Ulcer Bleeding Research Articles

Self-propelling thrombin powder enables hemostasis with no observable rebleeding or thrombosis over three days in a porcine model of upper gastrointestinal bleeding.

Hemostatic powders used to manage upper gastrointestinal bleeding continue to exhibit high rebleeding rates. Previously, self-propelling thrombin powder (SPTP) sprayed endoscopically managed severe Forrest Class 1A bleeds. Here, we evaluate SPTP in a 3-day recovery model of diffuse ulcerated bleeding. Five anesthetized pigs underwent an endoscopic mucosal snare resection to trigger a diffuse ulcer bleed and were treated with SPTP. The time to hemostasis and the amount of powder delivered were measured. Pigs were recovered and monitored. Pigs achieved hemostasis in 4.5 +/- 1.2 min (mean +/- SEM; n=5). At 3 days post-procedure, rescope showed no rebleeding in any animals. Measured blood parameters were not significantly different from baseline. There were no signs of foreign bodies or thromboembolism during gross necropsy and histopathology of key organs. SPTP is a promising novel material that stopped diffuse ulcer bleeds in 5 pigs without rebleeding or adverse local or systemic events.

Optimization of treatment of vulvar scleroatrophic lichen with using modern laser technologies

Background. Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis, which is characterized by focal skin atrophy of the vulva and mucous membranes. It leads to deformation of the perineum. The prevalence of VLS in children is up to 0.1%, among the adults — 3%. The average age of the first symptoms appearance in girls is 5.4 years, in women — 55.1 years. The diagnosis of VLS is made on the base of anamnesis, assessment of pubertal development, physical examination of the external genitalia, advanced vulvoscopy and vaginoscopy, bacteriological, bacterioscopic and cytological studies of vaginal wet mount, assessment of the hormonal profile. The treatment methods include high-potency steroids as the initial treatment, usage of diode, fractional CO2 and erbium lasers with different wavelengths and injections of platelet-rich plasma to improve the regeneration processes of the affected tissue by improving collagenogenesis, vasculogenesis, production of proteoglycans and glycoproteins.
 The aim of the study is to compare the effectiveness of photodestruction with a manual diode laser of the Dornier Medilas D LiteBeam, wavelength of 940 nm, minimum power in pulsed mode on the girls’ vulva mucosa with various types of VLS during neutral and preadolescent age. To obtain the results there were analyzed criteria including the size of the lesion after photodestruction therapy, the disappearance of cracks and angiomatosis in the LS area. The objectives of the complex therapy of VLS in girls were elimination of itching, decrease of the inflammatory changes, improvement of the skin and mucosa blood supply, and stimulation of local immunological mechanisms.
 Materials and methods. The study was conducted on the base of the gynecological department of Russian Children’s Clinical Hospital. The effectiveness of the laser-induced thermotherapy with a wavelength of 940 nm, minimum power in pulsed mode on the vulva of VLS girls of neutral and preadolescent periods as a part of the complex therapy was evaluated. Ninety 5 to 13 year VLS patients took part in the trial. They were divided into 3 groups. The first group included 30 patients (average age 7.5 ± 1.1) with atrophic form of lichen treated with a laser with a wavelength of 940 nm. The second group consisted of 30 patients (average age 6.8 ± 1.3) with erythematous-edematous lichen, who were treated with a laser with a wavelength of 635 nm. The third group included 30 patients (average age 7.3 ± 1.2) with erosive and ulcerative form of VLS, who received high-potency corticosteroids therapy. 
 Results. The treatment results in the three subgroups of VLS patients show a diode laser with a wavelength of 940 nm therapy to be the most effective. After the first treatment course 27 (90%) patients in the first group showed a positive trend with a decrease in itching and burning, pink-color presence in vulva mucousа, a decrease of the skin pigmentation area and an increase in the elasticity of the skin. After 2 courses, 29 (96.7%) patients had positive trend. The second most effective method of treatment is photodestruction with a 635 nm wavelength laser. After the 4 courses (two hospitalisations), 25 (83,3%) patients noted a decrease in itching and in a “tightening” feeling. In 24 (80%) patients there was an improvement in the condition of the mucous membranes of the vulva. Reduction of edema was observed in 23 (76.7%) patients by the time of an examination in 3 weeks after the last therapy course. However, it was not possible to completely restore the mucous membranes of the vulva in patients of this group. The least effective — drug therapy with high-potency steroids. 8 (26.7%) patients noted positive dynamics only by the 4th day therapy, 11 (36,7%) by the time of the 3 weeks after the initial application of the ointment, 12 (40%) by the 2nd month. In 5 (16.7%) patients, the visible condition of the mucous membranes did not change, the number of bleeding ulcers decreased minimally.
 Conclusions. The results of the trial indicate the high efficiency of laser therapy of VLS in children compared with the topical glucocorticoids treatment. The duration of the therapy and condition of the external genitalia after treatment depends on the histological form and stage of VLS. According to our study, laser therapy contributes to the remission onset in pediatric patients with different types of VLS in the shortest possible time after the photodestruction procedure.

A Comparison Between the Effectiveness of Isoamyl 2-Cyanoacrylate Tissue Adhesive and Silk Sutures in Wound Closure Following Minor Oral Surgical Procedures: A Prospective Clinical Study.

Background In order to maintain the surgery site's shape, functionality, and aesthetics, closure of the wound is essential for intra-oral and general surgical procedures. Wound closure speeds up healing by reducing the buildup of inflammatory cells. For a wound to heal well, the incision must be precise, the tissue must be handled delicately, the wound must be precisely repositioned, and the closure material must have optimum functional properties and be sterile. Aim This study aims to conduct a clinical comparison of the effectiveness of silk suture versus isoamyl 2-cyanoacrylate (IAC) for intra-oral mucosal incisions. Methodology Fifty patients who needed a minor oral surgical operation under local anesthesia from the Department of Oral and Maxillofacial Surgery were recruited for this prospective clinical trial.Ethical clearance and informed consent were obtained for this study. Two groups were created from the sample of 50 patients in this investigation. An intra-oral mucosal incision was closed in one group using a 3-0 silk suture and in the second using two drops of IAC. An accurate approximation of the incised edges was used to avoid leaving any gaps between them. Parameters such as the time taken for closure, pain, bleeding, swelling, mouth opening, wound dehiscence, wound infection, and local ulceration were evaluated in this study. A visual analogscale (0-10) was used to assess the pain score. Facial swelling was evaluated by the tape method given by Gabka and Matsumura. The measurement was done from tragus to pogonion, tragus to oral commissure, and outer canthus to gonion. The sum of these measurements was calculated. By measuring the distance between the incisal edges of the upper and lower central incisors, the trismus was evaluated using a graduated metal scale. Assessment of bleeding (0-4) was done by asking the patient. Assessment of wound dehiscence and local ulceration was done based on visual inspection and palpation on the first, second, and seventh days postoperatively. All the recorded parameters were tabulated. The statistical analysis was done using SPSS version 25.0 (IBM Corp., Armonk, NY). The Chi-square test was used to compare the categorical variables between the study groups. The independent t-test was used to compare the means between the study groups. The statistical significance was kept at a p-value less than 0.05. Results The results showed that there was no statistically significant difference between suture and IAC in terms of incidence of pain and wound dehiscence. Butthe time taken for wound closure was less with IAC, and the pain score on the seventh day was higher with IAC and statistically significant. Conclusion We observed that IAC was as effective as the gold standard silk suture. The advantages of IAC are its hemostatic and bacteriostatic qualities, and IAC also took less time to complete the procedure.

Surgical treatment of acute complicated duodenal ulcers

Complications of peptic ulcer of the stomach and duodenum are an integral part of urgent abdominal surgery. This especially applies to complications of duodenal ulcers (DU), which, in turn, is associated with a combination of several complications and problems with the choice of surgical tactics for their treatment. This is supported by postoperative mortality rates, which remain high and range from 15.0% to 68.0% according to various sources. The aim was to improve the results of treatment of complicated duodenal ulcers. The results of the analysis of surgical treatment of acutely complicated duodenal ulcers (combination of 3 and/or 4 combined complications) for 2 periods are presented: 1st – from 2000 to 2014 (group A) – 69 patients; 2nd – from 2015 to 2022 (group B) – 50 patients. 119 (100.0%) patients were operated on for complicated duodenal ulcers, of which 101 (84.9%) patients had a combination of three complications, and 18 (15.1%) – four complications. Out of 119 patients, 106 (89.1%) had bleeding complications. Complications of ulcer perforation in 53 (44.5%). Based on the obtained analysis data, there is a steady trend towards an increase in the rate of organ-preserving operations by 1.62 times (from 50.7% to 82%), a decrease in the number of gastric resections by 2.7 times (from 15.9 % to 6%). The number of performed organ-sparing operations was relatively stable: in group A – 15 (21.7%), in group B – 10 (20%). The use of modern measures of endoscopic hemostasis made it possible to implement a system of preparing patients for surgery, to operate on patients in the early delayed period, and their share from the first period to the second increased by 3.2 times (from 5.7% to 18.3%). The number of patients who underwent emergency surgery with ulcer perforation and bleeding as combined complications decreased in the second period compared to the first by 2.8 times, which is associated with the widespread use of mo­dern proton pump inhibitors in the conservative treatment of DU. Actively individualized tactics and the use of developed algorithms for choosing the type of surgical intervention made it possible to reduce the mortality rate by almost 2 times: from 16.8% in the first period (group A) to 8.9% in the second period (group B). Keywords: perforation, bleeding, stenosis, penetration, vagotomy, gastric resection.

What lies beneath a maggot infestation of an ulcerated foot wound?

We present here the case of a 55-year-old male patient with a past medical history of HIV infection on appropriate antiretroviral therapy (Bictegravir/Emtricitabine/Tenofovir Alafenamide), previously treated for hepatitis C with sustained viral response, who was diagnosed with squamous cell cancer of his right hand 2 years before, and treated with carboplatin and taxol, and surgery (partial amputation) for cancer progression and recurrent infections. He presented to our emergency department for worsening pain (NRS 10/10) of a suppurative and foul-smelling interdigital ulcerated lesion of his left foot, that had been present for 3 months. He reported 100% adherence to his HIV therapy and denied fever or chills. Initial work-up showed 10,690/mm3 leukocytes (8,240/ mm3 neutrophils, 1,560/mm3 lymphocytes), and a C-reactive protein of 2.89 mg/dL (normal value 0-0.5). CD4 count on presentation was 225 cells/µL. The patient was immediately treated with morphine (10 mg iv) and piperacillin/tazobactam (4.5 gr iv). The lesion presented erythematous ulcerated bleeding surface with serous and fetid secretion on which mobile larvae were found inside (as showed in the video). We removed about 20 maggots with blunt pliers, identified as larvae of Musca domestica (housefly).

Association between psychological stress, anxiety and oral health status among college students during the Omicron wave: a cross-sectional study

BackgroundWithin 3 years of the COVID-19 pandemic, increasing interest has been given to its potential influence on health status due to lockdowns caused by the pandemic. However, the impact is inadequately understood, especially for college students. This study aimed to investigate the potential association between psychological stress, anxiety and oral health of college students during the Omicron wave of the COVID-19 pandemic.MethodsAn online survey with measurements of psychological stress, anxiety and oral health was completed by 1770 Chinese college students. The Perceived Stress Scale-14 (PSS-14) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure psychological stress and anxiety, respectively. Oral health status was self-reported including toothache, gingival bleeding, and oral ulcer. Multivariable logistic regressions were performed to determine underlying associations for outcome variables. Structural equation modeling (SEM) was performed to confirm the relationship between mental and oral health status.ResultsOf the 1770 subjects, 39.2% presented high psychological stress and only 41.2% expressed no anxiety. A significant association was found between psychological stress, anxiety and oral health status. Anxiety has significant impacts on toothache (OR = 0.36; 95%CI: 0.23–0.55; p < 0.01), gingival bleeding (OR = 0.43; 95%CI: 0.29–0.65; p < 0.01), and oral ulcer (OR = 0.54; 95%CI: 0.36–0.80; p < 0.01). Anxiety significantly mediated the association between psychological stress and self-reported oral symptoms.ConclusionsAnxiety may be a significant risk indicator for mental health among college students and demonstrates a significant relationship with the occurrence of self-reported oral symptoms. Concerns about academic and life changes caused by the pandemic were the two most significant sources of stress.

Factors influencing outcome of angiographic embolization for gastroduodenal hemorrhage related to peptic ulceration

PurposeLong-term outcome and prognostic factors of transcatheter embolization for gastroduodenal peptic ulcer bleeding are unknown. This study was conducted to evaluate the clinical outcome and factors associated with early recurrent bleeding and 30-day mortality of transcatheter arterial embolization (TAE) for severe, upper gastroduodenal hemorrhage associated with peptic ulcer and refractory to medical and endoscopic therapy. MethodsA monocenter, retrospective study from 2005 to 2020 including 76 consecutive patients who underwent TAE as first-line therapy for bleeding gastroduodenal peptic ulcers refractory to endoscopic therapy. Patient demographics, endoscopy findings, co-morbidities and interventional procedure findings were recorded. The outcome measures were technical and clinical success, procedure related complications, recurrent bleeding, length of hospital stay, 30-day mortality and overall survival. ResultsThe technical success rate was 96% and the clinical success rate was 65,8%. The rebleeding and 30-day mortality rate were 30,7% and 22,4% respectively. A higher international normalized ratio (INR) was a statistically significant risk factor for 30-day mortality (OR, 7.15; 95% CI, 1.67–30.70; p = 0.008). The mean overall survival was 3.76 years (1.16–––5.09; 95% CI); a lower Charlson Comorbidity Index (CCI) and a lower Rockall score were significantly associated with a longer overall survival (HR, 1.24; 95% CI, 1.14–1.35; p = 0.0001; HR, 1.32; 95% CI, 1.10–1.59; p = 0.003) respectively. Early rebleeding was significantly associated with a lower overall survival (HR, 2.72; 95% CI, 1.57–4.71; p = 0.0004). ConclusionA higher INR was a significant risk factor with a higher 30-day mortality. A lower CCI, a lower Rockall score and the absence of early rebleeding were significantly associated with a longer overall survival.

Results of using transcatheter arterial embolization in gastroduodenal ulcer bleeding: a review of studies

The authors present the results of research comparing the efficacy and safety of different methods of hemostasis in patients with gastrointestinal ulcer bleeding. The work focuses on the possibilities of transcatheter arterial embolization (embolization of the syndrome-responsible arteries of the stomach and duodenum) in the treatment of this disorder. Objective. Based on information sources, to evaluate the potential of transcatheter arterial embolization in comparison with the results of surgical and endoscopic hemostasis in the management and prevention of recurrent gastroduodenal ulcer bleeding. Materials and methods. The authors analyzed data from 51 domestic and international information sources on the subject of this work. Results. Studies on the treatment of active ulcerative gastroduodenal bleeding refractory to endoscopic hemostasis, have demonstrated the advantage of transcatheter arterial embolization over surgical interventions in terms of the incidence of non-fatal surgical complications. Surgical interventions were associated with a lower incidence of recurrent bleeding compared to endovascular interventions. According to research results, there were no difference in overall mortality between the groups of endovascular and surgical hemostasis. The use of prophylactic transcatheter embolization of the syndrome-responsible artery in cases of ulcerative gastroduodenal bleeding in addition to effective primary endoscopic hemostasis showed promising results. In such cases, patients with initially high risk of hemorrhagic complications had significantly lower rate of recurrent bleeding, surgical complications, and mortality comparing to patients with effective primary endoscopic hemostasis but without subsequent transcatheter arterial embolization. Conclusion. Despite current advances in the field of surgery ulcerative gastroduodenal bleeding remains an acute medical and social problem that requires the search for new effective methods of hemostasis and prevention of recurrent hemorrhagic complications. In the majority of studies, transcatheter embolization of the syndrome-responsible arteries of the stomach and duodenum is used as such. Keywords: gastrointestinal ulcer bleeding, endoscopic hemostasis, transcatheter arterial embolization, prophylactic endovascular embolization

A Comparison between Traumatic and Atraumatic Over-The-Scope-Clips in patients with Duodenal Ulcer Bleeding: a Retrospective Analysis with Propensity-Score-based Matching.

The over-the-scope-clip (OTSC) substantially improved the endoscopic armamentarium for the treatment of severe gastrointestinal bleeding and can potentially overcome limitations of standard clips. Recent data indicated a superiority of OTSC in hemostasis as first and second line therapy. However, the impact of the OTSC design (traumatic (-t) or atraumatic (-a) type) in particular in duodenal ulcer bleeding has not been analyzed so far. Retrospective analysis of a prospective collected database from 2009 until 2020 of six German endoscopic centers. All patients who underwent emergency endoscopy and were treated by an OTSC for duodenal ulcer bleeding were included. OTSC-t and OTSC-a patients were compared by Fisher's exact test, chi-square- or Mann-Whitney U-test as appropriate. A propensity-score based 1:1 matching was performed to obtain equal distribution of baseline characteristics in both groups. The entire cohort comprised 173 patients (93 OTSC-a, 80 OTSC-t). Age, gender, anticoagulant therapy, Rockall-Score and treatment regimen had similar distributions in the two groups. However, OTSC-t group showed significantly more active bleeding ulcers (Forrest Ia/b). Matching identified 132 patients (66 in both groups) with comparable baseline characteristics. Initial bleeding hemostasis (OTSC-a: 90.9%, OTSC-t: 87.9%, p=0.82) or 72h-mortality (OTSC-a: 4.5%, OTSC-t: 6.0%, p>0.99) were not significantly different but the OTSC-t group revealed a clearly higher rate of rebleeding (34.9% vs. 7.6%, p<0.001) and necessity of red blood cell transfusions (5.1±3.4 vs. 2.5±2.4 concentrates, p<0.001). OTSC-a should be the preferred option for duodenal ulcer bleeding if the endoscopist aims for an over-the-scope-clip.

Utilizing Endoscopy for the Diagnosis of Acute Upper Gastrointestinal Bleeding.

Background Acute upper gastrointestinal bleeding (UGIB) is a medical emergency requiring immediate diagnosis. While endoscopy is a commonly employed procedure in the evaluation of UGIB, its timing, outcomes, and the range of identified causes vary widely across different medical settings and regions. Therefore, the purpose of this study was to use endoscopy to investigate the cause of UGIB. Methodology A cross-sectional study was conducted at the Department of Gastroenterology, Mayo Hospital, Lahore, over a period of one year, from July 1st, 2021 to June 28th, 2022. The study enrolled all patients who were 18 years of age or older and exhibited symptoms of UGIB, including hematemesis and/or melena, within 48 hours of onset. An upper gastrointestinal endoscopy procedure was conducted in order to identify the underlying cause of UGIBand to apply appropriate therapeutic interventions. In patients where the endoscopic examination revealed bleeding ulcers, a specimen for biopsy was excised to test for Helicobacter pylori. Similarly, in cases where a malignancy was suspected during the endoscopy, a biopsy was performed for confirmatory diagnosis. A pre-designed proforma was utilized to collect data including the demographic variables such as age, gender, ethnicity, family history; clinical variables such as clinical presentation, comorbidities, medical history, medication use, vital signs, biochemical evaluation, and imaging results; endoscopic findings such as endoscopic location and severity of bleeding, endoscopic diagnosis, and the use of endoscopic interventions. Information relevant to the treatment and outcomes was also observed. Under outcomes, the rates of re-bleeding, need for repeat endoscopy, length of hospital stay, and mortality were recorded. Results The study reports that the mean age of the participants was 54.72 years with a standard deviation of 12.5 years. The mean hemoglobin level at the presentation was 7.98 ± 2.88 mg/dl. Out of the 309 patients, 215 (69.58%) were male, 202 (65.37%) presented with hematemesis, 97 (31.39%) presented with melena, and 10 patients had a mixed presentation. A total of 154 (49.84%) patients had portal hypertension. Out of these, 128 (83.12%) had esophageal varices and 21 (13.64%) had gastric varices. Five patients suffered from portal hypertensive gastropathy. In 114 (36.89%) patients, the cause of bleeding was ulcerative disease and out of these, duodenal ulcers were found in 49 (42.98%) while gastric ulcers were found in 22 (19.30%) patients. In total malignant lesions were detected in 20 (6.47%) cases. Conclusion The researchindicates that hematemesis was the predominant initial symptom observed in individuals experiencing UGIB. The predominant etiology of the hemorrhage was identified as esophageal and gastric varices through endoscopic assessment. The study highlights the importance of early endoscopic evaluation in patients with UGIB as it can help identify the cause and guide appropriate management. This emphasizes the need for healthcare providers to be vigilant in identifying and managing patients with UGIB promptly to improve outcomes. Further research is needed to explore effective strategies for early detection and management of UGIB.

Precise application of topical tranexamic acid to enhance endoscopic hemostasis for peptic ulcer bleeding: a randomized controlled study (with video)

Peptic ulcer recurrent bleeding occurs in 20% to 30% of patients after standard endoscopic hemostasis, particularly within 4 days after the procedure. The application of additional tranexamic acid (TXA) to the ulcer may enhance hemostasis. This study investigated the effectiveness of TXA powder application on bleeding ulcers during endoscopic hemostasis. This study enrolled patients who had peptic ulcer bleeding between March 2022 and February 2023. After undergoing standard endoscopic therapy, the patients were randomly assigned to either the TXA group or the standard group. In the TXA group, an additional 1.25 g of TXA powder was sprayed endoscopically on the ulcer. Both groups then received 3 days of high-dose (8 mg/h) continuous infusion proton pump inhibitor therapy. Second-look endoscopy was conducted on days 3 to 4. The primary end point of early treatment failure was defined as ulcer recurrent bleeding within 4 days or major stigmata of recent hemorrhage on the second-look endoscopy. Sixty patients (30 in each group) with peptic ulcer bleeding and balanced baseline characteristics were randomly assigned to a treatment group. The early treatment failure rate was lower in the TXA group (6.7%) than in the standard group (30%) (P= .042). The freedom from treatment failure periods for 4 and 28 days was significantly longer in the TXA group than in the standard group (P= .023). No adverse events from TXA were recorded. The precise delivery of topical TXA alongside standard endoscopic hemostasis reduced the early treatment failure rate in patients with bleeding peptic ulcers. (Clinical trial registration number: NCT05248321.).

Epinephrine injection monotherapy shows similar hemostatic efficacy to epinephrine injection combined therapy in high-risk patients (Forrest Ib) with bleeding ulcers.

Whether combination therapy has higher hemostatic efficacy than epinephrine injection monotherapy in different Forrest classifications is not clear. This study aimed to compare hemostatic efficacy between epinephrine injection monotherapy (MT) and combination therapy (CT) based on different Forrest classifications. We retrospectively analyzed peptic ulcer bleeding (PUB) patients who underwent endoscopic epinephrine injections or epinephrine injections combined with a second therapy between March 2014 and June 2022 in our center, and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis. Overall, 605 patients who met the inclusion criteria were included, and after PSM, 173 patients in each of the CT and MT groups were included. For PUB patients with nonbleeding visible vessels (FIIa), the rebleeding rates by Days 3, 7, 14, and 30 after PSM were 8.8%, 17.5%, 19.3%, and 19.3% in the MT group, respectively, and rates were 0%, 4.1%, 5.5%, and 5.5% in the CT group, respectively, with significant differences observed between the two groups by Days 3, 7, 14, and 30 (P = 0.015, P = 0.011, P = 0.014, and P = 0.014, respectively). However, for PUB patients with oozing bleeding (FIb), the rebleeding rates by Days 3, 7, 14, and 30 after PSM were 14.9%, 16.2%, 17.6%, and 17.6% in the MT group, respectively, and rates were 13.2%, 14.7%, 14.7%, and 16.2% in the CT group, respectively, with no significant differences observed between the two groups by Days 3, 7, 14, and 30 (P = 0.78, P = 0.804, P = 0.644 and P = 0.825). Combined therapy has higher hemostatic efficacy than epinephrine injection monotherapy for PUB patients with visible blood vessel (FIIa) ulcers. However, epinephrine injection monotherapy is equally as effective as combined therapy for PUB patients with oozing blood (FIb) ulcers.

Massive Ulcerative Upper Gastrointestinal Bleeding: Surgical Treatment, Techniques and Results (Experience of a Moroccan Surgical Emergencies Department)

Introduction: Upper digestive haemorrhages represent a medico-surgical emergency that can be life threatening. Material and Method: this was a retrospective study that was carried out over a period of five years (2015- 2019) in the Department of Surgical Emergencies of the Ibn Sina University Hospital of Rabat, involving six patients aged between 36 and 82 years. Result: the clinical symptoms was marked by hematemesis and melena in five patients, rectal bleeding in one patient, epigastralgia preceding the gastrointestinal bleeding in 3 patients. All of our patients presented with heavy bleeding. One of our patients had a history of bulbar ulcer complicated by peritonitis, four patients are chronic smokers. Medication intake was noted in two patients. The oesogastro-duodenal fibroscopy made the diagnosis and showed a gastro-duodenal ulcer in all the patients. All patients underwent surgical treatment: three ulcer sutures and three antrectomies. Haemostasis was ensured in five patients, surgical revision was necessary in one patient with postoperative hemodynamic instability. Discussion: In light of these results and a review of the literature, surgery remains the essential recourse in the event of severe bleeding from peptic ulcer. Conclusion: haemorrhagic ulcer is the most common cause of upper ulcerative digestive haemorrhages, its diagnosis is clinical and endoscopic, emergency surgery is immediately indicated in the case of massive bleeding.

Chicken skin mucosa surrounding small colorectal cancer could be an endoscopic predictive marker of submucosal invasion.

Chicken skin mucosa (CSM) surrounding colon polyps is a common endoscopic finding with pale yellow-speckled mucosa during a colonoscopy screening. Although reports about CSM surrounding small colorectal cancer are scarce, and its clinical significance in intramucosal and submucosal cancers is unclear, previous studies have suggested it could be an endoscopic predictive marker for colonic neoplastic and advanced polyps. Currently, because of the inaccurate preoperative evaluation by endoscopists, many small colorectal cancers, particularly lesions with a diameter < 2 cm, are improperly treated. Therefore, more effective methods are required to better assess the depth of the lesion before treatment. To explore potential markers of small colorectal cancer early invasion under white light endoscopy, providing patients with better treatment alternatives. This retrospective cross-sectional study included 198 consecutive patients [233 early colorectal cancers (ECCs)] who underwent endoscopy or surgical procedures at the Digestive Endoscopy Center of Chengdu Second People's Hospital between January 2021 and August 2022. The participants had pathologically confirmed colorectal cancer with a lesion diameter < 2 cm and received endoscopic or surgical treatment, including endoscopic mucosal resection and submucosal dissection. Clinical pathology and endoscopy parameters, including tumor size, invasion depth, anatomical position, and morphology, were reviewed. Fisher's exact test, the χ2 test, and Student's t-test were used to analyze the patient's basic characteristics. Logistic regression analysis was used to examine the relationship between morphological characteristics, size, CSM prevalence, and ECC invasion depth under white light endoscopy. Statistical significance was set at P < 0.05. The submucosal carcinoma (SM stage) was larger than the mucosal carcinoma (M stage) with a significant difference (17.2 ± 4.1 vs 13.4 ± 4.6 mm, P < 0.01). M- and SM-stage cancers were common in the left colon; however, no significant differences were found between them (151/196, 77% and 32/37, 86.5%, respectively, P = 0.199). The endoscopic features of colorectal cancer revealed that CSM, depressed areas with clear boundaries, and erosion or ulcer bleeding were more common in the SM-stage cancer group than in the M-stage cancer group (59.5% vs 26.2%, 46% vs 8.7%, and 27.3% vs 4.1%, respectively, P < 0.05). CSM prevalence in this study was 31.3% (73/233). The positive rates of CSM in flat, protruded, and sessile lesions were 18% (11/61), 30.6% (30/98), and 43.2% (32/74), respectively, with significant differences (P = 0.007). CSM-related small colorectal cancer was primarily located in the left colon and could be a predictive marker of submucosal invasion in the left colon.

DENTAL APPROACH IN ONCOLOGICAL INTENSIVE CARE UNIT: A MOUTH PROTECTOR FOR A PATIENT WITH NEUROLOGICAL METASTASIS.

This report demonstrates the role of the dental surgeon in the diagnosis and treatment of trauma to the oral mucosa, in a 55-year-old male patient admitted to an oncology intensive care unit after removal of a metastatic tumor. He needed neuromuscular beta-blockers, sedation, vasoactive drugs, and orotracheal intubation. During the inpatient period, he developed involuntary biting, leading to bleeding ulcers on the mucous membranes and tongue, even though he was sedated. After the dental procedure, the diagnosis was carried out through clinical and laboratory tests, and a mouthpiece was made to protect the oral structures and conserve the tracheal tube. This procedure was associated with hygiene, using 0.12% chlorhexidine, an application of vitamin E, and photobiomodulation using a low-level laser. In conclusion, the installation of the protector leads to more comfort and fewer bite events, but it does not reduce the lesions resulting from the clinical condition. This report demonstrates the role of the dental surgeon in the diagnosis and treatment of trauma to the oral mucosa, in a 55-year-old male patient admitted to an oncology intensive care unit after removal of a metastatic tumor. He needed neuromuscular beta-blockers, sedation, vasoactive drugs, and orotracheal intubation. During the inpatient period, he developed involuntary biting, leading to bleeding ulcers on the mucous membranes and tongue, even though he was sedated. After the dental procedure, the diagnosis was carried out through clinical and laboratory tests, and a mouthpiece was made to protect the oral structures and conserve the tracheal tube. This procedure was associated with hygiene, using 0.12% chlorhexidine, an application of vitamin E, and photobiomodulation using a low-level laser. In conclusion, the installation of the protector leads to more comfort and fewer bite events, but it does not reduce the lesions resulting from the clinical condition.

ADENOID CYSTIC CARCINOMA WITH BONE AND PLEURAL METASTASIS: A CASE REPORT

A 52 year-old male patient, who was referred for a diagnosis of palatal swelling. He underwent an incisional biopsy of a palatal swelling in the right maxilla, approximately 5 cm, pink in color, resistant palpation, with bleeding ulceration to the touch in the posterior region. The teeth involved in the lesion were mobile. An anatomopathological examination confirmed the morphological and immunohistochemical findings for locally advanced ACC, being positive for CK7, p40, SOX10, and EMA markers. After complementary tests, bone and pleural metastasis were diagnosed. Subsequently, the therapeutic approach chosen was for pain control, including five sessions of radiotherapy with a dose of 5 × 4Gy, and palliative chemotherapy with Carboplatin AUC 5 + Paclitaxel 175 mg/m². The patient is alive at the last follow-up. Therefore, confirmation with anatomopathological examination is essential for the diagnosis of palate lesions, even if they do not have clinical features of malignancy. A 52 year-old male patient, who was referred for a diagnosis of palatal swelling. He underwent an incisional biopsy of a palatal swelling in the right maxilla, approximately 5 cm, pink in color, resistant palpation, with bleeding ulceration to the touch in the posterior region. The teeth involved in the lesion were mobile. An anatomopathological examination confirmed the morphological and immunohistochemical findings for locally advanced ACC, being positive for CK7, p40, SOX10, and EMA markers. After complementary tests, bone and pleural metastasis were diagnosed. Subsequently, the therapeutic approach chosen was for pain control, including five sessions of radiotherapy with a dose of 5 × 4Gy, and palliative chemotherapy with Carboplatin AUC 5 + Paclitaxel 175 mg/m². The patient is alive at the last follow-up. Therefore, confirmation with anatomopathological examination is essential for the diagnosis of palate lesions, even if they do not have clinical features of malignancy.

TOP-048 - Predictors and management of post-banding ulcer bleeding in cirrhosis: a systematic review and meta-analysis

TOP-048 - Predictors and management of post-banding ulcer bleeding in cirrhosis: a systematic review and meta-analysis

Predictors and management of post-banding ulcer bleeding in cirrhosis: A systematic review and meta-analysis.

Post-banding ulcer bleeding (PBUB) is an understudied complication of oesophageal varices endoscopic band ligation (EBL). This systematic review with meta-analysis aimed at: (a) evaluating the incidence of PBUB in patients with cirrhosis treated with EBL in primary or secondary prophylaxis or urgent treatment for acute variceal bleeding and (b) identifying predictors of PBUB. We conducted a systematic review of articles in English published in 2006-2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Searches were made in eight databases including Embase, PubMed and Cochrane Library. Random-effects meta-analysis was used to determine the incidence, mean interval and predictors of PBUB. Eighteen studies (9034 patients) were included. The incidence of PBUB was 5.5% (95% CI 4.3-7.1). The mean time for it to occur was 11 days (95% CI 9.94-11.97). Model for End-stage Liver Disease (MELD) score (OR 1.162, 95% CI 1.047-1.291) and EBL done in emergency setting (OR 4.902, 95% CI 2.99-8.05) independently predicted post-ligation ulcer bleeding. Treatment included drugs, endoscopic procedures and transjugular intrahepatic portosystemic shunt. Refractory bleeding was treated with self-expandable metallic stents or balloon tamponade. Mortality was on average 22.3% (95% CI 14.1-33.6). Patients with high MELD score and receiving EBL in an emergency setting are more prone to develop PBUB. Prognosis is still poor and the best therapeutic strategy to address remains to be ascertained.

Efficacy of Vonoprazan vs. Pantoprazole or Non-acid Suppression in Prevention of Post-variceal Ligation Ulcer Bleeding in Portal Hypertension: A Multi-arm Randomized Controlled Trial

Up-to-datedata about the role of acid suppression therapy e.g. proton-pump inhibitors; to reduce post-endoscopic variceal ligation (EVL) ulcer-bleeding are conflicting. Vonoprazan; a recently introduced potassium-competitor acid blocker, has not been studied to prevent post-EVL ulcer/bleeding. The aim was to evaluate the efficacy of vonoprazan vs. pantoprazole or non-acid suppression to prevent post-EVL ulcer/bleeding in portal hypertension patients. We enrolled 275 portal hypertension patients undergoing EVL in a three-arm randomized, single-blind, controlled study. A clinico-laboratory baseline evaluation was performed. Following EVL, patients were randomly and equally assigned to receive vonoprazan 20mg once daily, pantoprazole 40mg once daily, or no acid suppression therapy. Post-EVL ulcer bleeding, ulcer dimensions, odynophagia as well as vonoprazan safety were evaluated after 2 weeks of EVL. Post-EVL ulcer bleeding occurred among 2.15% of vonoprazan, 8.7% of pantoprazole, and 14.2% of the non-acid suppression groups (P<0.001). Post-ligation ulcer frequency and dimensions were higher among non-acid suppression and pantoprazole groups vs. vonoprazan (P<0.05). Chest pain and odynophagia were encountered among 73.6% and 54.9% of the non-acid suppression group vs. 39.6% and 45.1% in pantoprazole, and 17.2% and 21.5% in vonoprazan groups, respectively (P<0.05). There were no vonoprazan-related adverse events. Non-use of vonoprazan was the strongest independent predictor for post-EVL bleeding. Short course of vonoprazan 20mg/day is safe and superior to pantoprazole 40mg/day in the reduction of post-EVL ulcer dimensions at 2 weeks post-EVL, and prevention of ulcer-related bleeding. Acid suppression is superior to no acid suppression to prevent post-EVL complications.

COVID-19 hospitalized patients and oral changes: a case-control study.

To investigate the association between hospitalization for COVID-19 and oral changes, and to evaluate whether oral changes can indicate a higher risk of disease progression to death. This case-control study analyzed patients hospitalized (university hospital), including those in intensive care unit and clinical wards. The study group comprised 69 COVID-19 positive patients (PCR-test), while the control group included 43 COVID-19 negative patients. A dentist performed oral evaluations, and salivary samples were collected for calcium, phosphatase, and pH analysis. Sociodemographic data, hospitalization information, and hematological test results were collected from electronic-medical records. The presence of oral changes was assessed using chi-square tests, and the predicted risk of death was analyzed using binary logistic regression. COVID-19 positive patients had a significantly higher prevalence of oral changes compared to COVID-19 negative patients. The presence of any oral changes in COVID-19 positive patients indicated a 13-fold higher risk of mortality. "Bleeding ulcers," "pressure ulcers," and "angular cheilitis" were significantly associated with hospitalization for COVID-19. There may be an association between hospitalization for COVID-19 and the development of oral changes, including bleeding ulcers, pressure ulcers. and angular cheilitis. These oral changes may serve as potential indicator for disease progression an increased risk of death. COVID-19 hospitalized patients have a higher prevalence of oral changes, which indicate an increased risk of mortality. Oral medicine staff should be included in multidisciplinary teams to detect and treat these oral changes promptly.