Novel use of endoscopic morcellator to clear large obscuring clot in patient with upper-GI bleed.
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ABSTRACT:
SUBMITTER: Gubatan J
PROVIDER: S-EPMC7003128 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo highlight the basic points of brain endoscopic procedure for Cerebellar and Large Putaminal Hemorrhage to achieve repeatability and reproducibility in the results among the new brain endoscopic surgeons.MethodSharing the experience of 10 years as an endoscopic surgeon to bring out the basic insight into the method, challenges, points which need special attention during the surgery and discussion of recent advancements in the endoscopic equipment for safe surgery.ConclusionProcedure of endoscopic evacuation of brain hematoma is simple with learning curve. In the beginning new endoscopic surgeons should operate in the presence of experience surgeon. They should follow standard technique to achieve the good surgical outcome and uniformity in the result every time they perform the surgery.
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Project description:We represent a fatal case of atrio esophageal fistula that presented as upper GI bleed. The case was complicated by rapidly progressing multi organ dysfunction syndrome and eventual death. This was an iatrogenic complication of an elective procedure.
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Project description:ObjectiveTo highlight the basic points of brain endoscopic procedure for Putaminal Bleed to achieve repeatability and reproducibility in the results among the new brain endoscopic surgeons.MethodSharing the experience of 10 years as an endoscopic surgeon to bring out the basic insight into the method, challenges, points which need special attention during the surgery and discussion of recent advancements in the endoscopic equipment for safe surgery.ConclusionProcedure of endoscopic evacuation of brain hematoma is simple with learning curve. In the beginning new endoscopic surgeons should operate in the presence of experience surgeon. They should follow standard technique to achieve the good surgical outcome and uniformity in the result every time they perform the surgery.
| S-EPMC6417331 | biostudies-literature
Project description:Endoscopic injection of glues, clotting factors, or sclerosing agents is a well-known therapy for the treatment of non-variceal upper gastrointestinal bleeding (NVUGIB), but less is known about endoscopic ultrasound (EUS)-guided treatments. In this setting, literature data are scarce, and no randomized controlled trials are available. We performed a review of the existing literature in order to evaluate the role of EUS-guided therapies in the management of NVUGIB. The most common treated lesions were Dieulafoy's lesions, pancreatic pseudoaneurysms, and gastrointestinal stromal tumors (GISTs). Mostly, the treatments were performed as a salvage option after failure of conventional endoscopic hemostatic attempts, showing good efficacy and a good safety profile, also documented by Doppler monitoring of treated lesions. EUS-guided therapies may be an effective option in the treatment of refractory NVUGIB, thus avoiding radiological or surgical management. Nevertheless, available literature still lacks robust data.
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Project description:Background and aimsSingle-balloon enteroscopy (SBE) is utilized in the evaluation of obscure gastrointestinal bleeding, but 40-50% of these patients experience continued GI blood loss, in part due to missed lesions. The utilization of a transparent cap attached to the end of the endoscope can improve mucosal visualization in other endoscopic applications, but has not yet been evaluated in SBE. The aim of this study was to evaluate the impact of a cap on the diagnostic yield of SBE.MethodsConsecutive adult patients scheduled for anterograde SBE for the evaluation of obscure GI bleeding were screened for inclusion from 2014 to 2017. Patients were randomized to SBE with or without a transparent cap. The primary outcome was the proportion of enteroscopies in which a P2 lesion (high potential for bleeding) was identified.ResultsA total of 90 patients (65.7 ± 12.7 years old, 47.7% female) were analyzed. There were significantly more P2 arteriovenous malformations identified in the cap group (14.8% vs. 0%, p = 0.02). Additionally, the use of a cap was associated with a significantly greater depth of small bowel insertion (191.9 cm vs. 156.2 cm, p = 0.01). There was one perforation in the group without a cap, successfully treated with clip placement, and no adverse events in the cap group.ConclusionsThe use of a transparent cap during SBE performed for the evaluation of obscure gastrointestinal bleeding may be an important, safe augmentation to standard SBE techniques.
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Project description:Video 1Managing endoscopic challenges on the road to resect a largeulcerated gastric GI stromal tumor.
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Project description:Nasogastric (NG) tube is frequently used in clinical practice for a variety of indications; however, NG tubes are not without risks, and there are a multitude of gastrointestinal complications that are associated with their use. Simple precautions can help prevent these NG tube-related injuries.
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Project description:ObjectiveTo develop and validate risk algorithms (QBleed) for estimating the absolute risk of upper gastrointestinal and intracranial bleed for patients with and without anticoagulation aged 21-99 years in primary care.DesignOpen cohort study using routinely collected data from general practice linked to hospital episode statistics data and mortality data during the five year study period between 1 January 2008 and 1 October 2013.Setting565 general practices in England contributing to the national QResearch database to develop the algorithm and 188 different QResearch practices to validate the algorithm. All 753 general practices had data linked to hospital episode statistics and mortality data at individual patient level.EndpointGastrointestinal bleed and intracranial bleed recorded on either the linked mortality data or the linked hospital records.ParticipantsWe studied 4.4 million patients in the derivation cohort with 16.4 million person years of follow-up. During follow-up, 21,641 patients had an incident upper gastrointestinal bleed and 9040 had an intracranial bleed. For the validation cohort, we identified 1.4 million patients contributing over 4.9 million person years of follow-up. During follow-up, 6600 patients had an incident gastrointestinal bleed and 2820 had an intracranial bleed. We excluded patients without a valid Townsend score for deprivation and those prescribed anticoagulants in the 180 days before study entry.Risk factorsCandidate variables recorded on the general practice computer system before entry to the cohort, including personal variables (age, sex, Townsend deprivation score, ethnicity), lifestyle variables (smoking, alcohol intake), chronic diseases, prescribed drugs, clinical values (body mass index, systolic blood pressure), and laboratory test results (haemoglobin, platelets). We also included previous bleed recorded before entry to the study.ResultsThe final QBleed algorithms incorporated 21 variables. When applied to the validation cohort, the algorithms in women explained 40% of the variation for upper gastrointestinal bleed and 58% for intracranial bleed. The corresponding D statistics were 1.67 and 2.42. The receiver operating curve statistic values were 0.77 and 0.86. The sensitivity values for the top 10th of men and women at highest risk were 38% and 51%, respectively. There were similar results for men.ConclusionThe QBleed algorithms provided valid measures of absolute risk of gastrointestinal and intracranial bleed in patients with and without anticoagulation as shown by the performance of the algorithms in a separate validation cohort. Further research is needed to evaluate the clinical outcomes and the cost effectiveness of using these algorithms in primary care.
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Project description:Neoplasms of the small intestine are rare. Leiomyomas are the one of the benign neoplasms that can be found in the small intestine. These lesions usually remain asymptomatic and are often found incidentally; however, they can become symptomatic if obstruction occurs or the tumor outgrows its blood supply resulting mucosa. Their clinical manifestations can include abdominal pain, diarrhea, melena, a palpable abdominal mass and weight loss. Due to their vague presentation, leiomyomas of the small intestine are typically diagnosed after failed conservative therapy for other pathologies such as duodenal ulcers and diverticulosis. This case report describes a 34-year-old male who developed an acute GI bleed due to a symptomatic leiomyoma of the jejunum. He was initially treated with non-operative conservative management; however, his symptoms remained unresolved and he went on to require surgical intervention.
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