No abstract

Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

ObjectivesFor more than 15 years, the tissue glue cyanoacrylate (n-butyl-2-cyanoacrylate) has been successfully used in Europe and many other countries, but not in the United States, for the treatment of bleeding gastric varices. The use of cyanoacrylate for the treatment of esophageal and gastric varices via the percutaneous transhepatic route, was first described by Lundequist et al. [1]. Endoscopic injection of the tissue glue for gastric variceal bleeding was first reported in 1986 [2]. Due to its excellent efficacy [3 -14] cyanoacrylate is considered to be the optimal initial therapy for gastric variceal bleeding by many clinicians worldwide, with the exception of the US. In Europe, cyanoacrylate has recently been approved for endoscopic use (Glubran ; GEM, Viareggio, Italy).Despite its widespread use, there are still some controversies in the literature concerning technique, safety, and long-term results [15 -17]. Embolization of the glue is a potential risk and a cause for concern, as evidenced in recent reports [18 -20]. High rebleeding rates are related to incomplete obliteration of the varices. A rare and less severe complication is pyrexia. Instrument-related complications due to incorrect preparation include adhesion to the endoscope, sticking of the needle to the varix and obstruction of the injection catheter [21].This article deals with the practical details of cyanoacrylate injection of bleeding gastric varices, including equipment, preparation, injection technique and follow-up. Close attention to and implementation of these technical recommendations will result in a safer and successful use of the tissue glue.

We observed a ratio of 6:1 for UC to CD in our series. The incidence of IBD seems to be rising in Egypt.

Objective:Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer.Patients and Methods:A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2).Results:EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%).Conclusion:EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.