Urgent endoscopy in elderly patients with non-variceal upper gastrointestinal bleeding.

Abstract

IntroductionAge of the patient is an important prognostic factor in patients with non-variceal upper gastrointestinal bleeding (UGIB). Despite that fact, current treatment algorithms do not differentiate UGIB management according to the patient's age.AimTo compare treatment outcomes in patients below and above 75 years of age, treated for UGIB with urgent endoscopy.Material and methodsProspective analysis of treatment outcomes in 295 patients with non-variceal UGIB divided into two age groups (group A < 75 years of age, group B > 75 years of age). Urgent endoscopy (up to 3 h since admission) was performed in 292 patients. The groups were compared in regards to the duration of symptoms, previous UGIB, presence of factors predisposing to UGIB (NSAIDs, peptic ulcer disease, liver cirrhosis, and previous gastrointestinal surgery), haemodynamic state and haemoglobin (Hb) levels on admission. We analysed the causes of UGIB, severity of UGIB on the Forrest scale, type of endoscopic bleeding control method, and co-morbidities with use of the Charlson Co-morbidity Index (CCI). Treatment outcomes were assessed in regard of mortality rate, UGIB-recurrence rate, duration of hospital stay, amount of transfused blood products and the requirement of intensive therapy unit (ITU) or other departments’ admissions. Patients were followed until their discharge home.ResultsMortality rate was 6.8% (group A vs. B: 3.5% vs. 18.7%; p = 0.001). Upper gastrointestinal bleeding recurrence was noted in 12.2% of patients (group A vs. B: 12.5% vs. 10.9%; p = 0.73). 2.4% of patients required surgery for UGIB (group A vs. B: 1.7% vs. 4.7%; p = 0.16). Patients in group B required ITU admission more frequently (group A vs. B: 1% vs. 4.7%; p < 0.01). The mean hospital stay (4.3 days) and the mean number of transfused packed red blood cells (PRBCs) (2.35 Units) did not differ between the groups. Patients in group B used NSAIDS much more frequently, more often had hypovolaemic shock and had a higher CCI score.ConclusionsUrgent endoscopy is an important and broadly accepted method of treatment of UGIB. Despite strict adherence to the modern UGIB-treatment algorithms, mortality remains high in the elderly. Thus, these patients need particular attention. The presented study indicates that the standard management might not be sufficient in elderly patients.

Endoscopic submucosal dissection of gastric ectopic pancreas.

“…Most of these symptoms are not specific and thus require additional examinations, e.g. gastroscopy with biopsy and urease test, computed tomography scans, and preferably endoscopic ultrasound scan as well [2, 3]. Most gastric tumors turn out to be neoplasms and require a complete resection by means of total gastrectomy with adequate nodal dissection [2].…”

Correlation between the Glasgow-Blatchford score, shock index, and Forrest classification in patients with peptic ulcer bleeding

“…Therefore, emergency patients should first be assessed with the SI to determine their disease severity, and the GBS may be used to further assess their disease severity and prognosis after the completion of blood and other tests, as it may be helpful for risk stratification and decision-making clinically before endoscopy. With the wider application and higher importance of emergency endoscopy, identifying the cause of bleeding as early as possible via endoscopy is of great significance for the diagnosis and treatment in ANVUGIB patients [8,23]. The Forrest classification is an endoscopic scoring system, which classifies ulcer lesions into high-risk and low-risk, and it is helpful in predicting the risk of rebleeding and guiding endoscopic hemostasis therapy [17].…”

Giant Bauhin valve adenoma and laparoscopically assisted colonoscopic polypectomy.

“…Formerly, those patients would undergo segmental colon resection, but now when minimally invasive surgery is becoming the surgical method of choice even big colorectal polyps can be removed safely. Because of technological progress in medicine, pharmacotherapy and minimally invasive procedures, successful treatment of patients with severe comorbidities can be achieved [ 4 ]. As our case report shows, even a 4 cm × 5 cm circular Bauhin valve adenoma can be removed using minimally invasive methods.…”