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Efficacy and safety of combined endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous occlusion(BRTOcc)of gastrorenal shunts in patients with bleeding gastric fundal varices

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Gastroenterology Report 2021年第3期9卷 212-218,I0001,I0002页

作者： Fateh Bazerbachi Akira Dobashi Swarup Kumar Sanjay misra Navtej S.Buttar louis m.wong kee song Division of Gastroenterology Interventional Endoscopy ProgramMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Vascular and Interventional Radiology Mayo ClinicRochesterMNUSA

Background:Endoscopic cyanoacrylate(glue)injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts(GRSs).Balloon-occluded retrograde transvenous occlusion(BRTOcc)of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the *** study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic(BRTOcc)approach for the treatment of bleeding fundal ***:We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April *** were extracted for patient demographics,clinical and endoscopic findings,technical details,and adverse events of the endoscopic–BRTOcc approach and patient ***:We identified 30 patients(13[43.3%]women;median age 58[range,25–92]years)with gastroesophageal varices type 2(53.3%,16/30)and isolated gastric varices type 1(46.7%,14/30)per Sarin classification,and median clinical and endoscopic follow-up of 151(range,4–2,513)days and 98(range,3–2,373)days,*** median volume of octylcyanoacrylate:Lipiodol injected was 7(range,4–22)***-related adverse events occurred in three(10.0%)patients,including transient fever,non-life-threatening pulmonary glue embolism,and an injection-site ulcer *** gastric variceal obturation was achieved in 18 of 21 patients(85.7%)at endoscopic *** variceal rebleeding was confirmed in one patient(3.3%)and suspected in two patients(6.7%).Although no procedure-related deaths occurred,the overall mortality rate was 46.7%,primarily from liver-disease progression and ***:The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices,with a high rate of variceal obturation and a low rate of serious adverse events.

关键词： balloon-occluded retrograde transvenous occlusion cyanoacrylate injection gastric varices gastric variceal bleeding gastrorenal shunt

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Foreign object ingestion and esophageal food impaction:An update and review on endoscopic management

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World Journal of Gastrointestinal Endoscopy 2019年第3期11卷 174-192页

作者： Brian m Fung Seth Sweetser louis m wong kee song James H Tabibian UCLA-Olive View Internal medicine Residency Program Division of Gastroenterology and Hepatology Mayo Clinic Division of Gastroenterology Olive View-UCLA Medical Center

Foreign body ingestion encompasses both foreign object ingestion(FOI) and esophageal food impaction(EFI) and represents a common and clinically significant scenario among patients of all ages. The immediate risk to the patient ranges from negligible to life-threatening, depending on the ingested substance,its location, patient fitness, and time to appropriate therapy. This article reviews the FOI and EFI literature and highlights important considerations and implications for pediatric and adult patients as well as their providers. Where published literature is insufficient to provide evidence-based guidance, expert opinion is included to supplement the content of this comprehensive review.

关键词： Foreign bodies Endoscopy Gastrointestinal emergency medical management Dysphagia

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Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

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World Journal of Gastroenterology 2017年第4期23卷 614-621页

作者： Ryan Law Jithinraj E Varayil louis m wong kee song Jeff Fidler Joel G Fletcher John Barlow Jeffrey Alexander Elizabeth Rajan Stephanie Hansel Brenda Becker Joseph J Larson Felicity T Enders David H Bruining Nayantara Coelho-Prabhu Division of Gastroenterology and Hepatology Mayo Clinic Division of Radiology Mayo Clinic Division of Health Sciences Research Mayo Clinic

AImTo determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (mPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic *** cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary *** hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or mPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and mPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to mPCTE (OR = 5.9, P ment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or mPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.

关键词： Double balloon enteroscopy Computed tomography enterography Video capsule enteroscopy Obscure gastrointestinal bleeding

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