We developed a superior scoring model for identifying therapeutic intervention need in Japanese patients with upper gastrointestinal bleeding.

Background and study aims  Although endoscopic transpapillary gallbladder drainage (ETGBD) is reportedly useful in patients who have acute cholecystitis, its efficacy has not been compared to that of percutaneous transhepatic gallbladder drainage (PTGBD). We retrospectively compared the efficacy and safety of ETGBD and PTGBD in patients with acute cholecystitis. Patients and methods  We studied 75 patients who required gallbladder drainage for acute cholecystitis between January 2014 and December 2016. Using propensity score matching analysis, we compared the clinical efficacy and length of hospitalization in patients successfully treated with ETGBD and PTGBD. Moreover, we assessed the predictive factors for hospitalization period < 30 days using multivariate analysis. Results  ETGBD and PTGBD were successfully performed in 33 patients (77 %) and 42 patients (100 %) ( P  < 0.001). Twenty-seven matched pairs were obtained after propensity score matching analysis. No significant differences were observed between patients treated with ETGBD and those treated with PTGBD with respect to improvement in white blood cell count and serum C-reactive protein level. The length of hospitalization in patients treated with ETGBD was significantly shorter than in those treated with PTGBD regardless of the need for surgery. Multivariate logistic regression analysis revealed ETGBD (odds ratio, 7.07; 95 % confidence interval 2.22 – 22.46) and surgery (odds ratio 0.26; 95 % confidence interval 0.09 – 0.79) as independent factors associated with hospitalization period. There were no significant differences in occurrence of complications in ETGBD and PTGBD procedure. Conclusions  ETGBD was shown to be as useful as PTGBD for treatment of acute cholecystitis and was associated with shorter hospitalization period. ETGBD can be an alternative treatment option for acute cholecystitis at times when PTGBD is not possible.

ObjectiveTo assess the influence of biliary drainage to cholangitis on modified Glasgow Prognostic Score (mGPS) in patients with pancreatic cancer. MethodsmGPS was calculated before and after biliary drainage in 47 consecutive patients with inoperable pancreatic cancer who were receiving chemotherapy. Biliary drainage was indicated for malignant obstructive jaundice that prevented the administration of chemotherapy. To elucidate mGPS values, serum levels of CRP and albumin were measured at the time of diagnosis (before biliary drainage). Overall survival was evaluated and risk factors, which contribute to overall survival, were examined.

ObjectiveTo assess the influence of biliary drainage to cholangitis on modified Glasgow Prognostic Score (mGPS) in patients with pancreatic cancer.MethodsmGPS was calculated before and after biliary drainage in 47 consecutive patients with inoperable pancreatic cancer who were receiving chemotherapy. Biliary drainage was indicated for malignant obstructive jaundice that prevented the administration of chemotherapy. To elucidate mGPS values, serum levels of CRP and albumin were measured at the time of diagnosis (before biliary drainage). Overall survival was evaluated and risk factors, which contribute to overall survival, were examined.ResultsBiliary drainage was performed in 15 patients. Using values obtained before biliary drainage, there were no significant differences in median survival time between patients with a mGPS of 0 and those with a mGPS of 1 or 2 (10.7 vs. 9.4 months; p = 0.757). However, using values obtained after biliary drainage, median survival time was significantly higher in patients with a mGPS of 0 than in those with a mGPS of 1 or 2 (11.4 vs. 4.7 months; p = 0.002). Multivariate analysis revealed that a mGPS of 1 or 2 (HR: 3.38; 95% CI: 1.35–8.46, p = 0.009), a carbohydrate antigen 19–9 >1000 U/mL (2.52; 1.22–5.23, p = 0.013), a performance status of 2 (7.68; 2.72–21.28, p = 0.001), carcinoembryonic antigen level >10 ng/mL (2.29; 1.13–4.61, p = 0.021) were independently associated with overall survival.ConclusionmGPS values obtained after biliary drainage appear to be a more reliable indicator of overall survival in patients with inoperable pancreatic cancer.