Original Article
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Bile acid sequestrants in poor healing after endoscopic therapy of Barrett’s esophagus
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Lukas Welsch, Andrea May, Tobias Blasberg, Jens Wetzka, Elisa Müller, Myriam Heilani, Mireen Friedrich-Rust, Mate Knabe
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Clin Endosc 2023;56(2):194-202. Published online March 9, 2023
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DOI: https://doi.org/10.5946/ce.2022.121
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Graphical Abstract
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- Background
/Aims: Endoscopic therapy for neoplastic Barrett’s esophagus (BE) has become the standard of care over the past two decades. In clinical practice, we regularly encounter patients who fail to achieve complete squamous epithelialization of the esophagus. Although the therapeutic strategies in the individual stages of BE, dysplasia, and esophageal adenocarcinoma are well studied and largely standardized, the problem of inadequate healing after endoscopic therapy is only marginally considered. This study aimed to shed light on the variables influencing inadequate wound healing after endoscopic therapy and the effect of bile acid sequestrants (BAS) on healing.
Methods
Retrospective analysis of endoscopically treated neoplastic BE in a single referral center.
Results
In 12.1% out of 627 patients, insufficient healing was present 8 to 12 weeks after previous endoscopic therapy. The average follow-up duration was 38.8±18.4 months. Complete healing was achieved in 13 patients already after intensifying proton pump inhibitor therapy. Out of 48 patients under BAS, 29 patients (60.4%) showed complete healing. An additional eight patients (16.7%) improved, but only partial healing was achieved. Eleven (22.9%) patients showed no response to BAS augmented therapy.
Conclusions
In cases of insufficient healing even under exhaustion of proton pump inhibitors, treatment with BAS can be an option as an ultimate healing attempt.
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Citations
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Focused Review Series: Roles of Bariatric Endoscopy in Obesity Treatment
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Endoscopic Approach for Major Complications of Bariatric Surgery
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Moon Kyung Joo
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Clin Endosc 2017;50(1):31-41. Published online December 23, 2016
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DOI: https://doi.org/10.5946/ce.2016.140
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Abstract
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- As lifestyle and diet patterns have become westernized in East Asia, the prevalence of obesity has rapidly increased. Bariatric surgeries, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB), are considered the first-line treatment option in patients with severe obesity. However, postoperative complications have increased and the proper management of these complications, including the use of endoscopic procedures, has become important. The most serious complications, such as leaks and fistulas, can be treated with endoscopic stent placement and injection of fibrin glue, and a novel full-thickness closure over-the-scope clip (OTSC) has been used for treatment of postoperative leaks. Stricture at the gastrojejunal (GJ) anastomosis site after RYGB or incisura angularis in SG can be managed using stents or endoscopic balloon dilation. Dilation of the GJ anastomosis or gastric pouch may lead to failure of weight loss, and the use of endoscopic sclerotherapy, novel endoscopic suturing devices, and OTSCs have been attempted. Intragastric migration of the gastric band can be successfully treated using various endoscopic tools. Endoscopy plays a pivotal role in the management of post-bariatric complications, and close cooperation between endoscopists and bariatric surgeons may further increase the success rate of endoscopic procedures.
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Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer
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Young-Il Kim, Il Ju Choi
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Clin Endosc 2015;48(2):121-127. Published online March 27, 2015
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DOI: https://doi.org/10.5946/ce.2015.48.2.121
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Abstract
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Tumor bleeding is not a rare complication in patients with inoperable gastric cancer. Endoscopy has important roles in the diagnosis and primary treatment of tumor bleeding, similar to its roles in other non-variceal upper gastrointestinal bleeding cases. Although limited studies have been performed, endoscopic therapy has been highly successful in achieving initial hemostasis. One or a combination of endoscopic therapy modalities, such as injection therapy, mechanical therapy, or ablative therapy, can be used for hemostasis in patients with endoscopic stigmata of recent hemorrhage. However, rebleeding after successful hemostasis with endoscopic therapy frequently occurs. Endoscopic therapy may be a treatment option for successfully controlling this rebleeding. Transarterial embolization or palliative surgery should be considered when endoscopic therapy fails. For primary and secondary prevention of tumor bleeding, proton pump inhibitors can be prescribed, although their effectiveness to prevent bleeding remains to be investigated.
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Clinical Findings of Upper Gastrointestinal Bleeding and Risk Factors for Early Rebleeding in Patients with Bleeding Peptic Ulcers
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Hyeon Yong Park, M.D., Jin Wook Hur, M.D., Paul Choi, M.D., Nam Young Park, M.D., Jee Yeon Kim, M.D., Dong Wan Kim, M.D., Jee Young Lee, M.D., Ki Hwan Kim, M.D., Moo In Park, M.D., Seun Ja Park, M.D. and Ja Young Koo, M.D.
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Korean J Gastrointest Endosc 2003;27(2):57-63. Published online August 30, 2003
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Abstract
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- Background
/Aims: Upper gastrointestinal (UGI) bleeding may have serious complications. Endoscopic therapy is effective in the hemostasis of active bleeding. We analysed the causes of UGI bleeding and evaluated risk factors and rate of rebleeding in patients with bleeding peptic ulcer. Methods: Records from 326 patients admitted with upper gastrointestinal bleeding between January 1998 and December 2002 were reviewed. We retrospectively analyzed clinical findings and rebleeding risk factors of peptic ulcers. Results: Common causes of UGI bleeding were esophageal varix (38.0%), peptic ulcer (36.9%), Mallory-Weiss tear (13.8%), stomach cancer (6.4%). Early rebleeding of bleeding peptic ulcer after hemostasis occurred in 23 cases (19.2%). On the basis of univariate analysis, significant predictive factors for early rebleeding were old age (>65) (p=0.034), size of ulcer (>2 cm) (p=0.002), number of ulcer (>1) (p=0.059). In multivariate analysis, old age (odds ratio, OR=2.3), size of ulcer (OR=3.3), number of ulcer (OR=2.6) were independent risk factors of rebleeding. Conclusions: Common causes of UGI bleeding are esophageal varix, peptic ulcer, Mallory-Weiss tear. Predictive risk factors for early rebleeding in bleeding peptic ulcer may be old age, size of ulcer and number of ulcer. (Korean J Gastrointest Endosc 2003;27:5763)
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대량의 상부 위장관 출혈을 유발한 십이지장게실 1 예 ( A Case of Massive Upper Gastrointestinal Bleeding from a Duodenal Diverticulum )
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Korean J Gastrointest Endosc 2000;21(3):746-749. Published online November 30, 1999
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Abstract
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- Duodenal diverticulum is well-known pathologic entity. The incidence of duodenal diverticulum varies from 5% to 23% in the general population. Most of diverticula are asymptomatic and have been incidentally observed in upper gastrointestinal series or upper gastrointestinal endoscopy. It usually occurs in the second portion and the medial side of duodenum. The complications of duodenal diverticulum are rare but often result in significant morbidity. They include obstruction, cholelithiasis, ascending cholangitis, ulcers, hemorrhage and perforation. Major gastrointestinal hemorrhage resulting from an inflamed or ulcerated duodenal diverticulum is an uncommon event and it can be treated endoscopically. We report a case of massive upper gastrointestinal bleeding from a duodenal diverticulum which was treated endoscopically.