Question: A 57-year-old man was transferred to our hospital because of hypereosinophilia, skin eruption on his lower leg, and liver dysfunction while hospitalized for status asthmaticus in another hospital. Furthermore, he complained of paresthesia and myalgia of the extremities during further investigation in our hospital. Laboratory analysis revealed an elevated white blood cell count of 23,200/mm 3 and hypereosinophilia (70.0%). Cholestatic liver dysfunction tests showed the following results: aspartate transaminase (51 U/L), alanine aminotransferase (106 U/L), lactate dehydrogenase (262 U/L), alkaline phosphatase (736 U/L), and gglutamyl transferase (117 U/ L). Hepatitis B surface antigen and hepatitis C virus RNA test results were negative. Antinuclear antibody, antimitochondrial antibody, myeloperoxydase anti-neutrophil cytoplasmic antigen, and proteinase-3 anti-neutrophil cytoplasmic antigen were normal. Transbronchial lung biopsy and skin biopsy showed no pathological significance. An enhanced abdominal computed tomography (CT) scan was performed (Figure A; enlarged view in Figure B). What is the diagnosis? See the Gastroenterology web site (www. gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
All-cause readmission rates were 3.7% (NZ17) for POEM and 4.6% (NZ125) for LHM (pZ0.469). There was no difference in the odds ratio for readmission after POEM versus LHM (ORZ1.29, CI:0.77-2.17). Mean hospitalization charges for readmissions in the LHM group were significantly higher than the POEM group ($68547 vs. $27773, p<0.001). The length of stay for readmitted patients after LHM was also significantly higher than POEM (5.2 days vs. 2.8 days, p<0.001). There was no inpatient mortality for either group for readmission. Conclusions: Outcomes from our large database suggest that in real-world practice, POEM is the preferred treatment for patients who are frail, older, and have more comorbidities. There was no difference in readmission rates between the two POEM and LHM. However, LHM patients had a longer length of stay and higher total hospitalization costs during the rehospitalization.
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