ABSTRACT
Background/Aims@#This study aimed to determine the performance of the AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting outcomes in patients with upper gastrointestinal bleeding (UGIB), and to compare the results between patients with nonvariceal UGIB (NVUGIB) and those with variceal UGIB (VUGIB). @*Methods@#We conducted a prospective observational study between March 2016 and December 2017. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. The associations of all three scores with mortality were evaluated using multivariate logistic regression analysis. @*Results@#Of the total of 337 patients with UGIB, 267 patients (79.2%) had NVUGIB. AIMS65 was significantly associated (odds ratio [OR]=1.735; 95% confidence interval [CI]=1.148–2.620), RS was marginally associated (OR=1.225; 95% CI=0.973–1.543), but GBS was not associated (OR=1.017; 95% CI=0.890–1.163) with mortality risk in patients with UGIB. However, all three scores accurately predicted all other outcomes (all p0.05). Only AIMS65 precisely predicted mortality, the need for blood transfusion and the composite endpoint (all p<0.05) in patients with VUGIB. @*Conclusions@#AIMS65 is superior to GBS and RS in predicting mortality in patients with UGIB, and also precisely predicts the need for blood transfusion and the composite endpoint in patients with VUGIB. No scoring system could satisfactorily predict rebleeding in all patients with UGIB.
ABSTRACT
Background/Aims@#This study aimed to determine the performance of the AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting outcomes in patients with upper gastrointestinal bleeding (UGIB), and to compare the results between patients with nonvariceal UGIB (NVUGIB) and those with variceal UGIB (VUGIB). @*Methods@#We conducted a prospective observational study between March 2016 and December 2017. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. The associations of all three scores with mortality were evaluated using multivariate logistic regression analysis. @*Results@#Of the total of 337 patients with UGIB, 267 patients (79.2%) had NVUGIB. AIMS65 was significantly associated (odds ratio [OR]=1.735; 95% confidence interval [CI]=1.148–2.620), RS was marginally associated (OR=1.225; 95% CI=0.973–1.543), but GBS was not associated (OR=1.017; 95% CI=0.890–1.163) with mortality risk in patients with UGIB. However, all three scores accurately predicted all other outcomes (all p0.05). Only AIMS65 precisely predicted mortality, the need for blood transfusion and the composite endpoint (all p<0.05) in patients with VUGIB. @*Conclusions@#AIMS65 is superior to GBS and RS in predicting mortality in patients with UGIB, and also precisely predicts the need for blood transfusion and the composite endpoint in patients with VUGIB. No scoring system could satisfactorily predict rebleeding in all patients with UGIB.
ABSTRACT
Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.