Successful endoscopic hemostasis for ruptured duodenal varices after balloon-occluded retrograde transvenous obliteration.

A 75-year-old man with general malaise and appetite loss was transferred to our hospital for assessment and treatment of liver failure. Laboratory findings on admission showed anemia, and gastroduodenoscopy (GDS) revealed linear esophageal varices and tensive duodenal varices (DV) in the second portion of the duodenum. Systemic examinations did not reveal any significant lesion capable of explaining his anemia, except for DV. Balloon-occluded retrograde transvenous obliteration was carried out to prevent DV bleeding. Good pooling of sclerosant was observed using two balloon catheters. However, contrast-enhanced computed tomography after the procedure revealed no thrombosis in DV, and the patient complained of tarry stools before additional therapy. Emergent GDS revealed ruptured DV with fresh blood and erosions on the surface. Emergent endoscopic obliteration using the tissue adhesive N-butyl-2-cyanoacrylate was carried out and complete hemostasis was achieved. Although no rebleeding episodes were observed after emergent obliteration, the patient died of sepsis following spontaneous bacterial peritonitis 53 days after admission. Autopsy revealed that DV dropped out, and the deep vein was replaced by granulation tissue. No signs of thrombi were detected, except varices. This autopsy case revealed the difficulty in DV management.

Evaluation of autofluorescence colonoscopy for diagnosis of superficial colorectal neoplastic lesions.

BACKGROUND AND AIM: Autofluorescence (AF) imaging, which can potentially differentiate tissue types based on differences in fluorescence emission, may be useful in the diagnosis and treatment of colorectal malignancies. This study was designed to assess the potential usefulness of AF colonoscopy for evaluating superficial colorectal neoplastic lesions. METHODS: A total of 49 colorectal lesions in 43 patients were investigated. All superficial colorectal neoplastic lesions were identified with white light (WL) colonoscopy. Each detected lesion was investigated by WL colonoscopy, AF colonoscopy, and chromoendoscopy using 0.2% indigo carmine dye. Three endoscopists, blinded to each patient's history, evaluated the still images (as obtained with these three methods) in random order and evaluated their influence on the assessment of lesion visualization. All the lesions were biopsied or resected endoscopically, with the pathological results used as the gold standard. RESULTS: For visualization of the surface appearance and differences in color of the lesions compared with the surrounding mucosa, AF colonoscopy was superior to WL colonoscopy (p < 0.01) and comparable to chromoendoscopy (Mann-Whitney U test). For visualization of the circumferential margin, AF colonoscopy was superior to WL colonoscopy (p < 0.05) but inferior to chromoendoscopy (p < 0.01). CONCLUSIONS: AF colonoscopy may be a valuable tool for detection and diagnosis of superficial colorectal neoplastic lesions.

MELD score, child-pugh score, and decreased albumin as risk factors for gastric variceal bleeding.

BACKGROUND/AIMS: Ruptured esophagogastric varices are commonly associated with bleeding in patients with portal hypertension. However, the prediction of esophageal variceal bleeding is not matched by means of predicting gastric variceal bleeding. The present study aim is to elucidate risk factors for gastric variceal bleeding. METHODOLOGY: Twelve patients with gastric variceal bleeding and 18 patients receiving preventive treatment for gastric varices were included in the study. RESULTS: The Child-Pugh (8.0 +/- 0.9 vs. 5.5 +/- 0.3; p = 0.0025) and Model for end-stage liver disease (MELD) (10.6 +/- 2.7 vs. 4.0 +/- 0.9; p = 0.0095) scores were significantly higher for patients with bleeding than for those receiving preventive treatment. Serum albumin concentration was significantly lower in bleeding than in preventive treatment cases, as determined by univariate (2.9 +/- 0.2 vs. 3.7 +/- 0.1 mg/dL; p < 0.0001) and multivariate analyses of serological data (odds ratio, 0.02, 95% confidence interval, 0.001-0.479; p = 0.0144). CONCLUSIONS: The Child-Pugh and MELD scores were significantly higher for patients with gastric variceal bleeding than for those receiving preventive treatment, and multivariate analysis revealed that serum albumin was significantly lower in patients with gastric variceal bleeding. Control of serum albumin is important in preventing gastric variceal bleeding.