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Endoclips vs large or small-volume epinephrine in peptic ulcer recurrent bleeding

World Journal of Gastroenterology 2012年第18期18卷 2219-2224页

作者： Neven Ljubicic Ivan Budimir Alen Biscanin Marko Nikolic Vladimir Supanc Davor Hrabar tajana pavic Department of Internal Medicine 'Sestre milosrdnice' University Hospital Center10000 ZagrebCroatia

AIM:To compare the recurrent bleeding after endoscopic injection of different epinephrine volumes with hemoclips in patients with bleeding peptic ***:Between January 2005 and December 2009,150 patients with gastric or duodenal bleeding ulcer with major stigmata of hemorrhage and nonbleeding visible vessel in an ulcer bed(Forrest Ⅱa) were included in the *** were randomized to receive a small-volume epinephrine group(15 to 25 mL injection group;Group 1,n = 50),a large-volume epinephrine group(30 to 40 mL injection group;Group 2,n = 50) and a hemoclip group(Group 3,n = 50).The rate of recurrent bleeding,as the primary outcome,was compared between the groups of patients included in the *** outcomes compared between the groups were primary hemostasis rate,permanent hemostasis,need for emergency surgery,30 d mortality,bleeding-related deaths,length of hospital stay and transfusion ***:Initial hemostasis was obtained in all *** rate of early recurrent bleeding was 30%(15/50) in the small-volume epinephrine group(Group 1) and 16%(8/50) in the large-volume epinephrine group(Group 2)(P = 0.09).The rate of recurrent bleeding was 4%(2/50) in the hemoclip group(Group 3);the difference was statistically significant with regard to patients treated with either small-volume or large-volume epinephrine solution(P = 0.0005 and P = 0.045,respectively).Duration of hospital stay was significantly shorter among patients treated with hemoclips than among patients treated with epinephrine whereas there were no differences in transfusion requirement or even 30 d mortality between the ***:Endoclip is superior to both small and large volume injection of epinephrine in the prevention of recurrent bleeding in patients with peptic ulcer.

关键词： Peptic ulcer Hemorrhage Hemoclip Epinephrine Nonvariceal upper gastrointestinal bleeding

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Gut peptide changes in patients with obstructive jaundice undergoing biliary drainage:A prospective case control study

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World Journal of Clinical Cases 2022年第17期10卷 5551-5565页

作者： tajana pavic Stipe Pelajic Nina Blazevic Dominik Kralj Milan Milosevic Ivana Mikolasevic Ivan Lerotic Davor Hrabar Department of Gastroenterology and Hepatology University Hospital Center Sestre MilosrdniceZagreb 10000Croatia Andrija Stampar School of Public Health WHO Collaborative Centre for Occupational Health University of ZagrebSchool of MedicineZagreb 10000Croatia Department of Gastroenterology University Hospital Center RijekaRijeka 51000Croatia

BACKGROUND Biliary obstruction is a relatively common condition that affects approximately 5 in 1000 people *** is very common in patients with biliary obstruction and since it is associated with significant morbidity and mortality,it is important to identify factors and mechanisms involved in its *** To determine the influence of obstructive jaundice on the hormones controlling appetite and nutritive *** This was a prospective case control study performed in a tertiary center in Zagreb,*** with biliary obstruction undergoing internal biliary drainage from September 2012 until August 2013 were *** excluding patients who developed procedure related complications or were lost in the follow-up,out of initial 73 patients,55 patients were included in the analysis,including 34 with benign and 21 with malignant ***,40 non-jaundiced controls were also ***,nutritional status,and serum ghrelin,cholecystokinin(CCK),interleukin 6(IL-6),and tumor necrosis factorα(TNF-α)were determined at admission,48 h and 28 d after internal biliary *** square test was used for categorical *** variables were analysed for normality by Kolmogorov-Smirnov test and relevant non-parametric(Mann-Whitney,Kruskal-Wallis,and Friedman)or parametric(t-test and analysis of variance)tests were *** Patients with obstructive jaundice were significantly malnourished compared to controls,regardless of disease *** ghrelin and CCK levels were significantly higher in patients with obstructive *** bilirubin concentrations were negatively correlated with ghrelin levels and positively correlated with TNF-α,but had no correlation with CCK *** internal biliary drainage,a significant improvement of nutritional status was observed although serum concentrations of ghrelin,IL-6,and TNF-α remained significantly elevated even 28 d after the *** level

关键词： Ghrelin Cholecystokinin Biliary obstruction Malnutrition

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Scoring systems for peptic ulcer bleeding: which one to use?

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World Journal of Gastroenterology 2017年第41期23卷 7450-7458页

作者： Ivan Budimir Sanja Stojsavljevic Neven Barsic Alen Biscanin Gorana Mirosevic Sven Bohnec Lora Stanka Kirigin tajana pavic Neven Ljubicic Division of Gastroent-erology Department of Internal Medicine 'Sestre Milosrdnice' University Hospital Center Division of Endo-crinology Department of Internal Medicine 'Sestre Milosrdnice' University Hospital Center Gastronterologie Allgemeine Innere Medizin und Geriatrie Rems -Murr Klinik Winnenden

AIM To compare the Glasgow-Blatchford score(GBS), Rockall score(RS) and Baylor bleeding score(BBS) in predicting clinical outcomes and need for interventions in patients with bleeding peptic ulcers. METHODS Between January 2008 and December 2013, 1012consecutive patients admitted with peptic ulcer bleeding(PUB) were prospectively followed. The pre-endoscopic RS, BBS and GBS, as well as the post-endoscopic diagnostic scores(RS and BBS) were calculated for all patients according to their urgent upper endoscopy findings. Area under the receiver-operating characteristics(AUROC) curves were calculated for the prediction of lethal outcome, rebleeding, needs for blood transfusion and/or surgical intervention, and the optimal cutoff values were *** PUB accounted for 41.9% of all upper gastrointestinal tract bleeding, 5.2% patients died and 5.4% patients underwent surgery. By comparing the AUROC curves of the aforementioned pre-endoscopic scores, the RS best predicted lethal outcome(AUROC 0.82 vs 0.67 vs0.63, respectively), but the GBS best predicted need for hospital-based intervention or 30-d mortality(AUROC0.84 vs 0.57 vs 0.64), rebleeding(AUROC 0.75 vs 0.61 vs 0.53), need for blood transfusion(AUROC 0.83 vs0.63 vs 0.58) and surgical intervention(0.82 vs 0.63 vs 0.52) The post-endoscopic RS was also better than the post-endoscopic BBS in predicting lethal outcome(AUROC 0.82 vs 0.69, respectively).CONCLUSION The RS is the best predictor of mortality and the GBS is the best predictor of rebleeding, need for blood transfusion and/or surgical intervention in patients with PUB. There is no one 'perfect score' and we suggest that these two tests be used concomitantly.

关键词： Upper gastrointestinal bleeding Peptic ulcer bleeding Glasgow-Blatchford score Rockall score Baylor bleeding score

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