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rate of adverse events of Gastroduodenal snare polypectomy for non-flat polyp is low: A prospective and multicenter study

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World Journal of Gastroenterology 2017年第47期23卷 8405-8414页

作者： Henry Córdova Lidia Argüello Carme Loras Antonio Naranjo Rodríguez Faust Riu Pons Joan B Gornals David Nicolás-Pérez Xavier Andújar Murcia Luis Hernández Santos Santolaria Carles Leal Carles Pons Enrique Pérez-Cuadrado-Robles Orlando García-Bosch Michel Papo Berger José Luis Ulla Rocha Cristina Sánchez-Montes Gloria Fernández-Esparrach Endoscopy Unit.Institut de Malalties Digestives Hospital ClínicIDIBAPSCIBERehdUniversitat de Barcelona Digestive Endoscopy Unit Digestive Diseases DepartmentGastrointestinal Endoscopy Research GroupIISLa Fe Polytechnic University Hospital Hospital Universitari Mútua de Terrassa CIBERehd Hospital Reina Sofía Hospital Del Mar Hospital Universitari de Bellvitge IDIBELLUniversitat de BarcelonaHospitalet de Llobregat Hospital Universitario de Canarias Hospital Santos Reyes Aranda de Duero Hospital San Jorge Consorci Hospitalari de Vic Universitat de Vic Hospital de Viladecans Hospital Morales Meseguer Hospital Moisès Broggi Sant Joan Despí Hospital Joan XXIII Complejo Hospitalario de Pontevedra

AIM To evaluate the rate of adverse events(AEs) during consecutive gastric and duodenal polypectomies in several Spanish centers. METHODS Polypectomies of protruded gastric or duodenal polyps ≥ 5 mm using hot snare were prospectively included. Prophylactic measures of hemorrhage were allowed in predefined cases. AEs were defined and graded according to the lexicon recommended by the American Society for Gastrointestinal Endoscopy. Patients were followed for 48 h, one week and 1 mo after theprocedure. RESULTS308 patients were included and a single polypectomy was performed in 205. Only 36(11.7%) were on prior anticoagulant therapy. Mean polyp size was 15 ± 8.9 mm(5-60) and in 294 cases(95.4%) were located in the stomach. Hemorrhage prophylaxis was performed in 219(71.1%) patients. Nine patients presented AEs(2.9%), and 6 of them were bleeding(n = 6, 1.9%)(in 5 out of 6 AE, different types of endoscopic treatment were performed). Other 24 hemorrhagic episodes could be managed without any change in the outcome of the endoscopy and, consequently, were considered incidents. We did not find any independent risk factor of bleeding.CONCLUSION Gastroduodenal polypectomy using prophylactic measures has a rate of AEs small enough to consider this procedure a safe and effective method for polyp resection independently of the polyp size and location.

关键词： Polypectomy Bleeding Adverse events Protruded polyps Gastroduodenal Foregut

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Geographic differences in low-dose aspirin-associated Gastroduodenal mucosal injury

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World Journal of Gastroenterology 2015年第25期21卷 7709-7717页

作者： Katsunori Iijima Tooru Shimosegawa Division of Gastro- enterology Tohoku University Graduate School of Medicine

Aspirin, even at low doses, has been known to cause upper gastro-intestinal complications, such as Gastroduodenal ulcers, despite the definite benefits from its antithrombotic effects. Helicobacter pylori(H. pylori) is major pathogen responsible for Gastroduodenal ulcerformation. There have been conflicting results about the potential interaction between these two ulcerogenic factors and the geographic areas involved. In Western countries, the prevalence of Gastroduodenal ulcers is consistently higher in H. pylori-positive low-dose aspirin(LDA) users than in H. pylori-negative ones, suggesting that H. pylori infection exacerbates LDA-induced Gastroduodenal mucosal injury in these geographic areas. Meanwhile, previous studies from Japan have generally reported a similar prevalence of LDA-induced Gastroduodenal mucosal injury regardless of the presence of H. pylori infection, indicating that the infection is not an overall exacerbating factor for drug-induced injury. H. pylori infection could have a synergistic or antagonistic interaction with LDA use in adverse Gastroduodenal events depending on gastric acid secretion. It is wellrecognized that the net effect of H. pylori infection on gastric acid secretion shows considerable geographic variation at the population level. While gastric acid secretion levels were not decreased and were wellpreserved in most patients with H. pylori infection from Western countries, the majority of Japanese patients with H. pylori infection exhibited decreased gastric acid secretion. Such large geographic differences in the net effect of H. pylori infection on gastric acid secretion could be at least partly responsible for the geographically distinct interaction between LDA use and H. pylori infection on adverse Gastroduodenal lesions.

关键词： Helicobacter pylori Low-dose aspirin Gastricacid secretion Gastroduodenal ulcers Geographicvariation

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Predictors of the patency of self-expandable metallic stents in malignant Gastroduodenal obstruction

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World Journal of Gastroenterology 2015年第30期21卷 9134-9141页

作者： Seung Han Kim Hoon Jai Chun In Kyung Yoo Jae Min Lee Seung Joo Nam Hyuk Soon Choi Eun Sun Kim Bora Keum Yeon Seok Seo Yoon Tae Jeen Hong Sik Lee Soon Ho Um Chang Duck Kim Division of Gastroenterology and Hepatology Department of Internal MedicineKorea University College of Medicine

AIM:To investigate the predictive factors of selfexpandable metallic stent patency after stent placement in patients with inoperable malignant Gastroduodenal obstruction. METHODS:A total of 116 patients underwent stent placements for inoperable malignant Gastroduodenal obstruction at a tertiary academic center. Clinical success was defined as acceptable decompression of the obstructive lesion within the malignant Gastroduodenal neoplasm. We evaluated patient comorbidities and clinical statuses using the World Health Organization's scoring system and categorized patient responses to chemotherapy using the Response Evaluation Criteria in Solid Tumors criteria. We analyzed the relationships between possible predictive factors and stent patency. RESULTS:Self-expandable metallic stent placement was technically successful in all patients(100%),and the clinical success rate was 84.2%. In a multivariate Cox proportional hazards model,carcinoembryonic antigen(CEA) levels were correlated with a reduction in stent patency [P = 0.006; adjusted hazard ratio(a HR)= 2.92,95%CI:1.36-6.25]. Palliative chemotherapy was statistically associated with an increase in stent patency(P = 0.009; a HR = 0.27,95%CI:0.10-0.72).CONCLUSION:CEA levels can easily be measured at the time of stent placement and may help clinicians to predict stent patency and determine the appropriate stent procedure.

关键词： Malignant Gastroduodenal obstruction Stent Patency Predictive factor Carcinoembryonicantigen

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Gastroduodenal ulcer bleeding in elderly patients on low dose aspirin therapy

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World Journal of Gastroenterology 2018年第34期24卷 3908-3918页

作者： Koh Fukushi Keiichi Tominaga Kazunori Nagashima Akira Kanamori Naoya Izawa Mimari Kanazawa Takako Sasai Hideyuki Hiraishi Department of Gastroenterology Dokkyo Medical University Department of General Internal Medicine 2 Kawasaki Medical School General Medical Center

AIM To determine the clinical characteristics of elderly patients of hemorrhagic Gastroduodenal ulcer on low-dose aspirin(LDA)therapy.METHODS A total of 1105 patients with hemorrhagic Gastroduodenal ulcer treated in our hospital between January 2000 and March 2016 were grouped by age and drugs used,and these groups were compared in several factors.These groups were compared in terms of length of hospital stay,presence/absence of hemoglobin(Hb)decrease,presence/absence of blood transfusion,Forrest Ⅰ,percentage of Helicobacter pylori infection,presence/absence of underlying disease,and percentage of severe cases.RESULTS The percentage of blood transfusion(62.6%vs 47.7%,P<0.001),Hb decrease(53.8% vs 40.8%,P<0.001),and the length of hospital stay(23.5 d vs 16.7 d,P<0.001)were significantly greater in those on drug therapy.The percentage of blood transfusion(65.3%vs 47.8%,P<0.001),Hb decrease(54.2%vs 42.1%,P<0.001),and length of hospital stay(23.3 d vs 17.5 d,P<0.001)were significantly greater in the elderly.In comparison with the LDA monotherapy group,the percentage of severe cases was significantly higher in the LDA combination therapy group when elderly patients were concerned(16.1%vs34.0%,P=0.030).Meanwhile,among those on LDA monotherapy,there was no significant difference between elderly and non-elderly(16.1%vs 16.0%,P=0.985).CONCLUSION A combination of LDA with antithrombotic drugs or nonsteroidal anti-inflammatory drugs(NSAIDs)contributes to aggravation.And advanced age is not an aggravating factor when LDA monotherapy is used.

关键词： Hemorrhagic Gastroduodenal ulcer Low-dose aspirin Antithrombotic drugs Elderly patients Proton pump inhibitor

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Gastroduodenal intussusception due to gastric schwannoma treated by billroth Ⅱ distal gastrectomy:One case report

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World Journal of Gastroenterology 2015年第7期21卷 2225-2228页

作者： Jia-Hua Yang Min Zhang Zhi-Hua Zhao Yu Shu Jun Hong Yi-Jun Cao Department of General Surgery Putuo Hospital Shanghai University of Traditional Chinese Medicine

Schwannomas are rarely observed in the gastrointestinal tract.The most common symptoms of a gastric schwannoma are abdominal pain or dyspepsia,gastrointestinal bleeding,and an abdominal mass.Many gastric schwannomas are asymptomatic and are discovered incidentally or at postmortem.The diagnosis of a schwannoma is based on immunohistochemical positivity for S-100 protein.Wepresent a case report of a rare complication of gastric schwannoma causing Gastroduodenal intussusception that was successfully managed by a BillrothⅡdistal gastrectomy.In this rare case,the patient had intermittent,colicky abdominal pain,nausea,and vomiting for over 4wk accompanied by a weight loss.A diagnosis of gastric intussusception was made by computed tomography.A BillrothⅡdistal gastrectomy was then performed,and complete en bloc removal(R0 resection)was achieved.Pathology confirmed a gastric schwannoma through positive immunohistochemical staining for S-100 protein.

关键词： Gastroduodenal intussusception Gastric schwannoma

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Long-term follow-up study of Gastroduodenal lesions after radioembolization of hepatic tumors

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World Journal of Gastroenterology 2013年第19期19卷 2935-2940页

作者： Iago Rodríguez-Lago Cristina Carretero Maite Herráiz José C Subtil Maite Betés Macarena Rodríguez-Fraile Jesús J Sola José I Bilbao Miguel Muoz-Navas Bruno Sangro Endoscopy Unit Department of GastroenterologyUniversity of Navarra Clinic31008 PamplonaNavarraSpain Department of Nuclear Medicine University of Navarra Clinic31008 PamplonaNavarraSpain Department of Pathology University of Navarra Clinic31008 PamplonaNavarraSpain Department of Radiology University of Navarra Clinic31008 PamplonaNavarraSpain Liver Unit University of Navarra Clinic31008 PamplonaNavarraSpain National Biomedical Research Centre Network for Hepatic and Digestive Diseases 08036 BarcelonaCataluaSpain

AIM:To evaluate the long-term natural history of the Gastroduodenal lesions secondary to extrahepatic embolization with Ytrium 90(90 Y) spheres.METHODS:From September 2003 to January 2012,379 procedures of liver radioembolization(RE) using resin microspheres loaded with 90 Y were performed in our center.We have retrospectively compiled the data from 379 RE procedures performed in our center.We report a comprehensive clinical,analytical,endoscopic and histologic long-term follow-up of a series of patients who developed Gastroduodenal lesions after the treatment.RESULTS:Six patients(1.5%) developed gastrointestinal symptoms and had gastrointestinal lesions as shown by upper endoscopy in the next 12 wk after RE.The mean time between RE and the appearance of symptoms was 5 wk.Only one patient required endoscopic and surgical treatment.The incidence of gastrointestinal ulcerations was 3.75%(3/80) when only planar images were used for the pre-treatment evaluation.It was reduced to 1%(3/299) when singlephoton emission computed tomography(SPECT) images were also performed.The symptoms that lasted for a longer time were nausea and vomiting,until 25 mo after the treatment.CONCLUSION:All patients were free from severe symptoms at the end of follow-up.The routine use of SPECT has decreased the incidence of gastrointestinal lesions due to unintended deployment of 90 Y particles.

关键词： Radioembolization Liver neoplasms Gastroduodenal ulcer Single-photon emission computed tomography Liver

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Typical Gastroduodenal endoscopic findings in a Crohn's disease patient in remission stage

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World Journal of Gastrointestinal Endoscopy 2012年第3期4卷 96-98页

作者： Masahiro Iizuka Taku Harada Hiro-o Yamano Takeshi Etou Shiho Sagara Department of Gastroenterology Akita Red Cross HospitalAkita 010-1495Japan Akita Health Care Center Akita Red Cross Hospital

A 39-year-old patient with Crohn's disease (CD) was referred to our hospital for maintenance treatment of CD.He was diagnosed as having CD of the small and large intestines at 32 years old.He underwent partial resection of the ileum at 35 years old because of ileal perforation.He had received enteral nutritional supplement (1200 kcal/d) and metronidazole preparation (500 mg/d),and was in remission Crohn's disease activity index 73.We performed a routine Gastroduodenal endoscopic examination,which revealed the representative endoscopic findings of Gastroduodenal lesions in CD,namely,bamboo-joint-like appearance of the gastric body and cardia and a notched sign in the duodenum.These findings were clearly observed by using indigo carmine dye spraying.In our patient,typical Gastroduodenal findings were observed even in the remission stage,suggesting that these findings would contribute to the early diagnosis of CD not only in the active stage but also during remission.

关键词： Crohn’s disease Gastroduodenal findings Bamboo-joint-like appearance Notched sign

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Clinical features of Gastroduodenal injury associated with long-term low-dose aspirin therapy

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World Journal of Gastroenterology 2013年第11期19卷 1673-1682页

作者： Junichi Iwamoto Yoshifumi Saito Akira Honda Yasushi Matsuzaki Department of Gastroenterology Tokyo Medical UniversityIbaraki Medical CenterIbaraki 300-0395Japan

Low-dose aspirin(LDA) is clinically used for the prevention of cardiovascular and cerebrovascular events with the advent of an aging society.On the other hand,a very low dose of aspirin(10 mg daily) decreases the gastric mucosal prostaglandin levels and causes significant gastric mucosal damage.The incidence of LDAinduced gastrointestinal mucosal injury and bleeding has increased.It has been noticed that the incidence of LDA-induced gastrointestinal hemorrhage has increased more than that of non-aspirin non-steroidal anti-inflammatory drug(NSAID)-induced lesions.The pathogenesis related to inhibition of cyclooxygenase(COX)-1 includes reduced mucosal flow,reduced mucus and bicarbonate secretion,and impaired platelet aggregation.The pathogenesis related to inhibition of COX-2 involves reduced angiogenesis and increased leukocyte adherence.The pathogenic mechanisms related to direct epithelial damage are acid back diffusion and impaired platelet aggregation.The factors associated with an increased risk of upper gastrointestinal(GI) complications in subjects taking LDA are aspirin dose,history of ulcer or upper GI bleeding,age > 70 years,concomitant use of non-aspirin NSAIDs including COX-2-selective NSAIDs,and Helicobacter pylori(H.pylori) infection.Moreover,no significant differences have been found between ulcer and non-ulcer groups in the frequency and severity of symptoms such as nausea,acid regurgitation,heartburn,and bloating.It has been shown that the ratios of ulcers located in the body,fundus and cardia are significantly higher in bleeding patients than the ratio of Gastroduodenal ulcers in patients taking LDA.Proton pump inhibitors reduce the risk of developing gastric and duodenal ulcers.In contrast to NSAIDinduced gastrointestinal ulcers,a well-tolerated histamine H2-receptor antagonist is reportedly effective in prevention of LDA-induced gastrointestinal ulcers.The eradication of H.pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding.Continuous aspirin therapy for patients

关键词： Gastroduodenal ulcer Upper gastrointestinal bleeding Low-dose aspirin Non-steroidal antiinflammatory drugs

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Gastroduodenal artery aneurysm rupture in hospitalized patients:An overlooked diagnosis

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World Journal of Gastrointestinal Surgery 2010年第9期2卷 291-294页

作者： Kassem Harris Michel Chalhoub Ashish Koirala Pulmonary/Critical Care Department Staten Island University Hospital475 Seaview AveStaten IslandNew YorkNY 10305United States Internal Medicine Department Staten Island University Hospital475 Seaview AveStaten IslandNew YorkNY 10305United States

Gastroduodenal artery(GDA) aneurysm rupture is a rare serious condition.The diagnosis requires a high level of suspicion with specif ic attention to warning signs.Early diagnosis can prevent fatal outcomes.In this report,we describe a case of GDA aneurysm rupture presenting as recurrent syncope and atypical back and abdominal discomfort.The rupture manifested as hemorrhagic shock.The diagnosis was made by computed tomography of the abdomen which showed acute peritoneal and retroperitoneal bleeding.Angiographic intervention failed to coil the GDA and surgery with arterial ligation was the def initive treatment.

关键词： Gastroduodenal Hemorrhage Life-threatening Embolization Surgery

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Microbial Diversity in Patients with Gastroduodenal Diseases

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Advances in Microbiology 2014年第2期4卷 69-72页

作者： Shorena Khetsuriani Klara Khetsuriani Scientific Skills Center Tbilisi State Medical University Georgia

H. pylori infection is mainly spread in the kind of Gastroduodenal diseases: chronic gastritis, peptic ulcer disease, MALT-lymphoma, gastric cancer. According to certain literature, the mentioned bacterium causes diseases of other visceral organs of humans. Study of the aggravating impact of this infection is under the attention of the scientists. However, other infectious agents, including fungi, other bacteria, parasites, and viruses and their role in different Gastroduodenal diseases are not studied enough. The aim of our study was to identify mucous (parietal) Gastroduodenal microflora in patients with different diseases of this zone. 390 patients with chronic gastritis (CG), peptic ulcer diseases (PUD) and gastric cancer (GC) were included in the study. The resection materials and biopsy specimens were taken during the operation or endoscopy procedures. Identification of strains H. pylori, Candida spp and others was performed by established methods, on the basis of morphological, tinctorial, cultural and biochemical properties. Microflora of patients with different Gastroduodenal diseases is diverse enough. It is represented by facultative, obligate anaerobes, microaeropilic bacteria. More frequently, there were H. pylori and Candida sp, as well as in associations and monocultures. The obtained results confirmed the wide distribution of H. pylori and Candida spp and their frequent coexistence in patients with gastric cancer, chronic gastritis and peptic ulcer disease. Microflora of patients with CG and GC was represented on 11 species. Microflora of patients with PUD-13 species was more diverse.

关键词： Gastroduodenal Microflora Gastric Cancer Peptic Ulcer Disease Chronic Gastritis H. pylori Candida spp

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