Somatostatin adjunctive therapy for non-variceal upper gastrointestinal rebleeding after endoscopic therapy.

AIM: To evaluate the effect of pantoprazole with a somatostatin adjunct in patients with acute non-variceal upper gastrointestinal bleeding (NVUGIB). METHODS: We performed a retrospective analysis of a prospective database in a tertiary care university hospital. From October 2006 to October 2008, we enrolled 101 patients with NVUGIB that had a high-risk stigma on endoscopy. Within 24 h of hospital admission, all patients underwent endoscopic therapy. After successful endoscopic hemostasis, all patients received an 80-mg bolus of pantoprazole followed by continuous intravenous infusion (8 mg/h for 72 h). The somatostatin adjunct group (n = 49) also received a 250-µg bolus of somatostatin, followed by continuous infusion (250 µg/h for 72 h). Early rebleeding rates, disappearance of endoscopic stigma and risk factors associated with early rebleeding were examined. RESULTS: Early rebleeding rates were not significantly different between treatment groups (12.2% vs 14.3%, P = 0.766). Disappearance of endoscopic stigma on the second endoscopy was not significantly different between treatment groups (94.2% vs 95.9%, P = 0.696). Multivariate analysis showed that the complete Rockall score was a significant risk factor for early rebleeding (P = 0.044, OR: 9.080, 95% CI: 1.062-77.595). CONCLUSION: The adjunctive use of somatostatin was not superior to pantoprazole monotherapy after successful endoscopic hemostasis in patients with NVUGIB.

Is high-dose nafamostat mesilate effective for the prevention of post-ERCP pancreatitis, especially in high-risk patients?

OBJECTIVE: Infusion of the protease inhibitor nafamostat mesilate (20 mg) effectively prevents post-ERCP pancreatitis, but only in low-risk groups. This study was performed to evaluate the use of high-dose nafamostat mesilate (50 mg) for prevention of post-ERCP pancreatitis (PEP), especially in high-risk groups. METHODS: A total of 608 patients who underwent ERCP were included; 13 patients were excluded. Patients were divided into 3 groups: controls (group A), infusion with 20 mg of nafamostat mesilate (group B), or infusion with 50 mg of nafamostat mesilate (group C). The incidence of PEP was analyzed. RESULTS: The overall incidence of acute pancreatitis was 7.4% (44/595). There was a significant difference in the incidence of PEP with or without nafamostat mesilate (13.0% vs 4.0% and 5.1%, respectively; P < 0.0001). Subgroup analysis showed that in low-risk patients, the rate of PEP was significantly different with nafamostat (11.9% vs 2.7% and 4.0%, respectively; P = 0.007). In high-risk patients, the rate of PEP was not significantly different among treatment groups (14.6% vs 5.9% vs 6.9%, respectively; P = 0.108). CONCLUSIONS: Nafamostat mesilate prophylaxis (20 or 50 mg) is effective in preventing post-ERCP pancreatitis. However, the preventive effect of high-dose nafamostat mesilate (50 mg) is not significant in high-risk patients.

A double-layered (comvi) self-expandable metal stent for malignant gastroduodenal obstruction: a prospective multicenter study.

BACKGROUND: A self-expandable metal stent (SEMS) has emerged as an effective palliative treatment for malignant gastroduodenal obstruction resulting from gastric or periampullary malignancy. Despite the stent's effectiveness, tumor ingrowth and stent migration remain complications requiring reintervention. The purpose of this study was to evaluate the efficacy and safety of a double-layered SEMS (Comvi). METHODS: We performed a prospective multicenter study in two university hospitals and two referral hospitals. In fifty consecutive patients with malignant gastroduodenal obstructions, placement of double-layered SEMS, comprising an outer uncovered stent and an inner covered stent that overlap each other, was performed. Palliation, efficacy, and incidence of complications were evaluated. RESULTS: Technical and clinical success was achieved in 100 and 88% of patients, respectively. There were no procedure-related complications. Five patients experienced stent migration (10%). For four of five patients' stent migration occurred within two weeks of stent placement. Stent collapse occurred in five patients after one month. Reintervention for stent migration, collapse, or tumor overgrowth was required for 14 (28%) patients. CONCLUSIONS: Endoscopic placement of a double-layered stent is a safe and effective modality for the palliation of malignant gastroduodenal obstruction. However, considering reintervention, this stent does not seem to add any clear advantage compared with preexisting uncovered stents. Migration, especially within the first two weeks, and stent collapse are still unresolved problems. The device should be fixed or the design modified to reduce these problems.

[Effectiveness and complications of combination therapy with interferon alpha and ribavirin in patients with chronic hepatitis C].

BACKGROUND/AIMS: The effectiveness of combination therapy with conventional or pegylated interferon alpha and ribavirin in patients with chronic hepatitis C is well understood. However, the profound investigation about complications of the treatment has been rarely reported in Korea, where patients have broader spectrum of disease manifestations. The aim of this study was to evaluate the effectiveness and complications of the combination therapy of interferon alpha and ribavirin in patients with chronic hepatitis C. METHODS: Two hundred and forty patients with chronic hepatitis C were included. All patients were treated with interferon alpha (3 million units thrice a week) in combination with ribavirin (800-1,200 mg, depending on body weight). Patients were treated for 6 or 12 months according to the genotypes (genotype 1; 12 months, non-1; 6 months). We retrospectively evaluated ETR (end of treatment response) and SVR (sustained virologic response) on the basis of intent-to-treat in patients completing the therapy. RESULTS: In 154 patients who had completed the therapy, ETR was 79.2% and SVR was 61.0%. Multivariate analysis showed that genotype and early virologic response at 3 months of treatment were independent predictive factors of SVR. Due to insufficient response, 11.3% of the patients discontinued the therapy. In addition, 24.5% of the patients prematurely discontinued the therapy due to adverse events including aggravated liver function (15.4%), failure to return (7.9%), and others (1.2%). Dose modifications of interferon alpha or ribavirin were required due to anemia (15.4%), neutropenia (8.8%), or thrombocytopenia (4.6%). CONCLUSIONS: The overall SVR of patients who had completed the combination therapy with interferon alpha and ribavirin was 61.0%. However, about one third of the patients discontinued the therapy prematurely due to insufficient response, adverse events and/or noncompliance.