International Digestive Endoscopy Network consensus on the management of antithrombotic agents in patients undergoing gastrointestinal endoscopy

Antithrombotic agents, including antiplatelet agents and anticoagulants, are widely used in Korea because of the increasing incidence of cardiocerebrovascular disease and the aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. The clinical practice guidelines for this issue, developed by the Korean Society of Gastrointestinal Endoscopy, were published in 2020. However, new evidence on the use of dual antiplatelet therapy and direct anticoagulant management has emerged, and revised guidelines have been issued in the United States and Europe. Accordingly, the previous guidelines were revised. Cardiologists were part of the group that developed the guideline, and the recommendations went through a consensus-reaching process among international experts. This guideline presents 14 recommendations made based on the Grading of Recommendations, Assessment, Development, and Evaluation methodology and was reviewed by multidisciplinary experts. These guidelines provide useful information that can assist endoscopists in the management of patients receiving antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

IDEN Consensus on Management of Antithrombotic Agents in Patients Undergoing Gastrointestinal Endoscopy / 대한소화기학회지

Antithrombotic agents, including antiplatelet agent and anticoagulants are widely used in Korea due to increasing incidence of cardio-cerebrovascular disease and aging population. The management of patients using antithrombotic agents during endoscopic procedures is an important clinical challenge. Clinical practice guideline regarding this issue which was developed by the Korean Society of Gastrointestinal Endoscopy was published in 2020. However, since then, new evidence has emerged for the use of dual antiplatelet therapy and direct anticoagulant management, and revised guidelines were issued in the US and Europe. Accordingly, the previous guidelines were revised, cardiologists also participated in the development group, and the recommendations went through a consensus process among international experts. This guideline presents 14 recommendations made according to the Grading of Recommendations, Assessment, Development, and Evaluation methodology, and was reviewed by multidisciplinary experts. This guideline provides useful information that can assist endoscopists in the management of patients on antithrombotic agents who require diagnostic and elective therapeutic endoscopy. It will be revised as necessary to cover changes in technology, evidence, or other aspects of clinical practice.

Management of Antibiotic-Resistant Helicobacter pylori Infection: Perspectives from Vietnam

Antibiotic resistance is the most important factor leading to the failure of eradication regimens. This review focuses on the prevalence of Helicobacter pylori primary and secondary resistance to clarithromycin, metronidazole, amoxicillin, levofloxacin, tetracycline, and multidrug in Vietnam. We searched the PubMed, EMBASE, Vietnamese National Knowledge Infrastructure, and Vietnamese Biomedical databases from January 2000 to December 2016. The search terms included the following: H. pylori infection, antibiotic (including clarithromycin, metronidazole, amoxicillin, levofloxacin, tetracycline, and multidrug) resistance in Vietnam. The data were summarized in an extraction table and analyzed manually. Finally, Excel 2007 software was used to create charts. Ten studies (three studies in English and seven in Vietnamese) were included in this review. A total of 308, 412, 523, 408, 399, and 268 H. pylori strains were included in this review to evaluate the prevalence of H. pylori primary resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and multidrug resistance, respectively. Overall, the primary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and multidrug resistance were 15.0%, 34.1%, 69.4%, 27.9%, 17.9% and 48.8%, respectively. Secondary resistance rates of amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and multidrug resistance were 9.5%, 74.9%, 61.5%, 45.7%, 23.5% and 62.3%, respectively. In Vietnam, primary and secondary resistance to H. pylori is increasing over time and affects the effectiveness of H. pylori eradication.

Structured endoscopic ultrasonography (EUS) training program improved knowledge and skills of trainees: Results from the Asian EUS Group.

BACKGROUND AND AIM: A major reason impeding the growth of endoscopic ultrasound (EUS) in Asia is the lack of training availability. We aimed to prospectively evaluate the effectiveness of a short-term structured EUS training program in improving the knowledge and skill of EUS among trainees. METHODS: The study was conducted in six workshops in six countries including Sri Lanka, Pakistan, Thailand, Vietnam, Singapore and Philippines, within a year. Trainees were evaluated using written and skill tests before and after completion of the training. RESULTS: Pre- and post-workshop written tests from a total of 62 trainees were analyzed. Compared with pre-training, the trainees improved significantly in the overall mean (± SD) scores after the training (66.0 ± 0.3% to 77.5 ± 0.2%, P < 0.0001). Thirty-one trainees were randomly selected to undergo a skill test before and after the course. Compared with pre-training, the proportions of trainees who succeeded in locating each structure post-training were: celiac axis (36-80.5%), pancreatic body (51.5-80.5%), pancreatic body and tail (42-77.5%), splenic vein and artery (48.5-84%), left kidney (60-83%), and spleen (47-83%). Overall, there was a significant improvement in the proportion of trainees' successful localization of structures post-training compared to before training (P < 0.0001). CONCLUSION: Following a structured training program, trainees' knowledge and skills in EUS improved significantly. Structured training courses appear to be an effective way of imparting EUS knowledge and skills to aspiring endosonographers in the Asian region.

The value of AFP with lectins affinity in the diagnosis, distinguishable diagnosis, and observation the effects of treatment hepatocellular carcinoma

Examination the usefulness of the lectin reactive alpha-fetoprotein (AFP-L3) in patients with hepatocellular carcinoma (HCC), chronic liver disease (CLD) and patients with HCC treated by transcatheter oil chemoembolization (TOCE). AFP-L3 levels were measured by lectins affinity electrophoresis and antibody affinity blotting. After TOCE, 40 HCC patients were divided in two groups: 1st group (n=27) with AFP-L3 15%. Results: The mean value of AFP-L3 in the 110 HCC patients was 54.6  23.7%, significantly higher (p<0.001) than the value in CLD (11.2  3.1%). When the cut-off level was set 15% for AFP-L3, the sensitivity was 96.4%, the specificity was 95%. Survival rates after 12 and 18 months for all 27 patients calculated according to the Kaplan-Meier methods were 88.9% and 63% in the 1st group and 38.5% and 15.3% in the 2nd group, respectively. The recurrence of HCC for 1st and 2nd group were 10.2  3.5 months and 12.0  1.7 months, respectively.

The prophylactic varices ligation has been applied to patients with liver cirrhosis, cirrhosis accompanied by hepatocellular carcinoma

75 patients were diagnosed with liver cirrhosis (LC) and hepato cellular carcinoma (HCC) are divided into 3 groups: Group 1: 30patients of LC together HCC with digestive bleeding; Group 2: 30 parients of LC with digestive bleeding; Group 3: 15 patients of LC with high risk of digestive bleeding from oesophageal varices. The haemostasis success in Group 1 (LC accompanied by HCC) and Group 2 (LC with digestive bleeding due to oesophageal varices) are 73.3% and 93.3%, respectively. The success of breaking the cluster of oesophageal varices in Group 2 (LC) and Group 3 (LC with high risk of digestive bleeding and treated by prophylactic ligation) are 73.3% and 80%, respectively. The rate of rebleeding in Group 2 and 3 after a year is 20% and 13.3%, respectively.

Remarks on clinical characteristics, diagnosis and treatment of atypical chronic ulcerous colitis

From June 2001 to March 2004, Military Hospital 108 had performed flexible colonoscopy on 1056 subjects and had detected 18 cases (12 males, 6 females) of atypical ulcerous colitis. Clinical manifestations: bleeding stool, irregular diarrhoea or constifution, abdomen pain, weight loss... were most usual signs. Paraclinical signs occurred prevalently only in patients with numberous acute lesions in colon. 15/18 patients (83.4%) tolarated corticoid and salazopirin. 13/15 patients recovered completely without recurrence and without colon damage in colonoscopy. 5/18 patients (27.7%) was in acute stage.

The value of AFP with lectin affinity in diagnosis, differentiated diagnosis and in assessment of the effectiveness of treatment of hepatocellular carcinoma

A study was carried out on 40 hepatocellular carcinoma patients who were divided into 2 groups: 1st group (n=27) with AFP-L315%. Results: the mean value of AFP-L3 in the 110 HCC patients was 54.623.7%, significantly higher (p15%, respectively. The recurrence of HCC for 1st and 2nd group were 10.23.5 months and 12.01.7 months, respectively

To remark 3 cases of digestion tract tuberculosis: experiences in diagnosis and treatment

3 cases of digestion tract tuberculosis treated in Hospital 108 were presented. The first was operated because of intestinal obstruction, the second because of severe gastrointestinal bleeding, but biopsy showed that these two patients were treated intensively by antituberculosis chemotherapy with good success. The third was diagnosed and treated very lately loading to unsatisfied results. Therefore, it should be tried to treat with antituberculosis drug initially

For knowing the factors related to esophagian delation in liver selerosis patient

The study carries on 84 patients diagnosed cirrhosis. These patients were taken endoscopy to determine be esophagus varicosity. The result showed the risque of creation of varicosity knot is 30% in recoverable cirrhosis patients and 60% in no recoverable group. The varicosity knot has tendency filling out from 10 to 25%. The rate of appearance of varicosity knot is 8-10% every year. The risque factors: quantity of glomerule decreased on 30/84 patients with quantity of glomerule <140.000/mm, risque of esophagus varicosity is 83,33% on patients with spleenomegaly (p<0.001). However, the ascites and level of cirrhosis influences also to create esophagus varicosity knot

Remarks on the results of tying esophage vena in patients with liver cell carcinoma associated with liver sclerosis

The study carries on 30 patients with hepatocellular carcinoma treated by embolism liver artery by thrombosis. Following clinical and laboratory on form includes: anamnesis, medical history, symptom and entity, immune, biochemical, endoscope. The result relies on scale of child-pugh A/B/C = 8/18/4. The result of hemostatic: good 73.3%, failed 26.6%. Association between the result of treatment and esophageal varices: the rate death of patients with esophageal varices 3 degree is 87.3%. Sign of clinical and paraclinical of hepatocellular carcinoma complicating liver cirrhosis and bleeding due to rupture of esophageal vein is also grave stage of disease. The effect hemostatic of esophageal varices knot using knot method on hepatocellular carcinoma is 73.3%. The death rate associated to varix level and red mark of esophageal vein

A case of eelworm infection in digestive tract: clinical characteristic, diagnosis and treatment

A case of strongyloides stercoralis gastrointestinalis infection on a 88 years old of age women was admitted in Hospital No108 in the year 2003. The main symptoms were diarrhoea, anemia and abdominal pain. Fecal examination, gastroduodenal fluid and duodenal biopsy were performed. Strongyloides stercoralis and their larva were detected. Thiabendazole was defined was a treatment of choice