Emergency Endoscopy For Gastrointestinal Bleeding Research Articles

Differences in emergency endoscopy outcomes according to gastrointestinal bleeding location

Background and aim With recent technological advances in the field of endoscopic hemostasis, the prognosis of patients with gastrointestinal (GI) bleeding has improved. However, few studies have reported on the clinical course of patients with GI bleeding. This study aimed to evaluate the differences in clinical outcomes of patients with lower GI bleeding (LGIB) compared with upper GI bleeding (UGIB) and the factors related to their prognosis. Methods Patients who had undergone emergency endoscopy for GI bleeding were retrospectively reviewed. The severity of GI bleeding was evaluated using the Glasgow–Blatchford (GB), AIMS65, and NOBLADS scores. Patients in whom obvious GI bleeding relapsed and/or iron deficiency anemia persisted after emergency endoscopy were considered to exhibit rebleeding. Results We reviewed 1697 consecutive patients and divided them into UGIB (1054 patients) and LGIB (643 patients) groups. The proportion of patients with rebleeding was significantly greater in the UGIB group than in the LGIB group; the mortality rate was significantly higher in the UGIB group than in the LGIB group. Multivariate analysis showed that a GB score ≥12 and an AIMS65 score ≥2 were significantly associated with rebleeding in the UGIB group, whereas a NOBLADS score ≥4 was significantly associated with rebleeding in the LGIB group. Notably, the influence of emergency endoscopy differed according to GI bleeding location. Conclusions The clinical course was significantly worse in patients with UGIB than in patients with LGIB. The influence of emergency endoscopy differed according to GI bleeding location.

Emergency Endoscopy for Gastrointestinal Bleeding After Bariatric Surgery. Therapeutic Algorithm

ObjectiveGastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2–4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. Patients and methodFrom January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. ResultsTwenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1st–6th postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15–20 days after surgery. All other patients were managed non-operatively. ConclusionConservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow-up is very important for early detention and treatment of this complication.

Emergency Endoscopy for Gastrointestinal Bleeding in Pediatric Patients

Emergency Endoscopy for Gastrointestinal Bleeding in Pediatric Patients

The significance of bacterial contamination of fibreoptic endoscopes

Published surveys suggest that the risk of infection following fibreoptic endoscopy is minimal. However, we report three patients who became infected and one patient who was colonized following emergency endoscopy for gastro-intestinal bleeding with a strain of Pseudomonas aeruginosa, found to be resident in our upper gastrointestinal endoscopes. Bacteriological investigation showed that the cleaning procedure used failed to remove the organism from endoscopes. Thorough irrigation of instruments and accessories with 2% buffered glutaraldehyde before each session and simple cleaning with this agent during and after use, together with appropriate conditions for storage, reduced bacterial contamination of the instruments and eliminated oral colonisation of patients undergoing endoscopy. We conclude that bacterial contamination of upper gastro-intestinal endoscopes can be of clinical significance and meticulous attention to disinfection is essential for safe endoscopic practice.