm and the cyanoacrylate armtwo groups in treatment outcomes including re-bleeding within 30 days(17.4%vs.17.2%;P=0.98),median length of stay in the hospital(4.5 days vs.6.0 days;P紏0.35)or in-hospital mortality(9.0%vs.11.1%;P=0.74).In-hospital mortality was evaluated for 149 patients and lower albumin(P=0.015),higher MELD score(P<0.001),higher CTP score(P=0.005)and bleeding(P=0.008)were all significantly associated with in-hospital ***:These findings suggest that both treatments are equally *** offers a safe,effective alternative to TIPS for gastric varices,and physician may choose the best therapy for each patient,factoring in the availability of TIPS or cyanoacrylate,the individual patient’s presentation,and cost.

关键词： transjugular intrahepatic portosystemic shunt(TIPS) cyanoacrylate injection gastric varices gastrointestinal bleeding

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Increasing thirty-day readmissions of Crohn’s disease and ulcerative colitis in the United States:A national dilemma

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World Journal of Gastrointestinal Pathophysiology 2022年第3期13卷 85-95页

作者： Dushyant Singh Dahiya Abhilash Perisetti Asim Kichloo Amandeep Singh Hemant Goyal Laura Rotundo madhu Vennikandam Hafeez Shaka Gurdeep Singh Jagmeet Singh Sailaja Pisipati Mohammad Al-Haddad madhusudhan R sanaka Sumant Inamdar Department of Internal Medicine Central Michigan University College of MedicineSaginawMI 48601United States Division of Gastroenterology Parkview Cancer InstituteFort WayneIN 46845United States Division of Gastroenterology and Hepatology Cleveland Clinic FoundationClevelandOH 44195United States Department of Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18505United States Department of Internal Medicine Mercer University School of MedicineMaconGA 31207United States Department of Gastroenterology and Hepatology Sparrow Hospital/Michigan State University College of Human MedicineLansingMI 48912United States Department of Internal Medicine John H.StrogerJr.Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine Our Lady of Lourdes Memorial HospitalBinghamtonNY 13905United States Department of Internal Medicine Guthrie Robert Packer HospitalSayrePA 18840United States Division of Gastroenterology and Hepatology Mayo ClinicScottsdaleAZ 85259United States Division of Gastroenterology and Hepatology Indiana University School of MedicineIndianapolisIN 46202United States Division of Gastroenterology and Hepatology University of Arkansas for Medical SciencesLittle RockAR 72205United States

BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise *** rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare *** To identify trends and adverse outcomes for 30 d readmissions for CD and *** This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and ***<18 years,elective,and traumatic hospitalizations were excluded from this *** identified hospitalization characteristics and readmission rates for each calendar *** of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital ***,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two ***®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically *** Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for *** noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC ***,we found an increasing trend of mean THC for UC *** comparison,there w

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Readmissions Trends

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