Posible sangrado del intestino delgado. ¿Es la videocápsula endoscópica la mejor opción? / Is the videocapsule endoscopy the best option for diagnosis of possible bleeding from the small intestine?

Resumen En pacientes sin una causa clara de sangrado gastrointestinal luego de una endoscopia digestiva alta y baja, la causa se encontrará en el intestino delgado hasta en el 77 % de los casos. Ante el excelente rendimiento diagnóstico de la videocápsula endoscópica (VCE) para el estudio de este segmento del tracto gastrointestinal, surge la duda de si debería ser el método diagnóstico inicial de este grupo de pacientes con posible sangrado del intestino delgado (PSID) o si la realización de una nueva endoscopia alta y baja o algún método alternativo de estudio del intestino delgado debería serlo. En esta revisión se evalúa y evidencia el rendimiento diagnóstico superior y la mayor seguridad de la VCE como abordaje inicial de pacientes con PSID en relación con otros métodos. Sin embargo, se pone en tela de juicio la mejor costo-efectividad de este abordaje en nuestro medio, que en otros ha sido claramente demostrada.

Abstract When neither upper nor lower gastrointestinal endoscopy can find a clear cause of gastrointestinal bleeding, it will eventually be found in the small intestine in up to 77% of cases. Given the excellent diagnostic performance of video capsule endoscopy for studying this segment of the gastrointestinal tract, the question of whether it should become the initial diagnostic method for patients with possible bleeding from the small intestine arises. The alternatives are to perform additional upper and lower endoscopic procedures or to use some alternative method of studying the small intestine. This review documents and evaluates the superior diagnostic performance and greater safety of videocapsule endoscopy as the initial approach for possible bleeding from the small intestine and compares it with other methods. However, the cost-effectiveness of this approach, clearly demonstrated elsewhere, is questioned in our setting.

Endoscopic Management with a Novel Over-The-Scope Padlock Clip System

BACKGROUND/AIMS: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system.METHODS: Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients.RESULTS: All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed.CONCLUSIONS: The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

The analysis of etiologic changes and related factors in upper gastrointestinal bleeding in Guangdong region / 中华消化杂志

Objective To explore the changes of etiology and mortality of upper gastrointestinal bleeding (UGIB) in the last 20 years in Guangdong region. Methods A total of 3140 UGIB cases diagnosed in Guangdong General Hospital from January 1990 to October 2009 were analyzed with retrospective analysis. Groups were divided according to admission chronological order and age to analyze the causes of UGIB to get the trend of changes and influencing factors. Results UGIB occurred more in men than in women, the gender ratio was 2. 5∶1. There was no significant change in gender composition between the first and later 10 years. Peptic ulcer bleeding (PUB) was the main cause of UGIB in young and middle-age patients (age0. 05) and esophagogastric variceal bleeding (EVB) (11. 7% vs 12. 9%, P>0.05) remained stable. The occurrence of AGML bleeding significantly increased than before (32. 4% vs 18. 8%,P<0. 01), and became one of the most important causes of UGIB. Conclusions PUB is still the most important cause of UGIB in Guangdong region. AGML becomes another important cause of UGIB in elder patients, which may relate to the increasing use of non-steroidal anti-inflammatory drugs (NSAIDs), anti-platelet and antineoplastic medicine.

Transarterial embolization of gastrointestinal hemorrhages: retrospective study in Siriraj Hospital.

Objective: To determine the technical and clinical results of transarterial embolization of nonvariceal gastrointestinal hemorrhages (GIH) which cannot be managed endoscopically. Methods: A retrospective review of 21 embolizations in 77 patients who underwent arteriography for acute nonvariceal GIH was performed. Gastrointestinal hemorrhage was classified by the site of bleeding as upper, lower, or transpapillar including hemobilia and pancreatic duct bleeding. Clinical parameters and embolized data were assessed for clinical success. In-hospital mortality was also reported. Results: Technical success (bleeding target devascularization) was achieved in all 21 patients (100%). The complete technical success rate was 71.4% (15 out of 21 patients) while the partial technical success rate was 28.6% (6 out of 21 patients). The complication rate was very low (9.5%) including only 2 cases of bowel ischemia. No other complications were found. Eight out of 21 patients (38.1%) had rebleeding within 3 days. Upper GIH seemed to recur more frequently (4 out of 7 patients representing 57.1%) within the first 3 days than did lower (4 out of 11 patients at 36.4%) and transpapillar (0 of 3) GIH. Clinical success (no rebleeding after 30 days) was achieved in 11 of 21 patients (52.4%) including 3 out of 7 patients (42.9%) with UGIH, 7 of 11 patients (63.3%) with LGIH, and all patients with transpapillar hemorrhage. The overall mortality rate was 42.9% (9 out of 21 patients), with 42.9% (3 of 7 patients) for UGIH, 27.3% (3 of 11 patients) for LGIH and none for transpapillar hemorrhage. GIH was the cause of death in 6 of 9 patients (66.7%) while 3 out of 9 patients (33.3%) died from the other causes. Conclusion: Transarterial embolization is an effective treatment modality for lower GIH and transpapillar hemorrhage but less effective in upper GIH.

A Case of Cholelithiasis with Massive Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

Cholelithiasis is a relatively common disease and can present with various clinical manifestations and complications such as no symptoms, biliary pain, acute cholecystitis, biliary pancreatitis, acute cholangitis, gallstone ileus and biliary enteric fistula. However, cholelithiasis presenting with intra-gallbladder bleeding and massive gastrointestinal bleeding are relatively rare in the worldwide literature and there have been only a few reported case studies. We present here an interesting case of a 63 year-old women with gallstone, active intra-gallbladder bleeding and massive hematochezia who underwent open cholecystectomy, resection and anastomosis of the transverse colon. This patient's pathologic evaluation revealed a finding of acute and chronic cholecystitis with marked hemorrhage and transmural fibrinoid necrosis in the transverse colon.