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gastrointestinal bleeding in patients on novel oral anticoagulants:Risk,prevention and management

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World Journal of Gastroenterology 2017年第11期23卷 1954-1963页

作者： Ka-Shing Cheung Wai K Leung Department of Medicine The University of Hong KongQueen Mary HospitalHong KongChina

Novel oral anticoagulants(NOACs), which include direct thrombin inhibitor(dabigatran) and direct factor Xa inhibitors(rivaroxaban, apixaban and edoxaban), are gaining popularity in the prevention of embolic stroke in non-valvular atrial fibrillation as well as in the prevention and treatment of venous thromboembolism. However, similar to traditional anticoagulants, NOACs have the side effects of bleeding, including gastrointestinal bleeding(GIB). Results from both randomized clinical trials and observations studies suggest that high-dose dabigatran(150 mg b.i.d), rivaroxaban and high-dose edoxaban(60 mg daily) are associated with a higher risk of GIB compared with warfarin. Other risk factors of NOAC-related GIB include concomitant use of ulcerogenic agents, older age, renal impairment, Helicobacter pylori infection and a past history of GIB. Prevention of NOAC-related GIB includes proper patient selection, using a lower dose of certain NOACs and in patients with renal impairment, correction of modifiable risk factors, and prescription of gastroprotective agents. Overt GIB can be managed by withholding NOACs followed by delayed endoscopic treatment. In severe bleeding, additional measures include administration of activated charcoal, use of specific reversal agents such as idarucizumab for dabigatran and andexanent alfa for factor Xa inhibitors, and urgent endoscopic management.

关键词： Warfarin Endoscopy Apixaban Edoxaban gastrointestinal bleeding Dabigatran Rivaroxaban Novel anticoagulants

Brunner’s gland hyperplasia associated with lipomatous pseudohypertrophy of the pancreas presenting with gastrointestinal bleeding:A case report

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World Journal of Clinical Cases 2021年第31期9卷 9670-9679页

作者： Long Cong Nguyen Khanh Truong Vu Trang Thi Thuy Vo Chau Ha Trinh Tan Dang Do Ngoc Thi Van Pham Tuyen Van Pham Thanh Tuan Nguyen Hiep Canh Nguyen Jeong-Sik Byeon Gastroenterology and Hepatology Center Bach Mai HospitalHanoi 10000Viet Nam Department of Gastroenterology School of Medicine and PharmacyVietnam National University HanoiHanoi 10000Viet Nam Radiology Center Bach Mai HospitalHanoi 10000Viet Nam Pathology Center Bach Mai HospitalHanoi 10000Viet Nam Department of Human Pathology Kanazawa University Graduate School of MedicineKanazawa 920-8640Japan Department of Gastroenterology Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea

BACKGROUND Brunner’s gland hyperplasia(BGH)is a rare benign lesion of the *** pseudohypertrophy(LiPH)of the pancreas is an extremely rare *** each condition is rare,the probability of purely coincidental coexistence of both conditions is extremely *** SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal *** gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the *** examination of the duodenal biopsy specimens showed ***,abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas,confirmed by histopathological evaluation on percutaneous pancreatic *** on the radiological and histological findings,LiPH of the pancreas and BGH were *** patient refused any surgical ***,he was managed with supportive *** patient’s symptoms improved and there was no further *** This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.

关键词： Lipomatous pseudohypertrophy Pancreas gastrointestinal bleeding Brunner’s gland Case report

Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization:a case report and literature review

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2013年第6期14卷 549-554页

作者： Zhi-yu LI Bin LI Yu-lian WU Qiu-ping XIE Department of Surgery the Second Affiliated HospitalSchool of MedicineZhejiang University

Left-sided portal hypertension(LSPH)followed by acute pancreatitis is a rare condition with most patients being *** cases where gastrointestinal(GI)bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this *** patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography(CT)scan and *** embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe *** conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

关键词： Left-sided portal hypertension(LSPH) Gastric varices Acute pancreatitis gastrointestinal bleeding Splenic artery embolization(SAE)

High-dose vs low-dose proton pump inhibitors for upper gastrointestinal bleeding:A meta-analysis

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World Journal of Gastroenterology 2010年第20期16卷 2558-2565页

作者： Wu, Liu-Cheng Cao, Yun-Fei Huang, Jia-Hao Liao, Cun Gao, Feng Guangxi Med Univ Dept Colorectal & Anal Surg Affiliated Hosp 1 Nanning 530021 Guangxi Zhuang Peoples R China

AIM:To evaluate the efficacy of high-dose proton pump inhibitors(PPIs)vs low-dose PPIs for patients with upper gastrointestinal ***:PubMed,Embase,the Cochrane Library,and Web of Science were searched to identify relevant randomized controlled trials(RCTs).Eligible trials were RCTs that compared high-dose PPI with low-dose PPI following endoscopic *** primary endpoint was rebleeding;secondary endpoints were patient numbers that needed surgery,and *** meta-analysis was performed with a fixed effects model or random effects ***:Nine eligible RCTs including 1342 patients were *** results showed that high-dose intravenous PPI was not superior to low-dose intra-venous PPI in reducing rebleeding[odds ratio(OR)= 1.091,95%confidential interval(CI):0.777-1.532],need for surgery(OR=1.522,95%CI:0.643-3.605) and mortality(OR=1.022,95%CI:0.476-2.196).Subgroup analysis according to different region revealed no difference in rebleeding rate between Asian patients(OR=0.831,95%CI,0.467-1.480)and European patients(OR=1.263,95%CI:0.827-1.929).CONCLUSION:Low-dose intravenous PPI can achieve the same efficacy as high-dose PPI following endoscopic hemostasis.

关键词： Meta-analysis High-dose Low-dose Proton pump inhibitors gastrointestinal bleeding

Klippel-Trenaunay syndrome with gastrointestinal bleeding,splenic hemangiomas and left inferior vena cava

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World Journal of Gastroenterology 2010年第12期16卷 1548-1552页

作者： Wang, Zhen-Kai Wang, Fang-Yu Zhu, Ren-Min Liu, Jiong Nanjing Mil Command Chinese PLA Nanjing Cent Hosp Dept Gastroenterol Nanjing 210002 Jiangsu Prov Peoples R China

Klippel-Trenaunay syndrome is a congenital vascular anomaly characterized by a triad of varicose veins,cutaneous capillary malformation,and hypertrophy of bone and(or)soft *** vascular malformations in Klippel-Trenaunay syndrome may present with gastrointestinal *** majority of patients with spleenic hemangiomatosis and/or left inferior vena cava are *** herein report a case admitted to the gastroenterology clinic with life-threatening hematochezia and symptomatic iron deficiency *** to the asymptomatic mild intermittent hematochezia,splenic hemangiomas and left inferior vena cava,the patient did not seek any help for gastrointestinal bleeding until his admittance to our department for evaluation of massive gastrointestinal *** was referred to angiography because of his serious pathogenetic condition and inefficiency of medical *** method showed that hemostasis was successfully achieved in the hemorrhage site by embolism of corresponding *** endoscopy revealed vascular malformations starting from the stomach to the descending *** the other hand,computed tomography revealed splenic hemangiomas and left inferior vena *** the best of our knowledge,this is the first Klippel-Trenaunay syndrome case presenting with gastrointestinal bleeding,splenic hemangiomas and left inferior vena *** literature on the evaluation and management of this case is reviewed.

关键词： Klippel-Trenaunay syndrome gastrointestinal bleeding Splenic hemangiomas Left inferior vena cava

One in four patients with gastrointestinal bleeding develops shock or hemodynamic instability:A systematic review and meta-analysis

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World Journal of Gastroenterology 2023年第28期29卷 4466-4480页

作者： Mahmoud Obeidat Brigitta Teutsch Anett Rancz Edina Tari Katalin Márta Dániel Sándor Veres Nóra Hosszúfalusi Emese Mihály Péter Hegyi Bálint Erőss Centre for Translational Medicine Semmelweis UniversityBudapest 1085Hungary Institute for Translational Medicine Medical SchoolUniversity of PécsPécs 7623Hungary Department of Internal Medicine and Hematology Semmelweis UniversityFaculty of MedicineBudapest 1085Hungary Institute of Pancreatic Diseases Semmelweis UniversityBudapest 1083Hungary Department of Biophysics and Radiation Biology Semmelweis UniversityBudapest 1085Hungary

BACKGROUND Hemodynamic instability and shock are associated with untoward outcomes in gastrointestinal ***,there are no studies in the existing literature on the proportion of patients who developed these outcomes after gastrointestinal *** To determine the pooled event rates in the available literature and specify them based on the bleeding *** The protocol was registered on PROSPERO in advance(CRD42021283258).A systematic search was performed in three databases(PubMed,EMBASE,and CENTRAL)on 14^(th) October *** proportions with 95%CI were calculated with a random-effects model.A subgroup analysis was carried out based on the time of assessment(on admission or during hospital stay).Heterogeneity was assessed by Higgins and Thompson’s I^(2) *** Joanna Briggs Institute Prevalence Critical Appraisal Tool was used for the risk of bias *** Reference Citation Analysis(https://***/)tool was applied to obtain the latest highlight *** We identified 11589 records,of which 220 studies were eligible for data *** overall proportion of shock and hemodynamic instability in general gastrointestinal bleeding patients was 0.25(95%CI:0.17-0.36,I^(2)=100%).In non-variceal bleeding,the proportion was 0.22(95%CI:0.14-0.31,I^(2)=100%),whereas it was 0.25(95%CI:0.19-0.32,I^(2)=100%)in variceal *** proportion of patients with colonic diverticular bleeding who developed shock or hemodynamic instability was 0.12(95%CI:0.06-0.22,I^(2)=90%).The risk of bias was low,and heterogeneity was high in all *** One in five,one in four,and one in eight patients develops shock or hemodynamic instability on admission or during hospitalization in the case of non-variceal,variceal,and colonic diverticular bleeding,respectively.

关键词： gastrointestinal bleeding Hemodynamic instability Shock Meta-analysis Statistics Review

Does endoscopic intervention prevent subsequent gastrointestinal bleeding in patients with left ventricular assist devices?A retrospective study

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World Journal of Gastroenterology 2021年第25期27卷 3877-3887页

作者： Sonali Palchaudhuri Ishita Dhawan Afshin Parsikia Edo Y Birati Joyce Wald Shazia Mehmood Siddique Laurel R Fisher Division of Gastroenterology and Hepatology University of PennsylvaniaPhiladelphiaPA 19104United States Division of Cardiovascular Medicine University of PennsylvaniaPhiladelphiaPA 19104United States

BACKGROUND Patients with left ventricular assist devices(LVADs)are at increased risk for recurrent gastrointestinal bleeding(GIB)and repeat endoscopic *** assessed the frequency of endoscopy for GIB in patients with LVADs and the impact of endoscopic intervention on preventing a subsequent *** To evaluate for an association between endoscopic intervention and subsequent *** aims were to assess the frequency of GIB in our cohort,describe GIB presentations and sources identified,and determine risk factors for recurrent *** We conducted a retrospective cohort study of all patients at a large academic institution who underwent LVAD implantation from January 2011–December 2018 and assessed all hospital encounters for GIB through December *** performed a descriptive analysis of the GIB burden and the outcome of endoscopic procedures *** performed multivariate logistic regression to evaluate the association between endoscopic intervention and subsequent *** In the cohort of 295 patients,97(32.9%)had at least one GIB hospital *** were 238 hospital encounters,with 55.4%(132/238)within the first year of LVAD *** resolved on its own by discharge in 69.8%(164/235)*** GIB occurred in 55.5%(54/97)of patients,accounting for 59.2%(141/238)of all *** the 85.7%(204/238)of encounters that included at least one endoscopic evaluation,an endoscopic intervention was performed in 34.8%(71/204).The adjusted odds ratio for subsequent GIB if an endoscopic intervention was performed during a GIB encounter was not significant(odds ratio 1.18,P=0.58).CONCLUSION Patients implanted with LVADs whom experience recurrent GIB frequently undergo repeat admissions and endoscopic *** this retrospective cohort study,adherence to endoscopic guidelines for performing endoscopic interventions did not significantly decrease the odds of subsequent GIB,thus suggesting the uniqueness of the LVAD pop

关键词： gastrointestinal bleeding Left ventricular-assist device Endoscopic intervention,Inpatient care Hospital readmissions Recurrent bleeding

Rare causes of acute non-variceal upper gastrointestinal bleeding: A comprehensive review

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World Journal of Gastroenterology 2023年第27期29卷 4222-4235页

作者： Alberto Martino Marco Di Serafino Luigi Orsini Francesco Giurazza Roberto Fiorentino Enrico Crolla Severo Campione Carlo Molino Luigia Romano Giovanni Lombardi Department of Gastroenterology and Digestive Endoscopy AORN“Antonio Cardarelli”Naples 80131Italy Department of General and Emergency Radiology AORN“Antonio Cardarelli”Naples 80131Italy Department of Interventional Radiology AORN“Antonio Cardarelli”Naples 80131Italy Department of Oncology AORN“Antonio Cardarelli”Naples 80131Italy Department of Oncological Surgery AORN“Antonio Cardarelli”Naples 80131Italy Department of Pathology AORN“Antonio Cardarelli”Naples 80131Italy

Non-variceal upper gastrointestinal bleeding(NVUGIB)is a common gastroenterological emergency associated with significant morbidity and *** and other involved clinicians are generally assisted by international guidelines in its ***,NVUGIB due to peptic ulcer disease only is mainly addressed by current guidelines,with upper gastrointestinal endoscopy being recommended as the gold standard modality for both diagnosis and ***,the management of rare and extraordinary rare causes of NVUGIB is not covered by current *** they are frequently lifethreatening conditions,all the involved clinicians,that is emergency physicians,diagnostic and interventional radiologists,surgeons,in addition obviously to gastroenterologists,should be aware of and familiar with their ***,they typically require a prompt diagnosis and treatment,engaging a dedicated,patient-tailored,multidisciplinary team *** aim of our review was to extensively summarize the current evidence with regard to the management of rare and extraordinary rare causes of NVUGIB.

关键词： gastrointestinal bleeding Upper gastrointestinal bleeding Non-variceal upper gastrointestinal bleeding Rare causes Vascular causes Upper endoscopy

First-line endoscopic treatment with over-the-scope clips significantly improves the primary failure and rebleeding rates in high-risk gastrointestinal bleeding: A single-center experience with 100 cases

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World Journal of Gastroenterology 2016年第41期22卷 9162-9171页

作者： Hans-Jürgen Richter-Schrag Torben Glatz Christine Walker Andreas Fischer Robert Thimme Center of Interdisciplinary gastrointestinal Endoscopy Department of Medicine II Medical Center-University of Freiburg Faculty of Medicine University of Freiburg Department of General and Visceral Surgery Medical Center-University of Freiburg Faculty of Medicine University of Freiburg

AIM To evaluate rebleeding, primary failure(PF) and mortality of patients in whom over-the-scope clips(OTSCs) were used as first-line and second-line endoscopic treatment(FLET, SLET) of upper and lower gastrointestinal bleeding(UGIB, LGIB).METHODS A retrospective analysis of a prospectively collected database identified all patients with UGIB and LGIB in a tertiary endoscopic referral center of the University of Freiburg, Germany, from 04-2012 to 05-2016(n= 93) who underwent FLET and SLET with OTSCs. The complete Rockall risk scores were calculated from patients with UGIB. The scores were categorized as bleeding after OTSC *** Primary hemostasis and clinical success of bleeding lesions(without rebleeding) was achieved in 88/100(88%) and 78/100(78%), respectively. PF was significantly lower when OTSCs were applied as FLET compared to SLET(4.9% vs 23%, P = 0.008). In multivariate analysis, patients who had OTSC placement as SLET had a significantly higher rebleeding risk compared to those who had FLET(OR 5.3; P = 0.008). Patients with Rockall risk scores ≥ 7 had a significantly higher in-hospital mortality compared to those with scores bleeding and rebleeding-associated *** Our data show for the first time that FLET with OTSC might be the best predictor to successfully prevent rebleeding of gastrointestinal bleeding compared to SLET. The type of treatment determines the success of primary hemostasis or primary failure.

关键词： gastrointestinal bleeding Rockall risk score Over-the-scope clip First-line endoscopic treatment Second-line endoscopic treatment