ABSTRACT
Objective:To investigate the safety and clinical outcome of ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients.Methods:Cirrhotic patients with gastroesophageal variceal bleeding who received endoscopic treatment at the Endoscopic Center of Beijing Haidian Hospital were retrospectively included from January 2018 to January 2022. The patients were divided into ultra-early oral nutrition group where patients would fast for 4 hours after endoscopic treatment and routine treatment group where patients would fast for at least 48 hours after operation and receive parenteral nutrition during fasting. The rebleeding, infection events (including pulmonary infection, urinary infection, spontaneous bacterial peritonitis, etc.), hospitalization duration and hospital readmission were recorded and compared between the two groups.Results:A total of 96 patients were enrolled, including 52 with ultra-early oral nutrition, 44 with routine treatment. There was no significant difference in age, gender, BMI, cause of liver cirrhosis, Child-Pugh score, LDRf classification of gastroesophageal varices and degree of esophageal varices between the two groups ( P > 0.05). All patients were followed up for 6 weeks and there was no significant difference in incidence of rebleeding (5.8% vs 4.5%, P > 0.999), peritonitis (1.9% vs 4.5%, P = 0.883), pulmonary infection (5.8% vs 11.4%, P = 0.537) and urinary infection (3.8% vs 2.3%, P > 0.999) between the two groups. The non-inferiority analysis suggested that the safety defined as free from rebleeding in ultra-early oral nutrition group was not inferior to that in routine treatment group ( P = 0.0018). The hospitalization duration in ultra-early oral nutrition group was significantly shorter than that in routine treatment group (6 days vs 9 days, P < 0.001). The hospital readmission rate within 6 weeks in the ultra-early oral nutrition group tended to be lower than that in the routine treatment group (3.8% vs 9.1%, P = 0.526). Conclusion:Ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients shows similar rebleeding risk compared with current practice and can shorten hospitalization duration.
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Objective To observe the condition changes in patients with chronic hepatitis B (CHB) following medication withdraw of nucleoside/nucleotide analogues (NAs) treatment and to analyze the factors related to disease relapse.Methods Eighty-five CHB patients who discontinued medication of nucleoside/nucleotide analogues for antiviral therapy in Nanjing Second Municipal Hospital from January 2002 to December 2017 were enrolled in the study, among whom 22 cases met the withdrawal criteria (standard withdrawal group ) and 63 cases did not meet the withdraw criteria ( non-standard withdrawal group).The correlation of condition changes (abnormal liver function, positive rate of HBV DNA, hepatic failure with the drug withdrawal , the course of medication, serological transformation of HBeAg during drug withdrawal, HBsAg level, and liver cirrhosis during drug administration was analyzed.Results In standard withdraw group, the medication lasted for ＞3 years, only 1 case had HBV DNA positive conversion , abnormal ALT and TBil, and liver failure.In non-standard withdraw group, 50 cases (79.4%) had HBV DNA positive conversion, 36 (57.1%) had abnormal ALT, 25 ( 39.7%) had abnormal TBil and 14 (22.2%) had liver failure.There were 19 cases with HBsAg ＞1 000 IU/mL and 3 cases with HBsAg ≤1 000 IU/mL, and 1 case with HBsAg＞1 000 IU/mL (5.3%) had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.In non-standard withdraw group, there were 52 cases with HBsAg ＞1000 IU/mL, among whom 45 cases (86.5%) had positive HBV DNA conversion , 31 (59.6%) had ALT abnormalities, 25 (48.1%) had TBil abnormalities, and 13 (25.0%) had liver failure; there were 11 patients with HBsAg ≤1 000 IU/mL, among whom 6 cases (54.5%) had HBV DNA positive conversion , 5 (45.4%) had ALT abnormalities, and no TBil abnormalities or liver failure occurred.There were 5 cases of liver cirrhosis in the standard withdraw group , only 1 case had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.None of the 17 patients with non-cirrhosis had HBV DNA positive conversion , ALT, TBil abnormality and liver failure.There were 29 patients with liver cirrhosis in non-standard withdraw group showed positive HBV DNA conversion , 28 (96.6%) had ALT abnormalities, 22 (75.8%) had TBil abnormalities, and 11 (37.9%) had liver failure; among 34 non-cirrhosis patients, 21 (61.8%) had positive HBV DNA conversion, 8 (23.5%) had ALT abnormalities, 3 (8.8%) had TBil abnormalities, and 2 (5.9%) had liver failure.According to the standard discontinuation , 12 patients (16.7%) had positive HBV DNA transformation after HBeAg serological conversion , and no ALT abnormality, TBil abnormality and liver failure occurred.In non-standard withdraw group, only 17 cases without HBeAg serological conversion , 10 cases (58.8%) had positive HBV DNA conversion , 5 cases (29.4%) had ALT abnormalities, 2 cases (11.8%) had TBil abnormalities and liver failure did not occur.Conclusion CHB patients with medication of NAs should be discontinued according to the withdrawal criteria .and the course of medication, the immune index and the liver cirrhosis should be taken into account.
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Objective To analyze the clinical efficacy and relative influence factors of self-expanding metallic stents (SEMS) in treating colorectal cancer obstruction.Methods Information of 47 patients received SEMS to treat colorectal cancer obstruction from Mar.2012 to Dec.2017 in Beijing Haidian Hospital were collected,who were then followed up in outpatient or by telephone.Effective rate,survival rate and complications were recorded and calculated by the software of SPSS 17.0.Chi-square test was used to analyze relative influence factors.Results Results shown that the clinical efficacy was 100％ (47/47).Patients' 30-day survival rate and 6-month survival rate were 87.2％ (41/47) and 68.1％ (32/47),respectively.After surgery,2 patients presented with perforation,3 patients presented with migration and 5 patients presented with reobstruction.Clinical stage of tumor and stent length were related with complications and survival.Therein,complications presented more in patients with advanced cancer.And the longer stent length,the higher mortality.Conclusions Clinical stage of tumor and stent length maybe risk factors of complications and survival of patients after SEMS surgery of colorectal cancer obstruction.