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Endoscopic clipping for the secondary prophylaxis of bleeding gastric varices in a patient with cirrhosis:A case report

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World Journal of Clinical Cases 2022年第4期10卷 1447-1453页

作者： Guang-Chao Yang Ya-Xian Mo Wei-Hua Zhang Li-Bin Zhou Xu-Ming Huang Li-Ming Cao Department of Gastroenterology Shenzhen Shiyan People's HospitalShenzhen 518000Guangdong ProvinceChina Department of Internal Medicine Shenzhen University The First Affiliated HospitalShenzhen 518000Guangdong ProvinceChina

BACKGROUND Bleeding from gastroesophageal varices(GOV)is a serious complication in patients with liver cirrhosis,carrying a very high mortality rate.For secondary prophylaxis against initial and recurrent bleeding,endoscopic therapy is a critical intervention.Endoscopic variceal clipping for secondary prophylaxis in adult GOV has not been reported.CASE SUMMARY A 66-year-old man with cirrhosis was admitted to our hospital complaining of asthenia and hematochezia for 1 wk.His hemoglobin level and red blood cell counts were significantly decreased,and his fecal occult blood test was positive.An enhanced computed tomography of the abdomen showed GOV.The patient was diagnosed with hepatitis B cirrhosis-related GOV bleeding.A series of palliative treatments were administered,resulting in significant clinical improvement.Subsequently,an endoscopic examination revealed severe gastric fundal varices,prompting endoscopic variceal clipping.There were no further episodes of gastrointestinal bleeding.The GOV improved significantly on follow-up imaging and was confirmed as improved on endoscopy at the 5th post-operative month.CONCLUSION Our results suggest that endoscopic clipping is an inexpensive,safe,easy,effective,and tolerable method for the secondary prophylaxis of bleeding from gastric type 2 GOV.However,additional research is indicated to confirm its longterm safety and efficacy.

关键词： Endoscopy Metal clips Gastric varices Endoscopic variceal clipping secondary prophylaxis Case report

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Do statins reduce the mortality rate in stroke patients treated with systemic thrombolysis in a 5-year single-center study?

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Neural Regeneration Research 2021年第9期16卷 1807-1812页

作者： Toralf Brüning Mohamed Al-Khaled Department of Neurology University Medical Center Schleswig-HolsteinCampus LübeckLübeckGermany

The present study investigated the association between pre-treatment with a cholesterol-lowering drug(statin) or new setting hereon and the effect on the mortality rate in patients with acute ischemic stroke who received intravenous systemic thrombolysis. During a 5-year period(starting in October 2008), 542 consecutive stroke patients who received intravenous systemic thrombolysis with recombinant tissue plasminogen activator(rt-PA) at the Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany, were included. Patients were characterized according to statins. The primary endpoint was mortality;it was assessed twice: in hospital and 3 months after discharge. The secondary outcome was the rate of symptomatic intracerebral hemorrhage. Of the 542 stroke patients examined(mean age 72 ± 13 years;51% women, mean National Institutes of Health Stroke Scale(NIHSS) score 11), 138 patients(25.5%) had been pretreated with statin, while in 190 patients(35.1%) statin therapy was initiated during their stay in hospital, whereas 193(35.6%) never received statins. Patients pre-treated with statin were older and more frequently had previous illnesses(arterial hypertension, diabetes mellitus and previous cerebral infarctions), but were comparably similarly affected by the stroke(NIHSS 11 vs. 11;P = 0.76) compared to patients who were not on statin treatment at the time of cerebral infarction. Patients pretreated with statin did not differ in 3-month mortality from those newly treated to a statin(7.6% vs. 8%;P = 0.9). Interestingly, the group of patients pretreated with statin showed a lower rate of in hospital mortality(6.6% vs. 17.0;P = 0.005) and 3-month mortality(10.7% vs. 23.7%;P = 0.005) than the group of patients who had no statin treatment at all. The same effect was seen for patients newly adjusted to a statin during the hospital stay compared to patients who did not receive statins(3-month mortality: 7.1% vs. 23.7%;P < 0.001). With a good functional outcome(mRS ≤ 2), 60% of patients were dis

关键词： acute ischemic stroke hemorrhage mortality outcome secondary prophylaxis statins stroke systemic thrombolysis

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Defining the advantages and exposing the limitations of endoscopic variceal ligation in controlling acute bleeding and achieving complete variceal eradication

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World Journal of Gastrointestinal Endoscopy 2020年第10期12卷 365-377页

作者： Jake Krige Eduard Jonas Urda Kotze Christo Kloppers Karan Gandhi Hisham Allam Marc Bernon Sean Burmeister Mashiko Setshedi Departments of Surgery and Medicine University of Cape Town Health Sciences FacultyCape Town 7925South Africa Department of Surgery University of Cape Town Health Sciences FacultyCape Town 7925South Africa

BACKGROUND Bleeding esophageal varices(BEV)is a potentially life-threatening complication in patients with portal hypertension with mortality rates as high as 25%within six weeks of the index variceal bleed.After control of the initial bleeding episode patients should enter a long-term surveillance program with endoscopic intervention combined with non-selectiveβ-blockers to prevent further bleeding and eradicate EV.AIM To assess the efficacy of endoscopic variceal ligation(EVL)in controlling acute variceal bleeding,preventing variceal recurrence and rebleeding and achieving complete eradication of esophageal varices(EV)in patients who present with BEV.METHODS A prospectively documented single-center database was used to retrospectively identify all patients with BEV who were treated with EVL between 2000 and 2018.Control of acute bleeding,variceal recurrence,rebleeding,eradication and survival were analyzed using Baveno assessment criteria.RESULTS One hundred and forty patients(100 men,40 women;mean age 50 years;range,21-84 years;Child-Pugh grade A=32;B=48;C=60)underwent 160 emergency and 298 elective EVL interventions during a total of 928 endoscopy sessions.One hundred and fourteen(81%)of the 140 patients had variceal bleeding that was effectively controlled during the index banding procedure and never bled again from EV,while 26(19%)patients had complicated and refractory variceal bleeding.EVL controlled the acute sentinel variceal bleed during the first endoscopic intervention in 134 of 140 patients(95.7%).Six patients required balloon tamponade for control and 4 other patients rebled in hospital.Overall 5-d endoscopic failure to control variceal bleeding was 7.1%(n=10)and four patients required a salvage transjugular intrahepatic portosystemic shunt.Index admission mortality was 14.2%(n=20).EV were completely eradicated in 50 of 111 patients(45%)who survived>3 mo of whom 31 recurred and 3 rebled.Sixteen(13.3%)of 120 surviving patients subsequently had 21 EV rebleeding episodes and 10 patients bled from othe

关键词： Endoscopy Variceal ligation Variceal bleeding secondary prophylaxis Esophageal varices Variceal recurrence

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