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Characteristics and outcomes of acute upper gastrointestinal bleeding after therapeutic endoscopy in the elderly

World Journal of Gastroenterology 2011年第32期17卷 3724-3732页

作者： Phunchai Charatcharoenwitthaya Nonthalee Pausawasdi Nuttiya Laosanguaneak Jakkrapan Bubthamala Tawesak Tanwandee somchai leelakusolvong Division of Gastroenterology Department of Medicine Faculty of Medicine Siriraj Hospital Mahidol University

AIM: To characterize the effects of age on clinical presentations and endoscopic diagnoses and to determine outcomes after endoscopic therapy among patients aged ≥ 65 years admitted for acute upper gastrointestinal bleeding (UGIB) compared with those aged < 65 years. METHODS: Medical records and an endoscopy data-base of 526 consecutive patients with overt UGIB admitted during 2007-2009 were reviewed. The initial presentations and clinical course within 30 d after endoscopy were obtained. RESULTS: A total of 235 patients aged ≥ 65 years constituted the elderly population (mean age of 74.2 ± 6.7 years, 63% male). Compared to young patients, the elderly patients were more likely to present with melena (53% vs 30%, respectively; P < 0.001), have comorbidities (69% vs 54%, respectively; P < 0.001), and receive antiplatelet agents (39% vs 10%, respectively; P < 0.001). Interestingly, hemodynamic instability was observed less in this group (49% vs 68%, respectively; P < 0.001). Peptic ulcer was the leading cause of UGIB in the elderly patients, followed by varices and gastropathy. The elderly and young patients had a similar clinical course with regard to the utilization of endoscopic therapy, requirement for transfusion, duration of hospital stay, need for surgery [relative risk (RR), 0.31; 95% confidence interval (CI), 0.03-2.75; P = 0.26], rebleeding (RR, 1.44; 95% CI, 0.92-2.25; P = 0.11), and mortality (RR, 1.10; 95% CI, 0.57-2.11; P = 0.77). In Cox's regression analysis, hemodynamic instability at presentation, background of liver cirrhosis or disseminated malignancy, transfusion requirement, and development of rebleeding were significantly associated with 30-d mortality. CONCLUSION: Despite multiple comorbidities and the concomitant use of antiplatelets in the elderly patients, advanced age does not appear to influence adverse outcomes of acute UGIB after therapeutic endoscopy.

关键词：上消化道出血中老年人手术治疗急性胃镜检查血流动力学临床表现消化性溃疡

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Comparison of early pre-cutting vs standard technique for biliary cannulation in endoscopic retrograde cholangiopancreatography: A personal experience

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World Journal of Gastroenterology 2007年第27期13卷 3734-3737页

作者： Kannikar Laohavichitra Thawatchai Akaraviputh Asada Methasate somchai leelakusolvong Udom Kachintorn Department of Surgery Siriraj GI Endoscopy center Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand Siriraj GI Endoscopy center Faculty of Medicine Siriraj Hospital Mahidol University Bangkok 10700 Thailand

AIM: To compare the results and complications of early pre-cutting technique with standard technique. METHODS: From January 2003 to December 2004, a total of 416 consecutive therapeutic biliary ERCP procedures were performed by one endoscopist (T.A.). Data were retrospectively collected according to procedure indication and results. Of these, 293 procedures (70.4%) were done with standard technique (group A) and 123 procedures (29.6%) with early pre-cutting technique in case of difficult cannulation (group B). The results and complications of ERCP were compared. RESULTS: Success rate of first attempt cannulation was 98.0% in group A and 87.8% in group B. The overall incidence of post-ERCP pancreatitis, hemorrhage, perforation and cholangitis was 0%, 0.2%, 0.5% and 0.5%, respectively. Morbidity rate was not significantly different. No procedure-related mortality was occurred. CONCLUSION: For an experienced hand, the early pre-cutting technique for biliary cannulation is safe and effective as standard technique.

关键词：早期切除术胆汁导管插入术并发症胰腺炎个人经验

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Massive gastric antral vascular ectasia successfully treated by endoscopic band ligation as the initial therapy

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World Journal of Gastrointestinal Endoscopy 2013年第3期5卷 135-137页

作者： Varayu Prachayakul Pitulak Aswakul somchai leelakusolvong Siriraj GI Endoscopy Center Siriraj HospitalBangkok 10700Thailand Division of Gastroenterology Department of MedicineFaculty of MedicineMahidol UniversityBangkok 10700Thailand Liver and Digestive Institute Samitivej Sukhumvit HospitalBangkok 10120Thailand

Gastric antral vascular ectasia(GAVE) accounted for 4% of non-variceal gastrointestinal *** though unclear pathogenesis,GAVE often associated with chronic renal failure,autoimmune diseases and *** lesions were reasonably not to *** treatment options for GAVE are nonendoscopic and endoscopic *** the pharmacological treatment,some success were reported for the use of octreotide,thalidomide and tranexamic *** the endoscopic treatment is the mainstay for treatment of symptomatic *** endoscopic ablative therapies such as argon plasma coagulation was reported with good clinical ***,these treatment options had some limitation due to the need of special equipment and multiple sessions needed to control the *** reported another treatment option using the routine-achievable instrument such as endoscopic band ligation as an initial treatment which also provided a good treatment outcome and less sessions.

关键词： Gastric antral vascular ectasia Non variceal hemorrhage Endoscopic band ligation Water melon stomach Treatment

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Factors influencing clinical outcomes of Histoacryl~ glue injection-treated gastric variceal hemorrhage

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World Journal of Gastroenterology 2013年第15期19卷 2379-2387页

作者： Varayu Prachayakul Pitulak Aswakul Tanyaporn Chantarojanasiri somchai leelakusolvong Division of Gastroenterology Department of Internal MedicineFaculty of MedicineMahidol UniversitySiriraj HospitaBangkok 10700Thailand Division of Gastroenterology Department of Internal MedicineFaculty of MedicineMahidol UniversitySiriraj HospitalBangkok 10700Thailand Liver and Digestive Institute Samitivej Sukhumvit HospitalBangkok 10700Thailand

AIM: To determine the factors associated with clinical outcomes and complications of Histoacryl glue injection for acute gastric variceal hemorrhage. METHODS: Patients who presented to the Siriraj Gastrointestinal Endoscopy Center with active gastric variceal bleeding and were admitted for treatment between April 2008 and October 2011 were selected retrospectively for study inclusion. All bleeding varices were treated by injection of Histoacryl tissue glue (B. Braun Melsungen AG, Germany) through a 21G or 23G catheter primed with lipiodol to prevent premature glue solidification. Data recorded for each patient included demographic and clinical characteristics, endoscopic findings, clinical outcomes in terms of early and late re-bleeding, mortality, and procedure-related complications. Data from admission (baseline) and posttreatment were comparatively analyzed using stepwise logistic regression analysis to determine the correlation between factors and clinical ***: A total of 90 patients underwent Histoacryl injection to treat bleeding gastric varices. The mean age was 55.9 ± 13.9 (range: 15-88) years old, and 74.4% of the patients were male. The most common presentations were hematemesis (71.1%), melena (12.2%), and coffee ground emesis (8.9%). Initial hemostasis was experienced in 97.8% of patients, while re-bleeding within 120 h occurred in 10.0%. The presence of ascites was the only factor associated with early and late re-bleeding [odds ratio (OR)=10.67, 95%CI: 1.27-89.52, P=0.03 and OR=4.15, 95%CI: 1.34-12.86, P=0.01, respectively]. Early procedure-related complications developed in 14.4% of patients, and were primarily infections and non-fatal systemic embolization. Late re-bleeding was significantly correlated with early procedure-related complications by univariate analysis (OR=4.01, 95%CI: 1.25-12.87, P=0.04), but no factors were significantly correlated by multivariate analysis. The overall mortality rate was 21.1%, the majority of which w

关键词： Histoacryl Gastric varices Clinical outcome Complications Hemorrhage

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