The risk of delayed bleeding after EMR of large colorectal lesions is 3.7%. We developed a risk scoring system based on 6 factors that determined the risk for delayed bleeding (receiver operating characteristic curve, 0.77). The factors most strongly associated with delayed bleeding were right-sided lesions, aspirin use, and mucosal defects not closed by hemoclips. Patients considered to be high risk (score, 8-10) had a 40% probability of delayed bleeding.

SUMMARY BackgroundBalloon dilation (with or without steroid injection) is the endoscopic treatment of choice for short strictures in Crohn's disease (CD). The placement of a stent has only rarely been reported in this setting, and it may be a good alternative.

RFA for the treatment of GAVE seems feasible and safe, and significantly reduced the need for RBC transfusion and increased the hemoglobin level in this retrospective case series.

RFA seems to significantly decrease clinical symptoms and increase the hemoglobin concentration, thus reducing the need for transfusions.

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The purpose of this study was to evaluate the short-term splanchnic and systemic hemodynamics and hepatic function after TIPS creation. Fifteen cirrhotics with portal hypertension underwent TIPS placement for treatment of variceal hemorrhage, and extensive hemodynamic studies including right heart catheterization, portal pressure measurement, hepatic blood flow, and indocyanine green (ICG) clearance were performed before and 1 month after the procedure. Self-expandable metal stents (Strecker 11 mm diameter) were placed in all cases. Portasystemic gradient significantly diminished (18.3 +/- 4.2 vs 8 +/- 2.8; 54% +/- 18 mm Hg) after the technique, mainly due to a decrease in portal pressure, and remained stable in the final study. Cardiac output and mean arterial pressure increased (6.2 +/- 1.4 vs 8.2 +/- 1.8 liters/min, 80.1 +/- 10.1 vs 91 +/- 11.2 mm Hg, respectively), and a decrease in systemic vascular resistance was registered (1018 +/- 211 vs 872 +/- 168 dyne/sec/cm5); the hepatic blood flow and ICG clearance also decreased significantly (1.5 +/- 0.7 vs 0.68 +/- 0.2 liters/min, 0.4 +/- 0.2 vs 0.24 +/- 0.06 liters/min, respectively). There was an increase in the preload at the final study, as evidenced by a marked increase in right atrial (3.1 +/- 1.6 vs 4.35 +/- 2.2 mmHg, +15%, P< 0.05), pulmonary arterial (12.2 +/- 2.4 vs 15.9 +/- 3.2 mm Hg, +31.8%, P < 0.001), and wedge pulmonary arterial pressures (6.9 +/- 2.4 vs 9.8 +/- 3.1 mm Hg, +53%, P < 0.001). These results suggest that TIPS worsens the hyperdynamic syndrome associated to portal hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

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The new england journal of medicine 310 n engl j med 352;3 www.nejm.org january 20, 2005 Adefovir Dipivoxil for Chemotherapy-Induced Activation of Hepatitis B Virus Infection to the editor: Adefovir dipivoxil is an oral prodrug of adefovir, an analogue of AMP. Adefovir has recently been used for treatment of chronic infection with hepatitis B virus (HBV), resulting in an improvement in liver histology and a reduction in serum HBV DNA. 1 We describe a case of subfulminant HBV infection that was successfully treated with adefovir. A 69-year-old man with prostate adenocarcinoma (stage D2) and bone metastasis had had intermittent cholestasis of unknown origin years earlier. The patient had completed a course of chemotherapy with mitoxantrone and prednisone 30 days before he was admitted to the hospital for asthenia, anorexia, and jaundice. Laboratory tests revealed an international normalized ratio of 1.61, an alanine aminotransferase level of 990 IU per liter, and a total bilirubin level of 10.7 mg per deciliter