High values on MELD are associated with EV and thrombocytopenia, with varices which need prophylactic therapy. As a result of their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all patients with cirhosis.
Background: Pancreatic pseudocyst endoscopic drainage
has been described as a good treatment option,
with morbidity and mortality rates that are lower
than surgery. The aim of our study is to describe the
efficacy of different forms of endoscopic drainage
and estimate pseudocyst recurrence rate after short
follow up period.
Patients and Methods: We studied 30 patients with
pancreatic pseudocyst that presented some indication
for treatment: persistent abdominal pain, infection
or cholestasis. Clinical evaluation was performed
with a pain scale, 0 meaning absence of pain
and 4 meaning continuous pain. Pseudocysts were
first evaluated by abdominal CT scan, and after
endoscopic retrograde pancreatography the patients
were treated by transpapillary or transmural (cystduodenostomy
or cystgastrostomy) drainage. Pseudocyst
resolution was documented by serial CT
scans.
Results: 25/30 patients could be treated. Drainage
was successful in 21 (70% in an ‘intention to treat’
basis). After a mean follow-up of 42±35.82 weeks,
there was only 1 (4.2%) recurrence. A total of 6 complications
occurred in 37 procedures (16.2%), and all
but 2 were managed clinically and/or endoscopically:
there was no mortality related to the procedure.
Patients submitted to combined drainage
needed more procedures than the other groups.
There was no difference in the efficacy when we
compared the three different drainage methods.
Conclusions: We concluded that pancreatic pseudocyst
endoscopic drainage is possible in most
patients, with high success rate and low morbidity.
BEC and APC are both effective for the therapy of bleeding telangiectasias from CRCP. There are probably no major differences between them. Although APC seemed safer than BEC in this investigation, further studies, involving a much larger population, are needed to assess the complication rates and determine the best management option.
EBL alone and EBL+PP were effective in the primary prophylaxis of bleeding from EVs in cirrhotic patients (EV eradication, bleeding before EV eradication, mortality, and adverse events were similar in both groups). However, variceal recurrence was lower in the EBL+PP group than band ligation alone.
-Background -Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs. Objective -The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital. Methods -It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources. Results -The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding. Conclusion -The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.
Endoscopic sclerotherapy and banding ligation are the two preferred methods to treat oesophageal variceal bleeding. There are many reports dealing with such treatment in cirrhotic patients but we do not know how good they are to treat varices secondary to other forms of portal hypertension. Schistosomiais mansoni is the main cause of portal hypertension and oesophageal varices in Brazil. We performed a prospective randomised study to compare: 1) the efficacy of both treatments in eradicating oesophageal varices, and 2) complications secondary to both treatments. Forty patients were divided in two Groups. Both sclerotherapy and banding ligation were performed until variceal eradication. There were no severe complications. Variceal eradication was faster obtained with banding ligation than sclerotherapy although there was no statistical difference (mean number of sessions 3.05 vs 3.72, p=0.053). Benign complications were equally frequent in both Groups, although additional sedation was more common in the sclerotherapy Group. We concluded that both treatments are equally effective in the eradication of oesophageal varices, although banding ligation is better tolerated by the patient and probably faster.
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