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This article, published in the journal Endoscopy, explores the risk factors associated with delayed post polypectomy bleeding, which is a common complication of endoscopic polypectomy. The study suggests that endoscopic hemostasis is usually not necessary for low-risk stigmata, such as flat pigmented stigma or a clean base. However, for high-risk stigmata, such as active bleeding or visible vessels, endoscopic hemostasis may be warranted. The study also highlights potential risk factors for high-risk stigmata, including hemodynamic instability, the need for transfusion, shock index, polyp size, and the use of prophylactic hemostatic clips. The authors conclude that further research is needed to determine which patients with delayed post polypectomy bleeding can be treated conservatively. [Extracted from the article]

This article, published in the journal Endoscopy, discusses a case of caustic injury to the rectum in a 21-year-old male with a history of hemorrhoidal disease. The patient presented with acute bloody diarrhea and was found to have marked edema, erythema, and erosions of the rectosigmoid mucosa. It was later revealed that the patient had been using hydrogen peroxide as a cleaning aid. The article emphasizes the importance of a high suspicion index and thorough medical history in diagnosing and managing such cases. [Extracted from the article]

This article, titled "How we spray. TC-325 survival guide: Tips and tricks," aims to provide a comprehensive guide on the application of TC-325 hemostatic powder in clinical practice. The authors present various tips, techniques, and pitfalls to avoid when using TC-325 based on existing literature and their own experience. The article outlines a four-phase process for using the hemostatic powder, including selecting the appropriate hemostatic method, suctioning, preparation, and spraying. The authors emphasize the importance of following these steps carefully to improve the effectiveness of the technique and prevent mistakes. [Extracted from the article]

This article, titled "Parastomal variceal bleeding successfully treated with tissue adhesive injection (cyanoacrylate)," discusses the case of a 48-year-old female patient with a history of gastric bypass surgery and portal hypertension. The patient presented with hematemesis and was found to have bleeding from a parastomal varicose vein. The bleeding was successfully treated with cyanoacrylate glue injection. The article highlights the clinical challenge of managing ectopic parastomal varices and emphasizes the need for case-dependent treatment in the absence of general management guidelines. The authors of the article are C. Sotiropoulos, C. Konstantakis, O. Ampazis, G. Theocharis, C. Triantos, and K. Thomopoulos. [Extracted from the article]

This article, titled "Over-the-scope clip for recurrent peptic ulcer hemorrhage: Use of a novel tool as a rescue treatment," discusses the use of an over-the-scope clip system as a rescue treatment for persistent or recurrent bleeding caused by peptic ulcers. The article presents a case study of an 83-year-old patient who experienced in-hospital melena and was initially treated with epinephrine injection and a through-the-scope clip placement. However, the bleeding recurred and the patient underwent a repeat endoscopy, during which an active hemorrhage was detected and treated with the over-the-scope clip system. The article concludes that the over-the-scope clip is an effective and safe treatment for persistent or recurrent bleeding. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the successful treatment of anorectal variceal bleeding in a 76-year-old female patient with a history of hepatitis B virus-related liver cirrhosis. The patient experienced multiple episodes of hematochezia and underwent sigmoidoscopy, which revealed enlarged anorectal varicose veins. The bleeding vessels were treated successfully with the injection of a sclerosing agent called ethanolamine, commonly used in sclerotherapy of varicose veins in the lower extremities. Anorectal varices are a significant cause of bleeding in patients with portal hypertension. The article includes a video demonstrating the procedure. [Extracted from the article]

This article discusses a case of upper gastrointestinal bleeding in a patient who had previously undergone laparoscopic gastric plication bariatric surgery. The patient presented with symptoms of melena and fainting, and was treated with intravenous fluids, transfusions, and proton pump inhibitors. During a gastroscopy, ulcers were discovered in the stomach mucosa. The article highlights the potential complications associated with gastric plication surgery. [Extracted from the article]

This article, published in the journal Endoscopy, discusses the case of a 79-year-old man who was intubated in the intensive care unit due to a severe exacerbation of chronic obstructive pulmonary disease (COPD). The patient experienced melena, or black, tarry stools, while in the hospital. During a gastroscopy, two ulcers were found in the second part of the duodenum and were treated with adrenaline injection and through the scope clips. However, after 72 hours and the initiation of anticoagulant therapy, the patient experienced a recurrence of bleeding. Another endoscopy was performed, and an actively oozing duodenal ulcer was successfully treated with adrenaline injection and the placement of an Over-The-Scope Clip. The authors of the article are C. Sotiropoulos, C. Konstantakis, G. Theocharis, C. Triantos, and K. Thomopoulos. [Extracted from the article]

The article titled "The 'colonic single-stripe' sign: An evidence clue of ischemic colitis" discusses a case study of a 58-year-old female patient who presented with abdominal pain and rectal bleeding. After ruling out other potential causes, a colonoscopy revealed a linear ulcer on the colonic wall, which is referred to as the "colonic single-stripe" sign. Microscopic evaluation of the biopsied tissue confirmed the diagnosis of ischemic colitis. The article emphasizes that the presence of the "colonic single-stripe" sign during colonoscopy is highly indicative of colonic ischemia. [Extracted from the article]

This article discusses the use of TC-325 hemostatic powder in the management of bleeding upper gastrointestinal (GI) malignancy. The authors present three cases where the powder was successfully used to control bleeding in patients with different types of GI cancer. The powder not only provides hemostasis but also offers palliative benefits and can serve as a bridge to more definitive treatments like radiotherapy or surgery. The use of TC-325 can improve transfusion needs and overall quality of life for patients with upper GI malignancy. [Extracted from the article]

This article discusses the treatment of Mirizzi syndrome, a rare complication of gallstone disease. The traditional approach to treating this condition is through surgery, but the authors present a case series where endoscopic treatment was used instead. The cases involved patients who had previously undergone cholecystectomy, and different types of Mirizzi syndrome were successfully managed using single operator cholangioscopy and lithotripsy. The authors suggest that this endoscopic approach may be a feasible, effective, and safe alternative to surgery, particularly considering the high risk of complications associated with surgical treatment. [Extracted from the article]

This article, published in the journal Endoscopy, examines the incidence of multi-drug resistant (MDR) infections following endoscopic retrograde cholangiopancreatography (ERCP) procedures. The study compares data collected before and after the COVID-19 pandemic outbreak to identify potential risk factors for MDR infections. The results show a significant increase in post-ERCP MDR infections in the period following the pandemic, with 63.4% of cases occurring after COVID-19. The study highlights the complex and multifaceted factors contributing to the development of MDR infections, including the overuse of antibiotics, increased use of corticosteroids, and reallocation of antimicrobial stewardship resources. [Extracted from the article]

Gastroesophageal reflux disease (GERD) has been associated with a variety of pulmonary manifestations, but it is unclear if gastroesophageal reflux causes any abnormality in pulmonary function. Cardiopulmonary exercise test (CPET) is a specialized method that is used to evaluate respiratory function during exercise. The aim of this study was to reveal any abnormality of pulmonary function in patients with GERD and respiratory symptoms. We evaluated 34 patients with GERD (24 men and 10 women, aged 21-63) and extraesophageal respiratory symptoms (wheezing and/or cough) before therapy and after a 12-week treatment with double dose of omeprazole. No patient presented abnormal spirometry. CPET was performed in all the patients at baseline and after completion of the 12-week treatment. CPET parameters including VOrest, VOmax, VCOrest, VCOmax, O-puls rest, O-puls max, HR (heart rate) rest, HRmax, PETCOrest, PETCOmax, and VE/VCO slope were recorded pretreatment and posttreatment. Twenty-four patients (70.6%) had esophagitis (grade A-D), 16 patients had hiatal hernia (47.1%), and 13 patients (38.2%) tested positive for Helicobacter pylori. All of the patients completed the CPET. No one presented shortness of breath or respiratory symptoms. CPET parameters were within normal limits in all of the patients. Twenty-eight patients were reevaluated. No improvement in any CPET parameter posttreatment was observed despite remission of esophageal and extraesophageal respiratory symptoms in all patients. No statistically significant difference was observed pretreatment and posttreatment between the patients older and younger than 40 years, smokers and nonsmokers, Hp(+) and Hp(-) patients, and those with and without hiatal hernia and esophagitis. The patients with GERD and respiratory manifestations and normal spirometry present no pulmonary dysfunction during CPET. No alterations in CPET values posttreatment or differences in CPET values according to age, smoking, Hp status, presence of esophagitis, or hiatal hernia were observed. [ABSTRACT FROM AUTHOR]

Background Obstructive jaundice results in failure of the intestinal barrier with consequent systemic endotoxemia associated with septic complications. We have recently shown that gut barrier failure in experimental obstructive jaundice is associated with high intestinal oxidative stress. This study was undertaken to investigate whether oxidative alterations occur in the intestinal mucosa of patients with obstructive jaundice. Patients and methods Fifteen patients with malignant biliary obstruction and no signs of cholangitis and 15 control patients were subjected to duodenal biopsy to assess intestinal oxidative stress, estimated by lipid peroxidation (malondialdehyde – MDA) and glutathione redox state [reduced glutathione (GSH), glutathione disulphide (GSSG) and GSH/GSSG ratio]. In addition, mucosal biopsies were examined histologically and intestinal mucosal protein content was determined biochemically as an index of intestinal trophic state. Results Patients with obstructive jaundice presented high levels of intestinal oxidative stress, with significantly increased lipid peroxidation ( P < 0·001). Glutathione redox state was also suggestive of high intestinal oxidative stress in jaundiced patients, indicated by significantly decreased GSH ( P = 0·001) and GSH/GSSG ratio ( P = 0·006) and increased GSSG ( P = 0·026). Histological examination showed a mild infiltration of the lamina propria by chronic inflammatory cells in obstructive jaundice, whereas duodenal architecture remained intact and epithelial continuity was retained. Duodenal mucosa was atrophic in jaundiced patients as indicated by a significant reduction of mucosal protein content compared with controls ( P = 0·001). Among oxidative stress parameters, intestinal GSH exhibited a significant positive correlation with mucosal protein content ( r = 0·588, P = 0·021). Conclusions Obstructive jaundice in humans induces intestinal oxidative stress, which may be a key factor contributing to intestinal barrier failure and the development of septic complications in this patient population. [ABSTRACT FROM AUTHOR]

Lipoproteins are closely connected to the process of hepatitis C virus (HCV) infection. The aim of this study was to evaluate the lipaemic profile in patients with chronic HCV infection, and to identify any association between serum lipid levels and viral load, HCV genotype or liver histology. Total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and triglycerides (TG) were measured in the sera of 155 patients with chronic HCV infection and 138 normal subjects, matched for age and sex. Viral parameters and liver histology were evaluated in HCV-infected patients. Serum TC ( P < 0.0005), HDL-C ( P < 0.0005) and LDL-C ( P < 0.0005) were lower in chronic hepatitis C patients compared with controls. Grading score was positively correlated with TC and LDL-C. Patients with HCV genotype 3a had significantly lower levels of TC, HDL-C, LDL-C, higher viral load and higher frequency of hepatic steatosis than those with other genotypes. Logistic regression analysis identified genotype 3a (OR, 6.96; 95% CI, 2.17–22.32, P = 0.0011) as the only significant predictive variable associated with low serum cholesterol concentration. HCV infection is associated with clinically significant lower cholesterol levels (TC, LDL and HDL) when compared with those of normal subjects. This finding is more pronounced in patients infected with HCV genotype 3a. Further studies are necessary to define the pathophysiology of the relationship between lipid metabolism and HCV infection. [ABSTRACT FROM AUTHOR]

Candida oesophagitis (CO) is scarce among immunocompetent patients. This study aimed at evaluating predisposing factors, clinical symptoms and endoscopic findings in this group. We retrospectively reviewed 55 patients diagnosed as CO endoscopically (whitish plaques) and cytologically (fungal mycelia on brush cytology). Carcinoma, diabetes, acid suppression, steroids, gastric surgery and oesophageal motility disorders were considered as predisposing factors. Twenty of 55 patients lacked any predisposing factor for CO. These patients were more frequently asymptomatic (8/20) when compared with those with known predisposing factors (5/35) (p = 0.031). Moreover, dysphagia was more prevalent in the latter group (24/35 vs. 8/20; p = 0.039). Endoscopic findings correlated with the presence of neither predisposing factors nor symptoms (Wilcoxon p > 0.05). Thus, CO can be discovered in patients without apparent predisposing risk factors and clinical symptoms. Further studies are needed to elucidate the mechanisms of transition from colonisation to infection. [ABSTRACT FROM AUTHOR]

Candida oesophagitis (CO) is scarce among immunocompetent patients. This study aimed at evaluating predisposing factors, clinical symptoms and endoscopic findings in this group. We retrospectively reviewed 55 patients diagnosed as CO endoscopically (whitish plaques) and cytologically (fungal mycelia on brush cytology). Carcinoma, diabetes, acid suppression, steroids, gastric surgery and oesophageal motility disorders were considered as predisposing factors. Twenty of 55 patients lacked any predisposing factor for CO. These patients were more frequently asymptomatic (8/20) when compared with those with known predisposing factors (5/35) (p = 0.031). Moreover, dysphagia was more prevalent in the latter group (24/35 vs. 8/20; p = 0.039). Endoscopic findings correlated with the presence of neither predisposing factors nor symptoms (Wilcoxon p > 0.05). Thus, CO can be discovered in patients without apparent predisposing risk factors and clinical symptoms. Further studies are needed to elucidate the mechanisms of transition from colonisation to infection. [ABSTRACT FROM AUTHOR]

Siagris D, Giannakoulas N, Christofidou M, Tsamandas A, Lekkou A, Thomopoulos K, Zoumbos N, Labropoulou-Karatza Ch. Virological, immunological and histological aspects in adult β-thalassemic patients with chronic HCV infection. Liver International 2004: 24: 204–209. © Blackwell Munksgaard 2004 Multitransfused adult β-thalassemic patients constitute a population with high prevalence of hepatitis C virus (HCV) infection, because of transmission of HCV from infected blood donors prior to the introduction of anti-HCV screening. The aim of this study was to compare them with otherwise normal patients with HCV infection. Forty-two adult multitransfused β-thalassemics and 49 otherwise normal patients of the same age, with chronic HCV infection were studied. Viral parameters, autoimmunity indices and liver histology were evaluated. Serum HCV RNA levels were found significantly lower in thalassemic (median: 65 150 international units per milliliter (IU/ml); range: 3 059 380 IU/ml) than in non-thalassemic (NT) patients (median: 580 000 IU/ml; range: 10 956 000 IU/ml; P=0.001). The most prevalent genotype in thalassemic group was genotype 4 (32.4%) while in NT group was genotype 3a (59.2%). Cryoglobulins were detected in 8/42 (19%) thalassemic patients and in 12/49 (24.5%) NTs. Thalassemic patients had significantly lower levels of C3 and C4 components of complement and higher incidence of anti-nuclear antibodies than those without thalassemia. In patients with thalassemia a lower grading score was noted in liver biopsy compared with those without thalassemia (4.41±1.98 vs 5.38±2.09, P=0.038). On the contrary, thalassemic patients were found to have a higher staging score (3.08±1.51 vs 2.33±1.34, P=0.024). Adult β-thalassemic patients, compared with other patients with HCV infection, present lower necroinflammatory activity and lower viral load but higher staging score. Autoimmune features are marginally different. Age of acquiring the infection, iron overload and modulation of immune system by transfusions are the proposed causes of these differences. [ABSTRACT FROM AUTHOR]

Summary. A randomized trial was conducted to assess the efficacy of daily (QD) or thrice weekly (TIW) administration of interferon-α (IFN) in high doses in combination with ribavirin (1.0–1.2 g/day) in patients with chronic hepatitis C (CHC) who were nonresponders to previous IFN monotherapy. Interferon was administered as 10 MU IFN (QD or TIW) for 4 weeks, followed by 5 MU IFN (QD or TIW) for 20 weeks, and then by 3 MU IFN (QD or TIW) for 24 weeks. Sustained virological response (SVR) was evaluated in 142 patients who received at least one dose of medication. One-fourth of the patients achieved SVR, 26% of those treated with IFN QD and 25% of those treated with IFN TIW (P = 0.85). For genotype 1 patients, SVR rates were 32.4 and 15.8% for IFN QD and IFN TIW, respectively, whereas for genotype non-1 patients the corresponding SVR rates were 20.6 and 36.4%, respectively (test of homogeneity: P = 0.031). This finding was further confirmed by multivariate logistic regression analysis where a statistically significant interaction (P = 0.012) was found between treatment and HCV genotype indicating that the IFN QD regimen was superior to IFN TIW among genotype 1 patients whereas, among genotype non-1 patients, the two treatments were similar (odds ratio of SVR in IFN QD vs IFN TIW: 3.33 among genotype 1 patients, 95% CI: 1.00–11.14). In conclusion, re-treatment of patients not responding to previous IFN monotherapy with a combination of high daily dose of IFN with ribavirin may be beneficial for genotype 1 infected patients. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of a submucosal injection of adrenaline solution in endoscopic haemostasis is well documented in patients suffering from peptic ulcer bleeding. After treatment, however, a significant number of patients continue to bleed or rebleed, and require emergency surgical intervention. The aim of this study was to define factors associated with the failure of endoscopic injection haemostatic therapy in peptic ulcer bleeding. Methods: In the period 1992 to 1998, we prospectively studied all patients suffering from peptic ulcer bleeding and identified endoscopically as being either bleeding actively or carrying a visible vessel. A total of 427 patients (343 men and 84 women; mean age 58.6 ± 16.6 years) were all subjected to endoscopic injection with adrenaline solution on an emergency basis. Patients who eventually required surgical intervention for permanent haemostasis were considered as endoscopic haemostasis failures, whereas those who did not were considered as endoscopic treatment successes. We evaluated all clinical and endoscopic parameters that might have been related to failure of endoscopic injection therapy. Results: Endoscopic injection haemostasis was successful in 341 patients (79.9%) and a failure in 86 (20.1%) who finally underwent emergency surgical haemostasis. On analysing the examined parameters, failure was significantly related to shock on admission (OR 2.31, 95% CI 1.33, 6.97), spurt bleeding at endoscopy (OR 2.45, 95% CI 1.51, 3.98), posteriorly located duodenal ulcer (OR 2.48, 95% CI 1.37, 7.01) and anastomotic ulcer (OR 3.39, 95% CI 1.37, 7.29). Endoscopic injection haemostasis therapy was less effective in patients with chronic ulcers compared to those who had acute NSAID-related ulcers. A history of peptic ulcer (OR 1.57, 95% CI 1.14, 3.05), previous peptic ulcer bleeding (OR 2.45, 95% CI 1.51, 3.98) or non-use of NSAIDs (OR 2.81, 95% CI 1.33, 4.62) were negative predictors for the outcome of endoscopic haemostasis. Conclusion: With the use of specific clinical and endoscopic characteristics it is possible to define a subgroup of high-risk patients for continued bleeding or rebleeding despite endoscopic injection therapy. These patients may be candidates for intensive monitoring, early surgical intervention or possibly complementary endoscopic haemostatic methods. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the prevalence of intrapulmonary vascular dilatations (IPVD) in normoxaemic patients with early liver cirrhosis and to compare their occurrence in progressive alcoholic versus postviral hepatic insufficiency. Methods: Pulmonary function tests and arterial blood gas measurements were performed in 75 consecutive patients with cirrhosis of alcoholic and postviral aetiology. Contrast-enhanced echocardiography was used to identify IPVD. Results: All patients were grade A or B in accordance with the Child-Pugh modified classification. Arterial blood gas analyses showed normoxaemia in all patients. Eight of 75 patients (10.7%) had a positive contrast echocardiogram, all with a decreased diffusion capacity (Dl[sub CO] < 75% of the expected value). The abnormality was more prominent with advancing stage of liver failure (4.5% in grade A versus 19.4% in grade B; P < 0.05) and more common in patients with alcoholic cirrhosis (17.5% in alcoholic versus 2.9% in postviral cirrhosis; P < 0.05). Conclusion: In normoxaemic patients with early liver cirrhosis subclinical pulmonary vasodilatation, as assessed with contrast echocardiography, can occur. The finding is more prominent in alcoholic cirrhosis and possibly reflects an advancing degree of liver insufficiency. [ABSTRACT FROM AUTHOR]

Endoscopic hemostasis is the treatment of choice for bleeding gastroduodenal ulcers. Forest IIA gastroduodenal ulcers (non-bleeding visible vessel-NBVV) are related to high risk of rebleeding, which often necessitates surgical hemostasis for permanent control. The aim of this study was to define factors that would predict failure of endoscopic hemostasis in patients with NBW. During a four-year period (1997-2001), 1113 patients were treated at our hospital due to benign peptic ulcer bleeding, among them 191 with NBVV. Within 24 hours from admission they all underwent emergency endoscopic hemostasis with adrenaline injection, and were then followed intensively. In case of rebleeding, a second attempt for endoscopic hemostasis was carried out.