There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of th...There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.展开更多
Meckel diverticulum is an embryonic remnant of the Gastrointestinal duct which causes symptoms < 5% in the 2% population. Painless bleeding and abdominal pain are the most often reported symptoms. Dieulafoy lesion/...Meckel diverticulum is an embryonic remnant of the Gastrointestinal duct which causes symptoms < 5% in the 2% population. Painless bleeding and abdominal pain are the most often reported symptoms. Dieulafoy lesion/dieulafoy-like lesion often cause upper gastrointestinal(GI) tract bleeding, but massive lower gastrointestinal bleeding is rare. We reported a 19-year-old male presented massive lower GI tract bleeding caused by Meckel diverticulum synchronous dieulafoy-like lesion.展开更多
BACKGROUND The large majority of gastrointestinal bleedings subside on their own or after endoscopic treatment.However,a small number of these may pose a challenge in terms of therapy because the patients develop hemo...BACKGROUND The large majority of gastrointestinal bleedings subside on their own or after endoscopic treatment.However,a small number of these may pose a challenge in terms of therapy because the patients develop hemodynamic instability,and endoscopy does not achieve adequate hemostasis.Interventional radiology supplemented with catheter angiography(CA)and transarterial embolization have gained importance in recent times.AIM To evaluate clinical predictors for angiography in patients with lower gastrointestinal bleeding(LGIB).METHODS We compared two groups of patients in a retrospective analysis.One group had been treated for more than 10 years with CA for LGIB(n=41).The control group had undergone non-endoscopic or endoscopic treatment for two years and been registered in a bleeding registry(n=92).The differences between the two groups were analyzed using decision trees with the goal of defining clear rules for optimal treatment.RESULTS Patients in the CA group had a higher shock index,a higher Glasgow-Blatchford bleeding score(GBS),lower serum hemoglobin levels,and more rarely achieved hemostasis in primary endoscopy.These patients needed more transfusions,had longer hospital stays,and had to undergo subsequent surgery more frequently(P<0.001).CONCLUSION Endoscopic hemostasis proved to be the crucial difference between the two patient groups.Primary endoscopic hemostasis,along with GBS and the number of transfusions,would permit a stratification of risks.After prospective confirmation of the present findings,the use of decision trees would permit the identification of patients at risk for subsequent diagnosis and treatment based on interventional radiology.展开更多
Introduction: Gastrointestinal endoscopy plays a crucial role in the management of gastrointestinal diseases. The aim of this study was to report the indications and results of lower digestive endoscopy in a hospital ...Introduction: Gastrointestinal endoscopy plays a crucial role in the management of gastrointestinal diseases. The aim of this study was to report the indications and results of lower digestive endoscopy in a hospital center in Senegal. Patients and Methods: We conducted a descriptive retrospective study from September 1<sup>st</sup>, 2017, to September 30, 2018 at the gastrointestinal endoscopy unit of the regional hospital center of Thiès. All patients received for lower gastrointestinal endoscopy and whose reports were usable, were included. In the reports, we collected and analyzed sociodemographic data, indication and results of the endoscopic examination. Results: We included 250 patients. There were 140 men (sex ratio 1.27). The average age was 42 years [range 1 - 92 years]. There were 37 colonoscopies (14.8%), 51 rectosigmoidoscopies (20.4%) and 162 anorectoscopies (64.8%). The patients were from the region of Thiès in 82% of cases. In most cases, they were most often referred by general practitioners (22.8%) and surgeons (20.8%). The main indications were rectal bleeding (36.8%), hemorrhoidal disease (23.2%) and proctalgia (11.6%). Hemorrhoidal disease (63.6%), anal fistula (14%) and tumors (8.8%) were the most common pathologies. Conclusion: Admitted patients at the gastrointestinal endoscopy unit of the regional hospital center of Thiès have many indications as well as pathologies. Anal pathology is dominated by hemorrhoidal disease.展开更多
BACKGROUND Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal bleeding.Contrast extravasation is a prerequisite for successful embolizatio...BACKGROUND Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal bleeding.Contrast extravasation is a prerequisite for successful embolization.Provocative angiography is helpful in the detection of elusive bleeding.AIM We performed a retrospective analysis of angiographic treatment in patients with lower gastrointestinal hemorrhage and initially negative angiographies,as well as the role of norepinephrine(NE)in unmasking bleeding.METHODS We analyzed 41 patients with lower gastrointestinal bleeding after angiography who had undergone treatment over a period of 10 years.All patients had a positive shock index and needed intensive care.RESULTS In three of four patients,angiography disclosed the site of bleeding when NE was used during the procedure for hemodynamic stabilization.CONCLUSION We suggest that angiography performed after the administration of NE in unstable patients with gastrointestinal bleeding and an initially negative angiography has the potential to unmask bleeding sites for successful embolization.However,this statement must be confirmed in prospective studies.展开更多
Introduction： Gastrointestinal Dieulafoy＇s lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We re...Introduction： Gastrointestinal Dieulafoy＇s lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We report a case of a Cecum Dieulafoy＇s bleeding lesion that was managed endoscopically with a favorable outcome. Case report： Female, 70-year-old, diagnosed with type 2 diabetes, hypothyroidism, and chronic heart failure associated with rheumatic mitral stenosis, submitted to biological valve replacement in 2006 and with permanent atrial fibrillation using vitamin K antagonist anticoagulant for thrombosis prophylaxis. Her background includes a stroke in 2004 without any permanent disability. In 2016, the patient experienced voluptuous and painless lower gastrointestinal bleeding with severe acute anemia, requiring hospital admission, fluid resuscitation and blood transfusion. Urgent colonoscopy revealed a small reddish vascular malformation at the cecum with oozing active bleeding, about 3 mm in size. Initially argon plasma coagulation was performed with satisfactory and immediate hemostasis. One week later, she recurred with hematochezia. The lesion at the cecum was reassessed and it was possible to notice a large caliber vessel surrounded by a normal appearance mucosa, compatible with Dieulafoy＇s lesion and it was treated with an endoscopic clip placement with a good long-term response. Conclusion： Endoscopy is the method of choice for diagnosis of Dieulafuy＇s lesion and may provide efficient treatment with mechanical hemostasis such as endoclip placement with a high success rate.展开更多
AIMTo clarify the current state of practice for colonic diverticular bleeding(CDB)in Japan.METHODSWe conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnos...AIMTo clarify the current state of practice for colonic diverticular bleeding(CDB)in Japan.METHODSWe conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnoses(8 questions),treatments(7 questions),and outcomes(4 questions)in 37 hospitals across Japan.The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.RESULTSEndoscopists at all 37 hospitals answered the questions,and the mean number of endoscopists at these hospitals was 12.7.Of all the hospitals,computed tomography was performed before colonoscopy in 67%of the hospitals.The rate of bowel preparation was 46.0%.Early colonoscopy was performed within 24 h in 43.2%of the hospitals.Of the hospitals,83.8%performed clipping as first-line endoscopic therapy.More than half of the hospitals experienced less than 20%rebleeding events after endoscopic hemostasis.No significant difference was observed in the annual number of patients hospitalized for CDB between high-(≥700 beds)and low-volume hospitals.More emergency visits(P=0.012)and endoscopists(P=0.015),and less frequent participation of nursing staff in early colonoscopy(P=0.045)were observed in the high-volume hospitals.CONCLUSIONSome practices unique to Japan were found,such as performing computed tomography before colonoscopy,no bowel preparation,and clipping as first-line therapy.Although,the number of staff differed,the practices for CDB were common irrespective of hospital size.展开更多
目的探讨胶囊内镜(capsule endoscopy,CE)及CT小肠造影(computed tomography enteroclysis,C T E)在不明原因消化道出血(o b s c u r e gastrointestinal bleeding,OGIB)中的诊断价值.方法回顾性分析2011-01/2016-06在南京医科大学第一...目的探讨胶囊内镜(capsule endoscopy,CE)及CT小肠造影(computed tomography enteroclysis,C T E)在不明原因消化道出血(o b s c u r e gastrointestinal bleeding,OGIB)中的诊断价值.方法回顾性分析2011-01/2016-06在南京医科大学第一附属医院诊断为OGIB且先后接受CE和CTE两项检查的70例患者,比较CE和CTE在OGIB患者病变检出率、病因诊断率及两者诊断符合率.结果(1)C E病变检出率、病因诊断率显著高于CTE(90.00%vs 22.86%,P=0.000;61.43%v s 10.00%,P=0.000),两者病变检出符合率仅为27.14%;(2)CE联合CTE病变检出率及病因诊断率均略高于CE,但无显著差异(P>0.05);(3)在显性出血中CE病变检出率高于隐性出血(94.83%vs 66.67%,P=0.015);(4)CE对血管性病变、糜烂/溃疡、憩室的诊断高于CTE(P<0.05),然而,CTE对肠道肿瘤的检出高于CE(4例CTE提示肿瘤后经手术证实者,通过CE仅发现其中2例).结论CE和CTE均是安全、有效的用于OGIB检查方法,CE在OGIB中的诊断率明显优于CTE,两者联合应用价值并不明显优于CE,但对于OGIB患者CE检查无阳性发现者,行CTE检查可成为有益补充,尤其对于小肠肿瘤的发现.展开更多
基金Supported by the Italian Society of Pediatric Gastroenterology,Hepatology and Nutrition
文摘There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.ncbi.nlm.nih.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.
文摘Meckel diverticulum is an embryonic remnant of the Gastrointestinal duct which causes symptoms < 5% in the 2% population. Painless bleeding and abdominal pain are the most often reported symptoms. Dieulafoy lesion/dieulafoy-like lesion often cause upper gastrointestinal(GI) tract bleeding, but massive lower gastrointestinal bleeding is rare. We reported a 19-year-old male presented massive lower GI tract bleeding caused by Meckel diverticulum synchronous dieulafoy-like lesion.
文摘BACKGROUND The large majority of gastrointestinal bleedings subside on their own or after endoscopic treatment.However,a small number of these may pose a challenge in terms of therapy because the patients develop hemodynamic instability,and endoscopy does not achieve adequate hemostasis.Interventional radiology supplemented with catheter angiography(CA)and transarterial embolization have gained importance in recent times.AIM To evaluate clinical predictors for angiography in patients with lower gastrointestinal bleeding(LGIB).METHODS We compared two groups of patients in a retrospective analysis.One group had been treated for more than 10 years with CA for LGIB(n=41).The control group had undergone non-endoscopic or endoscopic treatment for two years and been registered in a bleeding registry(n=92).The differences between the two groups were analyzed using decision trees with the goal of defining clear rules for optimal treatment.RESULTS Patients in the CA group had a higher shock index,a higher Glasgow-Blatchford bleeding score(GBS),lower serum hemoglobin levels,and more rarely achieved hemostasis in primary endoscopy.These patients needed more transfusions,had longer hospital stays,and had to undergo subsequent surgery more frequently(P<0.001).CONCLUSION Endoscopic hemostasis proved to be the crucial difference between the two patient groups.Primary endoscopic hemostasis,along with GBS and the number of transfusions,would permit a stratification of risks.After prospective confirmation of the present findings,the use of decision trees would permit the identification of patients at risk for subsequent diagnosis and treatment based on interventional radiology.
文摘Introduction: Gastrointestinal endoscopy plays a crucial role in the management of gastrointestinal diseases. The aim of this study was to report the indications and results of lower digestive endoscopy in a hospital center in Senegal. Patients and Methods: We conducted a descriptive retrospective study from September 1<sup>st</sup>, 2017, to September 30, 2018 at the gastrointestinal endoscopy unit of the regional hospital center of Thiès. All patients received for lower gastrointestinal endoscopy and whose reports were usable, were included. In the reports, we collected and analyzed sociodemographic data, indication and results of the endoscopic examination. Results: We included 250 patients. There were 140 men (sex ratio 1.27). The average age was 42 years [range 1 - 92 years]. There were 37 colonoscopies (14.8%), 51 rectosigmoidoscopies (20.4%) and 162 anorectoscopies (64.8%). The patients were from the region of Thiès in 82% of cases. In most cases, they were most often referred by general practitioners (22.8%) and surgeons (20.8%). The main indications were rectal bleeding (36.8%), hemorrhoidal disease (23.2%) and proctalgia (11.6%). Hemorrhoidal disease (63.6%), anal fistula (14%) and tumors (8.8%) were the most common pathologies. Conclusion: Admitted patients at the gastrointestinal endoscopy unit of the regional hospital center of Thiès have many indications as well as pathologies. Anal pathology is dominated by hemorrhoidal disease.
文摘BACKGROUND Bleeding in the gastrointestinal tract is common and transarterial embolization enables the clinician to control gastrointestinal bleeding.Contrast extravasation is a prerequisite for successful embolization.Provocative angiography is helpful in the detection of elusive bleeding.AIM We performed a retrospective analysis of angiographic treatment in patients with lower gastrointestinal hemorrhage and initially negative angiographies,as well as the role of norepinephrine(NE)in unmasking bleeding.METHODS We analyzed 41 patients with lower gastrointestinal bleeding after angiography who had undergone treatment over a period of 10 years.All patients had a positive shock index and needed intensive care.RESULTS In three of four patients,angiography disclosed the site of bleeding when NE was used during the procedure for hemodynamic stabilization.CONCLUSION We suggest that angiography performed after the administration of NE in unstable patients with gastrointestinal bleeding and an initially negative angiography has the potential to unmask bleeding sites for successful embolization.However,this statement must be confirmed in prospective studies.
文摘Introduction： Gastrointestinal Dieulafoy＇s lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We report a case of a Cecum Dieulafoy＇s bleeding lesion that was managed endoscopically with a favorable outcome. Case report： Female, 70-year-old, diagnosed with type 2 diabetes, hypothyroidism, and chronic heart failure associated with rheumatic mitral stenosis, submitted to biological valve replacement in 2006 and with permanent atrial fibrillation using vitamin K antagonist anticoagulant for thrombosis prophylaxis. Her background includes a stroke in 2004 without any permanent disability. In 2016, the patient experienced voluptuous and painless lower gastrointestinal bleeding with severe acute anemia, requiring hospital admission, fluid resuscitation and blood transfusion. Urgent colonoscopy revealed a small reddish vascular malformation at the cecum with oozing active bleeding, about 3 mm in size. Initially argon plasma coagulation was performed with satisfactory and immediate hemostasis. One week later, she recurred with hematochezia. The lesion at the cecum was reassessed and it was possible to notice a large caliber vessel surrounded by a normal appearance mucosa, compatible with Dieulafoy＇s lesion and it was treated with an endoscopic clip placement with a good long-term response. Conclusion： Endoscopy is the method of choice for diagnosis of Dieulafuy＇s lesion and may provide efficient treatment with mechanical hemostasis such as endoclip placement with a high success rate.
文摘AIMTo clarify the current state of practice for colonic diverticular bleeding(CDB)in Japan.METHODSWe conducted multicenter questionnaire surveys of the practice for CDB including clinical settings(8 questions),diagnoses(8 questions),treatments(7 questions),and outcomes(4 questions)in 37 hospitals across Japan.The answers were compared between hospitals with high and low number of inpatient beds to investigate which factor influenced the answers.RESULTSEndoscopists at all 37 hospitals answered the questions,and the mean number of endoscopists at these hospitals was 12.7.Of all the hospitals,computed tomography was performed before colonoscopy in 67%of the hospitals.The rate of bowel preparation was 46.0%.Early colonoscopy was performed within 24 h in 43.2%of the hospitals.Of the hospitals,83.8%performed clipping as first-line endoscopic therapy.More than half of the hospitals experienced less than 20%rebleeding events after endoscopic hemostasis.No significant difference was observed in the annual number of patients hospitalized for CDB between high-(≥700 beds)and low-volume hospitals.More emergency visits(P=0.012)and endoscopists(P=0.015),and less frequent participation of nursing staff in early colonoscopy(P=0.045)were observed in the high-volume hospitals.CONCLUSIONSome practices unique to Japan were found,such as performing computed tomography before colonoscopy,no bowel preparation,and clipping as first-line therapy.Although,the number of staff differed,the practices for CDB were common irrespective of hospital size.
文摘目的 探讨大肠、小肠双充盈法肠道CT造影对不明原因消化道出血(OGIB)的诊断价值。方法 回顾40例OGIB患者的临床资料,患者均进行大肠、小肠双充盈法肠道CT造影及胶囊内镜检查,按检查方法分别设为CT组、内镜组,分析大肠、小肠双充盈法肠道CT造影检查的价值。结果 CT组总体病灶检出率为75.00%,显性出血率60.00%、隐性出血率40.00%,内镜组总体病灶检出率为85.00%,显性出血率67.65%、隐性出血率32.35%, 2组无显著差异( P >0.05)。CT组敏感度、特异度分别为61.54%、85.71%,内镜组敏感度、特异度分别为76.00%、73.33%,组间差异显著( P <0.05)。结论 大肠、小肠双充盈法肠道CT造影对OGIB具有明显的诊断效果。
文摘目的探讨胶囊内镜(capsule endoscopy,CE)及CT小肠造影(computed tomography enteroclysis,C T E)在不明原因消化道出血(o b s c u r e gastrointestinal bleeding,OGIB)中的诊断价值.方法回顾性分析2011-01/2016-06在南京医科大学第一附属医院诊断为OGIB且先后接受CE和CTE两项检查的70例患者,比较CE和CTE在OGIB患者病变检出率、病因诊断率及两者诊断符合率.结果(1)C E病变检出率、病因诊断率显著高于CTE(90.00%vs 22.86%,P=0.000;61.43%v s 10.00%,P=0.000),两者病变检出符合率仅为27.14%;(2)CE联合CTE病变检出率及病因诊断率均略高于CE,但无显著差异(P>0.05);(3)在显性出血中CE病变检出率高于隐性出血(94.83%vs 66.67%,P=0.015);(4)CE对血管性病变、糜烂/溃疡、憩室的诊断高于CTE(P<0.05),然而,CTE对肠道肿瘤的检出高于CE(4例CTE提示肿瘤后经手术证实者,通过CE仅发现其中2例).结论CE和CTE均是安全、有效的用于OGIB检查方法,CE在OGIB中的诊断率明显优于CTE,两者联合应用价值并不明显优于CE,但对于OGIB患者CE检查无阳性发现者,行CTE检查可成为有益补充,尤其对于小肠肿瘤的发现.
