Safety and clinical outcome of ultra-early oral nutrition after endoscopic treatment of gastroesophageal variceal bleeding in liver cirrhosis patients / 中华临床营养杂志

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.

Establishment of a risk prediction model for acute upper gastrointestinal rebleeding in elderly patients / 中华危重病急救医学

Objective:To establish a prediction model of acute upper gastrointestinal rebleeding (AUGIRB) for elderly patients by combining and applying multiple indicators.Methods:A retrospective observational study was conducted. The clinical data of 161 elderly patients (age ≥ 65 years old) who suffered from acute upper gastrointestinal bleeding (AUGIB) and who were hospitalized in Shanghai General Hospital from July 2018 to December 2020 were recorded. The patients were divided into the rebleeding group (31 cases) and the non-rebleeding group (130 cases) according to whether gastrointestinal rebleeding occurred. Univariate analysis was adopted to screen AUGIRB-related risk factors and Logistic regression analysis was used to screen independent predictors of AUGIRB so that a predictive model was constructed. Based on the area under the curve (AUC) of the receiver operator characteristic curve (ROC curve), the predictive ability of the prediction model for AUGIRB was evaluated, the optimal cut-off value was determined, and the odds ratio ( OR) and its 95% confidence interval (95% CI) were calculated. Bootstrap resampling technology was used to validate the predictive ability of the model. Results:Univariate Logistic analysis showed that oral anticoagulant drugs, oral antiplatelet drugs, albumin (ALB), platelet count (PLT), Glasgow-Blatchford bleeding score (GBS), D-dimer, fibrinogen (FIB), and international normalized ratio (INR) all had a significant effect on the occurrence of AUGIRB among elderly patients. Multivariate Logistic regression analysis showed that the oral antiplatelet drugs ( OR = 11.150, 95% CI was 1.888-65.852, P < 0.05) and GBS score ( OR = 2.503, 95% CI was 1.523-4.114, P < 0.05) were the independent risk factors of AUGIRB among elderly patients, while the ALB ( OR = 0.764, 95% CI was 0.626-0.932, P < 0.05) and FIB ( OR = 0.065, 95% CI was 0.011-0.370, P < 0.05) were the protective factors of AUGIRB among elderly patients. The AUC of the above four indexes joint prediction model was 0.979. The verification results of the model showed that the consistency index (C-index) of the model was 0.986. Conclusion:The prediction model fitted in this research has a high prediction accuracy and it also has a certain reference value for the judgment of elderly patients who suffer from AUGIRB.

Vascular embolization for acute non-variceal upper gastrointestinal rebleeding after conventional endoscopic hemostasis / 中华消化内镜杂志

From April 2017 to June 2020, 46 patients with acute non-variceal upper gastrointestinal bleeding (ANVUGIB) underwent endoscopic vascular embolization (EVE) in the Department of Gastroenterology of the First Affiliated Hospital of University of Science and Technology of China for rebleeding after endoscopic hemostasis therapy (including local drug injection, electrocoagulation, hemostatic clamp and ligation, etc.). All 46 patients immediately stopped bleeding after EVE, and the effective rate of immediate hemostasis was 100.0%. Postoperative abdominal pain occurred in 13 cases (28.3%), abdominal distension in 3 cases (6.5%) and fever in 2 cases (4.3%). The mucosa healed gradually under gastroscopy 3 and 12 months after the operation. No gastrointestinal rebleeding occurred during the follow-up. Therefore, EVE is a safe and effective method for ANVUGIB patients with failure of initial endoscopic hemostasis, which is worthy of further clinical study and application.

Analysis of risk factors for hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage / 中国医师进修杂志

Objective:To investigate the risk factors of hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage.Methods:The clinical data of 209 cerebral hemorrhage patients underwent decompressive craniectomy from January 2019 to October 2021 in the Second Affiliated Hospital of Zhejiang University and Keqiao District Traditional Chinese Medicine Hospital of Shaoxing City were retrospectively analyzed. According to the head CT result at the time of consultation and 24 h after the onset, the patients were divided into hematoma enlargement and rebleeding group (group A, 28 cases), hematoma enlargement group (group B, 47 cases), rebleeding groups (group C, 13 cases), non-hematoma enlargement and non-rebleeding group (group D, 121 cases). The gender, age, body mass index, time of first CT examination, first bleeding volume, admission Glasgow coma score (GCS), admission systolic pressures, admission diastolic pressure, admission activated partial thromboplastin time (APTT), admission alanine aminotransferase (ALT), admission white blood cell count, hematoma site, broken into the ventricle, irregular hematoma, timing of operation, maximum body temperature of 24 h after admission, intraoperative hemostasis and unsatisfactory on postoperative blood pressure control were collected. Multifactor Logistic regression analysis was used to analyze the independent risk factors of hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage.Results:There were no statistical difference in sex composition, age and body mass index among 4 groups ( P>0.05). The incidences of admission systolic pressures ≥140 mmHg (1 mmHg = 0.133 kPa), admission diastolic pressure ≥90 mmHg, admission APTT≥37 s, admission ALT≥40 U/L, admission white blood cell count ≥10 × 10 9/L, admission GCS, maximum body temperature of 24 h after admission ≥ 37 ℃, first bleeding volume ≥ 60 ml, time of first CT examination ≥3 h, time from onset to operation ≥ 12 h, irregular hematoma, hematoma in the thalamus, broken into the ventricle, intraoperative hemostasis, unsatisfactory on postoperative blood pressure control in group A were significantly higher than those in group B, group C and group D: 92.86% (26/28) vs. 55.32% (26/47), 7/13 and 23.97% (29/121); 89.29% (25/28) vs. 51.06% (24/47), 6/13 and 17.36% (21/121); 92.86% (26/28) vs. 48.94% (23/47), 6/13 and 14.88% (18/121); 78.57% (22/28) vs. 42.55% (20/47), 5/13 and 16.53% (20/121); 89.29% (25/28) vs. 53.19% (25/47), 7/13 and 18.18% (22/121); 89.29% (25/28) vs. 57.45% (27/47), 7/13 and 23.14% (28/121); 92.86% (26/28) vs. 55.32% (26/47), 7/13 and 23.97% (29/121); 85.71% (24/28) vs. 48.94% (23/47), 6/13 and 16.53% (20/121); 89.29% (25/28) vs. 53.19% (25/47), 7/13 and 23.14% (28/121); 89.29% (25/28) vs. 44.68% (21/47), 6/13 and 17.36% (21/121); 96.43% (27/28) vs. 51.06% (24/47), 7/13 and 22.31% (27/121); 67.86% (19/28) vs. 46.81% (22/47), 6/13 and 20.66% (25/121); 89.29% (25/28) vs. 42.55% (20/47), 6/13 and 18.18% (22/121); 92.86% (26/28) vs. 53.19% (25/47), 7/13 and 20.66% (25/121); 89.29% (25/28) vs. 48.94% (23/47), 6/13 and 16.53% (20/121), the incidences in group B and group C were significantly higher than those in group D, and there were statistical differences ( P<0.05); there were no statistical differences in the incidences between group B and group C ( P>0.05). Multifactor Logistic regression analysis result showed that maximum body temperature of 24 h after admission ≥ 37 ℃, time from onset to operation ≥12 h, hematoma in the thalamus, intraoperative hemostasis and unsatisfactory on postoperative blood pressure control were the independent risk factors of hematoma enlargement or rebleeding in the short term after decompressive craniectomy in patients with cerebral hemorrhage ( OR = 3.271, 25.739, 4.255, 3.995 and 13.749; 95% CI 1.072 to 9.977, 7.711 to 85.919, 1.297 to 13.954, 1.252 to 12.747 and 3.961 to 47.732; P<0.05 or <0.01). Conclusions:After decompressive craniectomy, some patients with cerebral hemorrhage may have hematoma enlargement or rebleeding in the short term. The admission body temperature, hematoma site, intraoperative hemostasis, postoperative blood pressure control and operation timing are influencing factors, and the corresponding intervention may help to prevent the occurrence of hematoma enlargement or rebleeding in a short term.

The value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding after laparoscopic splenectomy and azygoportal disconnection: a prospective study / 中华消化外科杂志

Objective:To investigate the value of liver fibrosis serum markers in predicting esophagogastric variceal re-bleeding (EGVR) after laparoscopic splenectomy and azygoportal discon-nection (LSD).Methods:The prospective study was conducted. The clinical data of 155 cirrhotic portal hypertension patients with EGVR after LSD in the Clinical Medical College of Yangzhou University from September 2014 to January 2017 were selected. Observation indicators: (1) grouping situations of the enrolled patients; (2) risk factors analysis for postoperative EGVR; (3) prediction of postoperative EGVR; (4) follow-up. Follow-up was conducted using telephone interview, outpatient examination and hospitalization. Patients were followed up once every 3 months after operation to detect occurrence of EGVR and survival of patient up to January 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data wite skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups were conducted using the chi-square test or Fisher exact probability. Logistic regression model was used for multivariate analysis. The area under curve (AUC) of receiver operating characteristic (ROC) curve was used to estimate the diagnostic efficiency. The Youden index was used to determine the optimal cut-off point. Results:(1) Grouping situations of the enrolled patients. A total of 155 patients were selected for eligibility. There were 106 males and 49 females, aged (53±11)years. Of the 155 patients, there were 21 cases with EGVR in the postoperative 1 year and 134 cases without EGVR in the postoperative 1 year. The protein expression of laminin and collagen Ⅳ were 100.3(range, 16.1?712.2)μg/L and 68.4(range, 35.0?198.8)μg/L in patients with EGVR, vs 35.5(range, 2.0?521.2)μg/L and 43.5(range, 4.3?150.4)μg/L in patients without EGVR, showing significant differences between them ( Z=?4.55, ?4.52, P<0.05). (2) Risk factors analysis for postoperative EGVR. According to the Youden index, the optimal cut-off point of protein expression of laminin and collagen Ⅳ were 64.0 μg/L and 65.0 μg/L, respec-tively. Results of multivariate analysis showed that the protein expression of laminin ≥64.0 μg/L and the protein expression of collagen Ⅳ ≥65.0 μg/L were independent risk factors for postoperative EGVR ( odds ratio=9.69, 8.16, 95 confidence intervals as 3.05?30.82, 2.65?25.15, P<0.05). (3) Prediction of postoperative EGVR. Results of ROC curve showed that the AUC of laminin and collagen Ⅳ in predicting postoperative EGVR was 0.79 (95% confidence interval as 0.66?0.92), with sensi-tivity as 0.62 and specificity as 0.96. (4) Follow-up. All the 155 patients were followed up for 12(range, 1?12)months. During the follow-up, there were 21 of the 155 patients (13.55%) with post-operative EGVR, including 3 cases died of EGVR. Of the 21 patients with postoperative EGVR, there were 6 cases with postoperative EGVR during the first month after operation including 2 cases died, 5 cases with postoperative EGVR at postoperative 1?3 month, 6 cases with postoperative EGVR more than 3 month and less than 6 month after operation and 4 cases with postoperative EGVR at postoperative 6?12 months including 1 case died at postoperative 12 month. Conclusions:Laminin and collagen Ⅳ show satisfactory ability to predict EGVR after LSD.

Clinical value of regular endoscopic treatment for esophageal and gastric variceal bleeding in patients with liver cirrhosis / 中华消化内镜杂志

Objective:To evaluate the regular endoscopic therapy for esophageal and gastric variceal bleeding (EGVB) in patients with liver cirrhosis.Methods:A total of 305 patients of EGVB with liver cirrhosis who received endoscopic hemostasis in Nanjing Drum Tower Hospital between January 2015 and January 2018 were included in the retrospective cohort study. Patients were divided into the regular endoscopic treatment group ( n=145) and the irregular endoscopic treatment group ( n=160). The primary outcome measure was rebleeding rate, and the secondary outcome measures were follow-up time, rebleeding interval and rebleeding mortality. Results:There were no significant differences between the two groups in terms of gender composition, average age, etiology composition, the cause of disease under or out of control, liver reserve function, or administration of non-selective β-blockers ( P>0.05), and the baseline data were comparable. The rebleeding rate was 11.7% (17/145) in the regular endoscopic treatment group and 41.9% (67/160) in the irregular endoscopic treatment group ( χ2=38.74, P<0.001). The follow-up time, rebleeding intervals and mortalies of rebleeding in the regular endoscopic treatment group and the irregular endoscopic treatment group were 28.14±11.11 months and 21.10±12.37 months ( t=5.21, P<0.001), 12.0 (6.0, 23.0) months and 1.0 (1.0, 6.0) months ( U=164.00, P<0.001), and 1.4% (2/145) and 10.6% (17/160) ( χ2=11.13, P=0.001), respectively. Conclusion:Compared with irregular endoscopic treatment, regular endoscopic treatment of EGVB in patients with liver cirrhosis has more clinical significance, which can significantly reduce the rebleeding rate, prolong the rebleeding interval, and reduce the mortality of rebleeding.

The controlled study of efficacy and safety of infusion of ilaprazole sodium versus esomeprazole sodium in prevention of peptic ulcer rebleeding / 中华消化杂志

Objective:To explore the efficacy and safety of intermittent infusion of ilaprazole sodium and high-dose continuous infusion of esomeprazole sodium in preventing rebleeding in patients with peptic ulcer bleeding after successful endoscopic hemostasis.Methods:This is a multi-center, interval randomized, double-blind, double-dummy, parallel controlled study. From March 3rd to June 15th, 2021, 151 patients with high risk of peptic ulcer bleeding and successfully underwent endoscopic hemostasis from 33 hospitals including the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled. Patients were interval randomly divided into the trial group (74 cases) and the control group (77 cases). Patients in the trial group received intermittent intravenous infusion of ilaprazole sodium once daily (20 mg administered as a 60 min intravenous infusion on day 1, and 10 mg administered as a 30 min intravenous infusion on day 2 and 3); patients in the control group received continuous intravenous infusion of esomeprazole sodium for 72 h (esomeprazole sodium 80 mg at first dose in half an hour, and 8 mg per hour continuous intravenous infusion for 71.5 h). After intravenous infusion treatment, patients of both groups were given oral ilaprazole enteric-coated tablets, 10 mg each time, once a day for 4 d. The rebleeding rate after 72 h and within 7 d after treatment and the proportion of patients who received endoscopic retreatment or surgery due to rebleeding within 72 h after treatment were analysised based on the full analysis set (72 cases in the trial group and 75 cases in the control group); and the incidence rate of adverse reactions was observed in the two groups based on the safety analysis set (74 cases in the trial group and 76 cases in the control group). Chi-square test or Fisher exact probability test was used for statistical analysis.Results:There was no rebleeding case in the trial group within 72 h and 1 case of rebleeding within 7 d (1.39%, 1/72). In the control group, there was 1 case of rebleeding (1.33%, 1/75) within 72 h and 4 cases of rebleeding (5.33%, 4/75) within 7 d. There was no significant difference in rebleeding rate either after 72 h or within 7 d after treatment between the two groups (both P>0.05). Within 72 h of treatment, no patients in both groups needed endoscopic or surgical retreatment due to rebleeding. Adverse reactions occurred in 5 cases (6.8%, 5/74) and 6 cases (7.9%, 6/76) in the trial group and control group, respectively, which recovered spontaneously without treatment. No serious adverse reactions occurred in both groups. Conclusion:In patients with high-risk peptic ulcer bleeding with successful endoscopic hemostasis, intermittent intravenous infusion of ilaprazole sodium has similar efficacy and safety as continuous high-dose intravenous infusion of esomeprazole sodium, but the dosage of intermitten regimen is less, the administration is more convenient, and it is worthy of clinical promotion.

Analysis of the influencing factors of recurrence of non-variceal upper gastrointestinal bleeding after endoscopic treatment / 国际生物医学工程杂志

Objective:To analyze the factors affecting the recurrence of patients with non-varices upper gastrointestinal bleeding (NVUGIB) after receiving digestive endoscopy.Methods:The clinical data of 120 patients with NVUGIB who received digestive endoscopy were retrospectively analyzed. The patients were divided into recurrence group and non-recurrence group according to their recurrence status, and the risk factors affecting recurrence were analyzed.Results:The results of univariate analysis showed that there was no significant difference in age, gender and body mass index between the relapsed group and the non-relapsed group (all P>0.05), and there was significant difference in Forrest grade, hemoglobin concentration, platelet count, peptic ulcer, shock, improper diet, premature getting out of bed, constipation and subsequent proton pump inhibitors (all P<0.05). The results of multivariate logistic regression analysis showed that the Forrest grade(Ⅰa), hemoglobin level (<100 g/L), platelet count (<100×10 9/L), peptic ulcer, shock, improper diet, premature getting out of bed, constipation and subsequent proton pump inhibitorsare the risk factors of recurrence in patients with NVUGIB (all P<0.05). Conclusions:Clinically, targeted preventive measures should be taken based on the risk factors that affect the recurrence of patients with NVUGIB after digestive endoscopic treatment.

Effects of Adjuvant Chinese Patent Medicine Therapy on Prevention of Variceal Rebleeding: A Retrospective Cohort Study / 中国结合医学杂志

OBJECTIVE@#To assess whether adjuvant Chinese patent medicines (CPMs) to standard treatment could reduce recurrent bleeding after variceal bleeding in cirrhotic patients.@*METHODS@#This study retrospectively collected 555 consecutive patients who recovered from variceal bleeding. A population-based cohort study was established depending on if adjuvant CPMs were administered to prevent rebleeding. A total of 139 patients who had taken ⩾28 cumulative defined daily doses (cDDDs) of CPMs were included in the CPMs cohort, and 416 patients who used 180 cDDDs of CPMs, respectively. The median rebleeding interval in the CPMs cohort was significantly larger compared with the non-CPMs cohort (113.5 vs. 93.0 days; P=0.008).@*CONCLUSION@#Adjuvant CPMs to standard therapy can significantly reduce the incidence of variceal rebleeding and delay the time to rebleeding.

Application value of portal vein flow velocity after different interventions on rebleeding in patients with hepatitis B cirrhosis complicated with esophageal and gastric variceal bleeding / 中华传染病杂志

Objective:To investigate the predictors of rebleeding three months after treatment of esophageal and gastric variceal bleeding (EGVB) in patients with hepatitis B cirrhosis and the effects of different treatments on rebleeding.Methods:From January 2018 to January 2020, the hepatitis B cirrhosis patients with first onset of EGVB in the First Hospital of Lanzhou University were enrolled and followed up for three months. The development of rebleeding, information about portal vein flow velocity and model for end-stage liver disease (MELD) scores after treatment of first bleeding were collected. The statistical analysis was conducted by chi-square test and binary logistic regression analysis. The efficacy for predictors of rebleeding was evaluated by using area under the receiver operating characteristic curve.Results:Among the 33 patients with the first EGVB, the rebleeding rate during three months follow-up was 42% (14 cases), including one patient (1/8) who underwent transjugular intrahepatic portosystemic shunt, 10 patients (10/19) were treated with therapeutic endoscopy, and three patients (3/6) were treated with vasoactive drugs. No statistically significant difference in rebleeding rates was found among the three treatment groups ( χ2=3.853, P=0.175). Portal vein flow velocity after treatment for the first onset of EGVB (odds ratio ( OR)=0.21, 95% confidence interval ( CI) 0.05 to 0.93, P=0.039) and MELD score ( OR=1.53, 95% CI 1.02 to 2.30, P=0.040) were independent predictors for the occurrence of rebleeding events during three months. When the portal vein flow velocity after treatment for the first bleeding was 19 cm/s, the area under the receiver operating characteristic curve for prediction of the occurrence of rebleeding during three months was 0.86, with the sensitivity of 92% and the specificity of 61%. Conclusion:Among the patients with hepatitis B cirrhosis and the first onset of EGVB, different treatments may have little relationship with three-month rebleeding, while portal vein flow velocity ≤19 cm/s is the main predictor for rebleeding within three months.

Riesgo de resangrado en hemorragia digestiva alta según la escala de Glasgow-Blatchford: herramienta de triaje / Upper gastrointestinal hemorrhage re-bleeding risk according to the Glasgow-Blatchford scale: a triage tool

Resumen Introducción: Con la escala de Glasgow-Blatchford (EG-B) se califica mediante datos clínicos, el riesgo de resangrado después de hemorragia del tubo digestivo alto (HTDA); y con las escalas de Forrest y Dagradi, mediante endoscopia. Objetivo: Evaluar la capacidad de la EG-B para identificar riesgo de resangrado a 30 días después de una HTDA; el estándar de oro de comparación fue la endoscopia. Método: Se analizaron 129 expedientes de pacientes con HTDA y endoscopia. Se cuantificaron las escalas de Glasgow-Blatchford, Forrest y Dagradi; se calculó sensibilidad, especificidad y área bajo la curva ROC (ABC-ROC) del riesgo de resangrado reportado por EG-B. Resultados: La EG-B identificó a 53 pacientes con riesgo bajo de resangrado (41.09 %) y 76 con riesgo alto (58.91 %). Con la endoscopia se identificó a 107 pacientes con hemorragia no variceal (82.94 %), 98 con riesgo bajo (89.9 %) y 11 con riesgo alto (10.09 %); además, 22 pacientes con hemorragia variceal (17.05 %), 12 con riesgo bajo (54.54 %) y 10 con riesgo alto (45.45 %). La EG-B mostró sensibilidad de 0.857, especificidad de 0.462 y ABC-ROC de 0.660. Conclusiones: La EG-B es sencilla, objetiva y útil para identificar riesgo de resangrado después de HTDA; se sugiere como herramienta de triaje en urgencias.

Abstract Introduction: The Glasgow-Blatchford scale (GBS) classifies the risk of re-bleeding after upper gastrointestinal bleeding (UGIB) using clinical data, whereas the Forrest and Dagradi scales do it by endoscopy. Objective: To assess GBS’s ability to identify re-bleeding risk within 30 days of an UGIB, using endoscopy as the gold standard for comparison. Method: 129 medical records of patients with UGIB and endoscopy were analyzed. The Glasgow-Blatchford, Forrest and Dagradi scales were quantified; sensitivity, specificity and area under the ROC curve (AUC-ROC) of GBS-reported re-bleeding risk were calculated. Results: GBS identified 53 patients with low re-bleeding risk (41.09 %) and 76 with high risk (58.91 %). Endoscopy identified 107 patients with non-variceal bleeding (82.94 %): 98 with low risk (89.9 %) and 11 with high risk (10.09 %); in addition, it identified 22 patients with variceal hemorrhage (17.05 %): 12 with low risk (54.54 %) and 10 with high risk (45.45 %). GBS showed a sensitivity of 0.857, specificity of 0.462 and an AUC-ROC of 0.660. Conclusions: GBS is simple, objective and useful to identify the risk of re-bleeding after UGIB; it is suggested as a triage tool in the emergency department.

Effects of diabetes on rebleeding after endoscopic treatment in liver cirrhosis patients with esophageal varices / 中华消化内镜杂志

Objective@#To investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices.@*Methods@#A total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study. The cases were divided into bleeding group (n=54) and non-bleeding group (n=153) according to the presence or absence of rebleeding within 6 months after treatment. The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis.@*Results@#Univariate analysis showed that gender composition, age, presence or absence of portal vein thrombosis, smoking history, drinking history (P=0.05), hypertension, platelet count, total bilirubin level, albumin level, alanine aminotransferase level, prothrombin time, degree of esophageal varices, and surgical methods were not significantly different (all P≥0.05) between the bleeding group and the non-bleeding group. There were significant differences in diabetes, hemoglobin level, blood glucose level, ascites composition, and liver function grade composition between the two groups (all P<0.05). Combined diabetes (yes/no), hemoglobin levels, blood glucose levels, ascites (none-mild/medium-severe), liver function Child-Pugh classification (Grade A/B-C), and history of drinking (yes/no) were included in multivariate analysis, and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices (P=0.008, OR=2.973, 95%CI: 1.322-6.689).@*Conclusion@#After endoscopic treatment of liver cirrhosis patients with esophageal varices, rebleeding is more likely to occur in patients complicated with diabetes.

A Quantitative Analysis on Requirement of Blood Transfusion in Upper Gastrointestinal Bleeding using Blatchford Bleeding Score

Introduction: The GBS enables assessment of risk based on clinical variables alone without the use of endoscopic findings. Its purpose is to aid in identification of patients requiring intervention, such as blood transfusion, or endoscopic or surgical intervention to control UGI haemorrhage. Study objective was to correlate the requirement of blood transfusion in patients presenting with upper gastrointestinal bleeding and Blatchford scoring system.To analyse and correlate the score with prediction of rebleeding, duration of hospital stay. Material and Methods: A Cross sectional quantitative study was conducted in Medical ICU/Wards of Pushpagiri medical college. From (January 2016 to June 2017). All Patients admitted with upper gastrointestinal bleeding during this period was selected as sample size. A detailed history was taken, and a thorough clinical examination was done, complemented by relevant investigation as required for the study. Unpaired t-test,Chi square test and Correlation were used as Test of significance. P-value <0.05 is considered statistically significant using Epi-info 7 software. Results: Majority of patients were in the age group of 41 to 50 years (28.6%). 72.6% were males and the remaining females. 54.8% of patients did not require blood transfusion at all, 20.2% was transfused 1 unit of packed red cells and only 1.2% with 4 units. Only 3.6% patients who presented with upper GI bleed had a rebleeding which further tells the need of blood transfusion.majority of the patients had a mean hospital stay of 5 – 8 days around 48%. There was significant correlation between Blatchford score on admission and requirement of blood transfusion (p value 0.000) and duration of hospital stay (p value 0.008). Conclusion: There was a significant correlation between Blatchford scoring on admission and requirement of blood transfusion. There was also a significant correlation between initial Blatchford scoring and duration of hospital stay and outcome

Comparision between portosystemic shunts and endoscopic therapy for prevention of variceal re-bleeding: a systematic review and meta-analysis / 中华医学杂志(英文版)

Background:@#Portosystemic shunts, including surgical portosystemic shunts and transjugular intra-hepatic portosystemic shunt (TIPS), may have benefit over endoscopic therapy (ET) for treatment of variceal bleeding in patients with cirrhotic portal hypertension; however, whether there being a survival benefit among them remains unclear. This study was to compare the effect of three above-mentioned therapies on the short-term and long-term survival in patient with cirrhosis.@*Methods:@#Using the terms "variceal hemorrhage or variceal bleeding or variceal re-bleeding" OR "esophageal and gastric varices" OR "portal hypertension" and "liver cirrhosis," the Cochrane Central Register of Controlled Trials, PubMed, Embase, and the references of identified trials were searched for human randomized controlled trials (RCTs) published in any language with full texts or abstracts (last search June 2017). Risk ratio (RR) estimates with 95% confidence interval (CI) were calculated using random effects model by Review Manager. The quality of the included studies was evaluated using the Cochrane Collaboration’s tool for the assessment of the risk of bias.@*Results:@#Twenty-six publications comprising 28 RCTs were included in this analysis. These studies included a total of 2845 patients: 496 (4 RCTs) underwent either surgical portosystemic shunts or TIPS, 1244 (9 RCTs) underwent either surgical portosystemic shunts or ET, and 1105 (15 RCTs) underwent either TIPS or ET. There was no significant difference in overall mortality and 30-day or 6-week survival among three interventions. Compared with TIPS and ET, separately, surgical portosystemic shunts were both associated with a lower bleeding-related mortality (RR = 0.07, 95% CI = 0.01–0.32; P < 0.001; RR = 0.17, 95% CI = 0.06–0.51, P < 0.005) and rate of variceal re-bleeding (RR = 0.23, 95% CI = 0.10–0.51, P < 0.001; RR = 0.10, 95% CI = 0.04–0.24, P < 0.001), without a significant difference in the rate of postoperative hepatic encephalopathy (RR = 0.52, 95% CI = 0.25–1.00, P = 0.14; RR = 1.09, 95% CI = 0.59–2.01, P = 0.78). TIPS showed a trend toward lower variceal re-bleeding (RR = 0.46, 95% CI = 0.36–0.58, P < 0.001), but a higher incidence of hepatic encephalopathy than ET (RR = 1.78, 95% CI = 1.34–2.36, P < 0.001).@*Conclusions:@#The overall analysis revealed that there seem to be no short-term and long-term survival advantage, but surgical portosystemic shunts are with the lowest bleeding-related mortality among the three therapies. Surgical portosystemic shunts may be the most effective without an increased risk of hepatic encephalopathy and TIPS is superior to ET but at the cost of a higher incidence of hepatic encephalopathy. However, some of findings should be interpreted with caution due to the lower level of evidence and the existence of significant heterogeneity.

Interventionaltreatmentofdelayedhemorrhageafterabdominalsurgery / 实用放射学杂志

Objective Toevaluatetheclinicaleffectofinterventionaltreatmentfordelayedhemorrhageinpatientsafterabdominal surgery.Methods Dataof76patients,undergoingangiographyduetodelayedpostoperativehemorrhage,wereanalyzedretrospectively. Theexclusioncriteriaincludedpositiveangiographywithoutembolizationorhaemorrhagecausedbyothercauses(urologicaland reproductivesystemdiseases).Basedonendovascularprocedures,thepatientsweredividedintoembolizedgroup (positiveangiography withembolization)andnon-embolizedgroup(negativeangiographywithoutembolization).Theoutcomesoftreatmentwerecompared betweentwogroupsandfactorsassociatedwithrebleedingwerealsoanalyzed.Results Angiogramswerepositivein70% (53/76)of patients,andintravascularembolizationswereperformed.Intheembolizationgroup,technicalsuccessrateandclinicalsuccessrate were98.1%(52/53)and71.7%(38/53),respectively.Noseverecomplications,suchasgastrointestinalorhepaticischemicnecrosis wereobservedinallpatients.Therebleedingrateswere28.3%and52.2%intheembolizationgroupandthenon-embolizationgroup, respectively(P＝0.046).Multivariateanalysisshowedthatuseofvasopressoragentsbeforesurgerywasanindependentriskfactor forrebleeding (P＝0.022).Conclusion Intravascularinterventionaltherapyisasafeandeffectivemethodfordelayedhemorrhageafter abdominalsurgery.Useofvasopressoragentsbeforesurgerymayincreasetheriskofpostoperativerebleeding.

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding

OBJECTIVE: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. MATERIALS AND METHODS: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. RESULTS: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09–9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21–6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07–0.95; p = 0.041). CONCLUSION: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.

Risk factors of postoperative rebleeding after hypertensive cerebral hemorrhage / 局解手术学杂志

Objective To analyze the risk factors of postoperative rebleeding after hypertensive cerebral hemorrhage,and provide a basis for clinical prevention of postoperative recurrent hemorrhage. Methods The clinical data of 413 patients with hypertensive intracerebral hemorrhage in our hospital from January 2007 to December 2017 were retrospectively analyzed.The possible correlation factors of postopera-tive recurrent hemorrhage and the high-risk factors were collected and summarized. Results According to univariate unconditional logistic regression analysis, there was a significant correlation between systolic blood pressure, GCS score, bleeding volume, coagulation dysfunction and the use of sedative analgesics with the hypertensive cerebral hemorrhage after surgery(P<0.05);they were also the risk factors of post-operative rebleeding after hypertensive cerebral hemorrhage according to the multivariate unconditional logistic regression analysis (P<0.05). Conclusion The results indicate that there are many factors influencing postoperative rebleeding in patients with hypertensive cerebral hemorrhage.In the perioperative period,higher systolic blood pressure,deeper consciousness disorder,more bleeding,and coagulation dysfunction are independent factors influencing postoperative re-bleeding, and more attention should be paid to it.

Cause analysis and prevention of rehaemorrhage after surgical procedure on cirrhotic portal hypertension / 中华消化外科杂志

The ratio of postoperative rehaemorrhage after surgical procedure on cirrhotic portal hypertension is about 10％,and most common reason is reformation and rupture of esophagogastric varices.Other causes such as gastric mucosal lesion of portal hypertension,gastric antral vasodilatation and ectopic bleeding,have different clinical manifestations.There-fore different diagnostic and therapeutic strategies are needed.And these strategies would decrease the occurrence of complications and increase the therapeutic effects and prolong the survival duration.

Risk factor analysis for early rebleeding in patients with peptic ulcer bleeding / 中华消化杂志

Objective To explore the risk factors for early rebleeding in patients with peptic ulcer bleeding (PUB) .Methods From June 2006 to May 2017 ,a total of 1210 hospitalized patients with PUB from The General Hospital of Ningxia Medical University were enrolled . Totally 1040 patients with bleeding stopped after the treatment were taken as the control group . And 170 patients with early rebleeding were as the rebleeding group .The clinical data of the patients in two groups were analyzed . Chi-square test ,t-test and multivariate factors analysis were performed for statistical analysis . Results Between control group and rebleeding group ,there were statistical significances in gender ,age ,place of residence , hematemesis , shock , volume of blood transfusion , anticoagulant use , combined diseases , hemoglobin level ,albumin level ,urea nitrogen ,neutrophil ratio ,platelet count ,ulcer location ,maximum ulcer diameter ,Forrest classification and endoscopic treatment (all P< 0 .05) .The rate of endoscopic hemostasis of rebleeding group (92 .56％ ,112/121) was lower than that of control group (98 .70％ ,228/231) , and the difference was statistically significant (χ2=13 .609 ,P=0 .001) .The result of multivariate logistic regression analysis showed that Forrest classification (odds ratio (OR)= 7 .735 , P< 0 .01) ,hemoglobin (OR=7 .332 ,P=0 .040) ,shock (OR=5 .245 , P<0 .01) and ulcer size (OR=2 .360 , P=0 .029) were independent risk factors for rebleeding in patients with PUB .The effect of Forrest classification better than hemoglobin ,hemoglobin better than shock and shock better than ulcer size in assessing the risk of rebleeding .Conclusions Forrest classification ,hemoglobin ,shock ,ulcer size are the risk factors for rebleeding in patients with PUB .Endoscopic hemostasis can reduce the risk of rebleeding .

Risk factors analysis of early rebleeding after endoscopic treatment of esophageal varices / 中华消化内镜杂志

Objective To investigate the risk factors of early rebleeding after endoscopic treatment of esophageal varices. Methods A retrospective analysis was performed on the clinical data of 384 cirrhotic patients with esophageal varices. The factors of early rebleeding group[n=36(9.4%)]and non?bleeding group(n=348)were compared by single factor analysis and multivariate analysis of Logistic regression. Results Single factor analysis showed that there were differences between the two groups in cirrhosis with hepatocellular carcinoma, Child?Pugh classification, Child?Pugh score, ascites volume, portal vein thrombosis, portal vein width, portal hypertensive gastropathy, shapes and numbers of varicose veins, numbers of varicose vein ligation, varicose vein red syndrome, albumin, total bilirubin, prothrombin time, prothrombin activity and platelet number. Further multivariate analysis showed that mass ascites(P=0.000, OR=7.614,95%CI: 3.590?16.147), portal vein thrombosis(P=0.003, OR=2.867, 95%CI: 1.429?5.750),portal hypertensive gastropathy(P=0.000, OR=6.212, 95%CI: 3.036?12.711), and Child?Pugh C(P=0.008,OR=3.078,95%CI:1.338?7.083)were independent risk factors of early rebleeding after endoscopic treatment. Conclusion The early rebleeding rate was high after endoscopic treatment of esophageal varices. Patients with massive ascites,portal vein thrombosis,portal hypertensive gastropathy and Child?Pugh C should be highly vigilant for early rebleeding.