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Visceral artery pseudoaneurysms (VAPs) are a rare but important cause of gastrointestinal (GI) bleeding, requiring rapid diagnosis and intervention to prevent life-threatening haemorrhage. These ‘false’ aneurysms, formed due to a breach in the vascular wall, are commonly triggered by local inflammation, infection or vascular trauma. Although rare, VAPs are prone to rupture, carrying a significantly higher mortality rate than true aneurysms. The clinical presentation of VAPs can be non-specific, with symptoms ranging from non-specific abdominal pain to signs of GI bleeding, often leading to hypovolaemic shock.Radiological imaging, particularly contrast-enhanced CT, plays a central role in diagnosing VAPs and can subsequently guide management strategies. Endovascular intervention, typically involving embolisation of the pseudoaneurysm, can be used to treat VAPs, offering high success rates. This review describes two clinical cases of clinically significant VAPs as well as outlining the aetiology, pathophysiology, clinical presentation, diagnostic strategies and management of VAPs, with a focus on the critical role of gastroenterologists in recognising and managing these life-threatening conditions. We emphasise the importance of a timely, multidisciplinary approach to investigation and management of VAPs.

IntroductionAcute upper gastrointestinal bleeding (AUGIB) remains a common presentation accounting for 0.1% of acute medical admissions. Current risk stratification to guide management is weighted on patient factors (eg, Glasgow-Blatchford Score, GBS, or Rockall Score, RS). With an increasingly comorbid population these scores may have less utility. We assess blood-detection capsules (BDC) to triage low-risk, non-variceal, AUGIB referrals.MethodsA prospective service evaluation was performed at a district general hospital in East London. All AUGIB referrals received during the evaluation period were screened for suitability. The BDC was administered while participants wore an external receiver. If positive, participants underwent inpatient gastroscopy; if negative, they were managed as outpatients. Subsequent results, including complications and mortality, were recorded.Results21 referrals were screened during the evaluation period. 11 were excluded with the most common reasons being pacemaker incompatibility or haemodynamic instability. 10 participants with a median age of 76.5 years, Charlson Comorbidity Index of 5.5, GBS 9 and RS 4 were included. Six participants had a negative BDC. Four had a positive BDC; one non-bleeding duodenal ulcer, one oozing Roux-en-Y anastomotic ulcer and two normal examinations. The 90-day mortality was 0% and there were no adverse events among the participants.ConclusionIntroduction of a BDC as a triage tool may reduce the need for inpatient gastroscopies, otherwise indicated by high GBS/RS. We propose patients with suspected non-variceal AUGIB and a negative BDC can be safely managed as outpatients, irrespective of GBS/RS. Larger cohort data is needed to assess the long-term benefit, cost-effectiveness and complication rates.

Background Obesity today is a leading cause of global morbidity and mortality, and bariatric surgeries such as laparoscopic sleeve gastrectomy (LSG) are increasingly playing a key role in its management. Such operations, however, carry many difficult and sometimes fatal complications, including leaks. This study aims at evaluating the effectiveness of endoscopic stenting in treating gastric leaks post-LSG. Methods A retrospective study was conducted to the patients who were admitted with post-LSG gastric leak at Al-Amiri Hospital Kuwait from October 2008 to December 2012 and were subsequently treated with stenting. The patients were stented endoscopically with self-expandable metal stent (SEMS), and a self-expandable plastic stent (SEPS) was used to facilitate stent removal. Results A total of 17 patients with post-LSG leaks underwent endoscopic stenting. The median age was 34 years (range 19–56), 53 % of the patients were male, and mean body mass index (BMI) was 43 kg/m 2 . The median duration of SEMS placement per patient was 42 days (range 28–84). The SEPS-assisted retrieval process took a median duration of 11 days (range 14–35). Successful treatment of gastric leak was evident in 13 (76 %) patients, as evident by gastrografin swallow 1 week after stent removal. In addition, a shorter duration between the LSG and the time of stent placement was associated with a higher success rate of leak seal. Conclusions The use of SEMS appears to be a safe and effective method in the treatment of post-LSG leaks, with a success rate of 76 %. The time frame of intervention after surgery is critical, as earlier stent placement is associated with favorable outcomes. Finally, SEPS is often required to facilitate SEMS removal, and further modification of stents and its delivery system may improve results.

Over 2.5 million gastrointestinal endoscopic procedures are carried out in the United Kingdom (UK) every year. Procedures are carried out with local anaesthetic r with sedation. Sedation is commonly used for gastrointestinal endoscopy, but the type and amount of sedation administered is influenced by the complexity and nature of the procedure and patient factors. The elective and emergency nature of endoscopy procedures and local resources also have a significant impact on the delivery of sedation. In the UK, the vast majority of sedated procedures are carried out using benzodiazepines, with or without opiates, whereas deeper sedation using propofol or general anaesthetic requires the involvement of an anaesthetic team. Patients undergoing gastrointestinal endoscopy need to have good understanding of the options for sedation, including the option for no sedation and alternatives, balancing the intended aims of the procedure and reducing the risk of complications. These guidelines were commissioned by the British Society of Gastroenterology (BSG) Endoscopy Committee with input from major stakeholders, to provide a detailed update, incorporating recent advances in sedation for gastrointestinal endoscopy.This guideline covers aspects from pre-assessment of the elective ‘well’ patient to patients with significant comorbidity requiring emergency procedures. Types of sedation are discussed, procedure and room requirements and the recovery period, providing guidance to enhance safety and minimise complications. These guidelines are intended to inform practising clinicians and all staff involved in the delivery of gastrointestinal endoscopy with an expectation that this guideline will be revised in 5-years’ time.

This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions. We developed this joint official statement based on a systematic review of the literature, critical appraisal of existing guidelines and expert consensus using a two-stage modified Delphi process. This joint APAGE-APSDE Practice Guideline is intended to be an educational tool that assists clinicians in improving care for patients on antithrombotics who require emergency or elective GI endoscopy in the Asian Pacific region.

ObjectiveWhile it is recommended that patients presenting with acute upper gastrointestinal bleeding (AUGIB) should receive endoscopic intervention within 24 hours, the optimal timing is still uncertain. We aimed to assess whether endoscopy timing postadmission would affect outcomes.DesignWe conducted a retrospective, territory-wide, cohort study with healthcare data from all public hospitals in Hong Kong. Adult patients (age ≥18) that presented with AUGIB between 2013 and 2019 and received therapeutic endoscopy within 48 hours (n=6474) were recruited. Patients were classified based on endoscopic timing postadmission: urgent (t≤6), early (6

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