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Original Articles
Efficacy of hemostasis by gastroduodenal covered metal stent placement for hemorrhagic duodenal stenosis due to pancreatobiliary cancer invasion: a retrospective study
Yasunari Sakamoto, Taku Sakamoto, Akihiro Ohba, Mitsuhito Sasaki, Shunsuke Kondo, Chigusa Morizane, Hideki Ueno, Yutaka Saito, Yasuaki Arai, Takuji Okusaka
Received June 18, 2023  Accepted January 15, 2024  Published online June 14, 2024  
DOI: https://doi.org/10.5946/ce.2023.155    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Advanced pancreatic and biliary tract cancers can invade the duodenum and cause duodenal hemorrhagic stenosis. This study aimed to evaluate the efficacy of covered self-expandable metal stents in the treatment of cancer-related duodenal hemorrhage with stenosis.
Methods
Between January 2014 and December 2016, metal stents were placed in 51 patients with duodenal stenosis. Among these patients, a self-expandable covered metal stent was endoscopically placed in 10 patients with hemorrhagic duodenal stenosis caused by pancreatobiliary cancer progression. We retrospectively analyzed the therapeutic efficacy of the stents by evaluating the technical and clinical success rates based on successful stent placement, degree of oral intake, hemostasis, stent patency, and overall survival.
Results
The technical and clinical success rates were 100%. All 10 patients achieved a Gastric Outlet Obstruction Scoring System score of three within two weeks after the procedure and had no recurrence of melena. The median stent patency duration and overall survival after stent placement were 52 days (range, 20–220 days) and 66.5 days (range, 31–220 days), respectively.
Conclusions
Endoscopic placement of a covered metal stent for hemorrhagic duodenal stenosis associated with pancreatic or biliary tract cancer resulted in duodenal hemostasis, recanalization, and improved quality of life.
  • 1,446 View
  • 55 Download
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Clinical outcomes of nonvariceal upper gastrointestinal bleeding in nonagenarians and octogenarians: a comparative nationwide analysis
Khaled Elfert, James Love, Esraa Elromisy, Fouad Jaber, Suresh Nayudu, Sammy Ho, Michel Kahaleh
Clin Endosc 2024;57(3):342-349.   Published online February 7, 2024
DOI: https://doi.org/10.5946/ce.2023.130
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Nonagenarians will purportedly account for 10% of the United States population by 2050. However, no studies have assessed the outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) in this age group.
Methods
The National Inpatient Sample database between 2016 and 2020 was used to compare the clinical outcomes of NVUGIB in nonagenarians and octogenarians and evaluate predictors of mortality and the use of esophagogastroduodenoscopy (EGD).
Results
Nonagenarians had higher in-hospital mortality than that of octogenarians (4% vs. 3%, p<0.001). EGD utilization (30% vs. 48%, p<0.001) and blood transfusion (27% vs. 40%, p<0.001) was significantly lower in nonagenarians. Multivariate logistic regression analysis revealed that nonagenarians with NVUGIB had higher odds of mortality (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3–1.7) and lower odds of EGD utilization (OR, 0.86; 95% CI, 0.83–0.89) than those of octogenarians.
Conclusions
Nonagenarians admitted with NVUGIB have a higher mortality risk than that of octogenarians. EGD is used significantly in managing NVUGIB among nonagenarians; however, its utilization is comparatively lower than in octogenarians. More studies are needed to assess predictors of poor outcomes and the indications of EGD in this growing population.
  • 2,450 View
  • 36 Download
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Novel upper gastrointestinal bleeding sensor capsule: a first human feasibility and safety trial
Lukas Bajer, Marvin Ryou, Christopher C. Thompson, Pavel Drastich
Clin Endosc 2024;57(2):203-208.   Published online January 17, 2024
DOI: https://doi.org/10.5946/ce.2023.111
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Upper gastrointestinal bleeding (UGIB) is the most common GI condition requiring hospitalization, and can be diagnosed by direct visualization. The present study aimed to evaluate the safety and feasibility of using the PillSense system (EnteraSense Ltd.), a novel diagnostic tool designed for the rapid in vivo detection of UGIB, in human volunteers.
Methods
In the present study, 10 volunteers swallowed a PillSense capsule, followed by 2 servings of an autologous blood preparation. Participants were monitored for capsule passage, overall tolerability of the procedure, and adverse events.
Results
The procedure was completed per the protocol established in the present study in 9/10 cases. In 9 of the subjects, after capsule ingestion, the device indicated the absence of blood with sensor output values of 1. After the ingestion of the first blood mixture, the sensor outputs of all devices increased from 2.8 to 4, indicating that each camera detected blood. The sensor output remained within that range after the ingestion of the second mixture; however, in one case, the baseline capsule signal was positive, because of a preexisting condition. The passage of the capsule was verified in all patients, and no adverse events were reported.
Conclusions
The first trial of the PillSense system in human subjects demonstrated the feasibility, safety, and tolerability of utilizing this product as a novel, noninvasive, and easy-to-use triage tool for the diagnosis of patients suspected of having UGIB.

Citations

Citations to this article as recorded by  
  • Could a bleeding-sensor device be established as a new paradigm for detecting upper gastrointestinal bleeding before performing endoscopy?
    Sun Gyo Lim
    Clinical Endoscopy.2024; 57(2): 191.     CrossRef
  • Approaches of wearable and implantable biosensor towards of developing in precision medicine
    Elham Ghazizadeh, Zahra Naseri, Hans-Peter Deigner, Hossein Rahimi, Zeynep Altintas
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • 2,384 View
  • 157 Download
  • 2 Crossref
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Review
Endoscopic management of postoperative bleeding
Sung Hyeok Ryou, Ki Bae Bang
Clin Endosc 2023;56(6):706-715.   Published online November 2, 2023
DOI: https://doi.org/10.5946/ce.2023.028
AbstractAbstract PDFPubReaderePub
Postoperative gastrointestinal bleeding is a rare but serious complication that can lead to prolonged hospitalization and significant morbidity and mortality. It can be managed by reoperation, endoscopy, or radiological intervention. Although reoperation carries risks, particularly in critically ill postoperative patients, minimally invasive interventions, such as endoscopy or radiological intervention, confer advantages. Endoscopy allows localization of the bleeding focus and hemostatic management at the same time. Although there have been concerns regarding the potential risk of creating an anastomotic disruption or perforation during early postoperative endoscopy, endoscopic management has become more popular over time. However, there is currently no consensus on the best endoscopic management for postoperative gastrointestinal bleeding because most practices are based on retrospective case series. Furthermore, there is a wide range of individual complexities in anatomical and clinical settings after surgery. This review focused on the safety and effectiveness of endoscopic management in various surgical settings.
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  • 145 Download
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Original Articles
Preclinical study of a novel ingestible bleeding sensor for upper gastrointestinal bleeding
Kimberly F. Schuster, Christopher C. Thompson, Marvin Ryou
Clin Endosc 2024;57(1):73-81.   Published online May 31, 2023
DOI: https://doi.org/10.5946/ce.2022.293
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Upper gastrointestinal bleeding (UGIB) is a life-threatening condition that necessitates early identification and intervention and is associated with substantial morbidity, mortality, and socioeconomic burden. However, several diagnostic challenges remain regarding risk stratification and the optimal timing of endoscopy. The PillSense System is a noninvasive device developed to detect blood in patients with UGIB in real time. This study aimed to assess the safety and performance characteristics of PillSense using a simulated bleeding model.
Methods
A preclinical study was performed using an in vivo porcine model (14 animals). Fourteen PillSense capsules were endoscopically placed in the stomach and blood was injected into the stomach to simulate bleeding. The safety and sensitivity of blood detection and pill excretion were also investigated.
Results
All the sensors successfully detected the presence or absence of blood. The minimum threshold was 9% blood concentration, with additional detection of increasing concentrations of up to 22.5% blood. All the sensors passed naturally through the gastrointestinal tract.
Conclusions
This study demonstrated the ability of the PillSense System sensor to detect UGIB across a wide range of blood concentrations. This ingestible device detects UGIB in real time and has the potential to be an effective tool to supplement the current standard of care. These favorable results will be further investigated in future clinical studies.

Citations

Citations to this article as recorded by  
  • Miniaturized Capsule System Toward Real‐Time Electrochemical Detection of H2S in the Gastrointestinal Tract
    Justin M. Stine, Katie L. Ruland, Luke A. Beardslee, Joshua A. Levy, Hossein Abianeh, Santiago Botasini, Pankaj J. Pasricha, Reza Ghodssi
    Advanced Healthcare Materials.2024;[Epub]     CrossRef
  • 2,344 View
  • 150 Download
  • 1 Web of Science
  • 1 Crossref
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Comparison of conventional and new endoscopic band ligation devices for colonic diverticular bleeding
Ayaka Takasu, Takashi Ikeya, Yasutoshi Shiratori
Clin Endosc 2022;55(3):408-416.   Published online February 18, 2022
DOI: https://doi.org/10.5946/ce.2021.200
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite Co. in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL.
Methods
Seventy-nine patients who underwent EBL for CDB at St. Luke’s International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated.
Results
Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (p=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (18.2 minutes vs. 14.2 minutes, p=0.02). No adverse events were observed in either group.
Conclusions
The N-EBL device is safe and useful and may reduce EBL procedure time.

Citations

Citations to this article as recorded by  
  • Advances in endoscopic management of colonic diverticular bleeding
    Yasutoshi Shiratori, Syed Matthew Kodilinye, Ahmed E. Salem
    Current Opinion in Gastroenterology.2024;[Epub]     CrossRef
  • Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline
    Neil Sengupta, Joseph D. Feuerstein, Vipul Jairath, Amandeep K. Shergill, Lisa L. Strate, Robert J. Wong, David Wan
    American Journal of Gastroenterology.2023; 118(2): 208.     CrossRef
  • Effective endoscopic band ligation for diverticular perforation with a refractory pelvic abscess
    Koichi Soga, Atsushi Majima
    Clinical Endoscopy.2023; 56(2): 252.     CrossRef
  • A new band ligation device to treat colonic diverticular bleeding
    Yunho Jung
    Clinical Endoscopy.2022; 55(3): 367.     CrossRef
  • 3,988 View
  • 241 Download
  • 2 Web of Science
  • 4 Crossref
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Case Reports
Management of Biliopancreatic Limb Bleeding after Roux-en-Y Gastric Bypass: A Case Report
Christophe Riquoir, Luis Antonio Díaz, David Chiliquinga, Roberto Candia, Fernando Pimentel, Alex Arenas
Clin Endosc 2021;54(5):754-758.   Published online May 25, 2021
DOI: https://doi.org/10.5946/ce.2021.060
AbstractAbstract PDFPubReaderePub
The Roux-en-Y gastric bypass is one of the most extensive surgical treatments for obesity. The treatment of upper gastrointestinal bleeding after Roux-en-Y gastric bypass is complex due to the difficulty of accessing the excluded gastric antrum and duodenal bulb. There is no consensus regarding the management of this complication. While various techniques have been described to access the biliopancreatic limb, double-balloon enteroscopy is the most commonly used. If double-balloon enteroscopy is unavailable, a pediatric colonoscope may be used as an alternative; however, its use in such cases has not been described. We report the case of a 50-year-old male patient who underwent gastric bypass 13 years ago and was admitted for a second episode of upper gastrointestinal bleeding. The initial approach using upper endoscopy, colonoscopy, and abdominal computed tomography angiography did not reveal the cause of gastrointestinal hemorrhage; therefore, an endoscopic study of the biliopancreatic limb was performed using a pediatric colonoscope. A Forrest Ib ulcer was found in the duodenal bulb, and endoscopic therapy was administered. The evolution was found to be satisfactory.

Citations

Citations to this article as recorded by  
  • Endoscopic management of postoperative bleeding
    Sung Hyeok Ryou, Ki Bae Bang
    Clinical Endoscopy.2023; 56(6): 706.     CrossRef
  • 3,185 View
  • 75 Download
  • 1 Web of Science
  • 1 Crossref
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Rare and Fatal Gastrointestinal Mucormycosis (Zygomycosis) in a COVID-19 Patient: A Case Report
Epifanio Silvino do Monte Junior, Marcos Eduardo Lera dos Santos, Igor Braga Ribeiro, Gustavo de Oliveira Luz, Elisa Ryoka Baba, Bruno Salomão Hirsch, Mateus Pereira Funari, Eduardo Guimarães Hourneaux de Moura
Clin Endosc 2020;53(6):746-749.   Published online November 19, 2020
DOI: https://doi.org/10.5946/ce.2020.180
AbstractAbstract PDFPubReaderePub
The novel coronavirus disease (COVID-19) quickly spread to all continents. However, data regarding all the signs and symptoms of COVID-19 are insufficient. Patients with COVID-19 might present higher susceptibility to fungal coinfections. Mucormycosis is a rare and often life-threatening fungal disease characterized by vascular invasion by hyphae, resulting in thrombosis and necrosis. This is the first case report of mucormycosis in a COVID-19 patient. An 86-year-old male patient was admitted to the emergency room with acute diarrhea, cough, dyspnea, and fever from 5 days prior. Blood tests revealed a hemoglobin level of 14.3 mg/dL. Five days following the admission, the patient presented with melena and a hemoglobin level of 5.6 mg/dL. A transfusion of three units of red blood cells was required. Esophagogastroduodenoscopy revealed two giant gastric ulcers with necrotic debris and a deep hemorrhagic base without active bleeding. Furthermore, biopsies confirmed mucormycosis. Despite intensive care, the patient died 36 hours after the esophagogastroduodenoscopy.

Citations

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  • The potential for rapid antigen testing for mucormycosis in the context of COVID-19
    Christopher R. Thornton
    Expert Review of Molecular Diagnostics.2024; 24(3): 161.     CrossRef
  • A New Proposed Combined CT and MRI Staging System for Covid-19-Associated Rhino-Orbito-Cerebral Fungal Infection: A Multi-center Study with Pathological Correlation
    Noha Yahia Ebaid, Haitham Foda, Doaa Khedr Mohamed Khedr, Ahmed Ebeed, Mahmoud Ahmed Ebada, Rabab Mohamed Abdelhay, Ali Awad, Amany Abd Al Badea, Basma Hamed Ibrahim, Emad Hassan Emara
    Academic Radiology.2024; 31(3): 1055.     CrossRef
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    Rajashri Patil, Sahjid Mukhida, Jyoti Ajagunde, Uzair Khan, Sameena Khan, Nageswari Gandham, Chanda Vyawhare, Nikunja K Das, Shahzad Mirza
    Future Microbiology.2024; 19(4): 297.     CrossRef
  • COVID-19 Second Wave with Mucormycosis, a Deadly Combination: A Systemic Review
    Neetu Jain, Seema Bhadauria
    Biomedical and Biotechnology Research Journal.2024; 8(1): 13.     CrossRef
  • Mucorales: A systematic review to inform the World Health Organization priority list of fungal pathogens
    C Orla Morrissey, Hannah Yejin Kim, Katherine Garnham, Aiken Dao, Arunaloke Chakrabarti, John R Perfect, Ana Alastruey-Izquierdo, Thomas S Harrison, Felix Bongomin, Marcelo Galas, Siswanto Siswanto, Daniel Argaw Dagne, Felipe Roitberg, Valeria Gigante, Ha
    Medical Mycology.2024;[Epub]     CrossRef
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    Ayoung Lee, Sung Woo Jung, Jung Mogg Kim
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2024; 24(2): 136.     CrossRef
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    Antonio Romano, Roberta Gasparro, Maria Domenica Campana, Biagio Pinchera, Rosa Maria Di Crescenzo, Donatella Del Guercio, Marco Sarcinella, Marco Tatullo, Gilberto Sammartino
    Current Problems in Surgery.2024; 61(9): 101555.     CrossRef
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    Zeinab Soleimani Shiyadeh, Shirin Farahyar, Laleh Vahedi Larijani, Justin Beardsley, Noura Nouri, Shahram Mahmoudi, Shahla Roudbar Mohammadi, Célia Fortuna Rodrigues, Maryam Roudbary
    Antibiotics.2024; 13(7): 633.     CrossRef
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    Goteti V. Padmaja, Shanigarapu R. Kumar
    Journal of Dr. YSR University of Health Sciences.2024; 13(2): 83.     CrossRef
  • The cross-talk between mucormycosis, steroids and diabetes mellitus amidst the global contagion of COVID-19
    Shrey Dwivedi, Princy Choudhary, Ayushi Gupta, Sangeeta Singh
    Critical Reviews in Microbiology.2023; 49(3): 318.     CrossRef
  • Magnetic resonance imaging spectrum of COVID-associated rhino-orbital-cerebral mucormycosis and assessment of anatomical severity
    Ishan Kumar, Ashish Verma, Jyoti Dangwal, Pramod Kumar Singh, Ram Chandra Shukla, Jaya Chakravarty
    The Neuroradiology Journal.2023; 36(4): 404.     CrossRef
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    Current Microbiology.2023;[Epub]     CrossRef
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    European Journal of Medicinal Chemistry.2023; 246: 115010.     CrossRef
  • cotH Genes Are Necessary for Normal Spore Formation and Virulence in Mucor lusitanicus
    Csilla Szebenyi, Yiyou Gu, Teclegiorgis Gebremariam, Sándor Kocsubé, Sándor Kiss-Vetráb, Olivér Jáger, Roland Patai, Krisztina Spisák, Rita Sinka, Ulrike Binder, Mónika Homa, Csaba Vágvölgyi, Ashraf S. Ibrahim, Gábor Nagy, Tamás Papp, Anuradha Chowdhary
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  • Surge of mucormycosis during the COVID-19 pandemic
    Paulami Dam, Marlon H. Cardoso, Sukhendu Mandal, Octávio L. Franco, Pınar Sağıroğlu, Osman Ahmet Polat, Kerem Kokoglu, Rittick Mondal, Amit Kumar Mandal, Ismail Ocsoy
    Travel Medicine and Infectious Disease.2023; 52: 102557.     CrossRef
  • COVID-19 and Mucormycosis of Orofacial Region: A Scoping Review
    Abhishek Banerjee, Moumalini Das, Pooja Verma, Abhishek Chatterjee, Karthikeyan Ramalingam, Kumar Chandan Srivastava
    Cureus.2023;[Epub]     CrossRef
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    Sachin Arora, Ashish Singh, Pallavi Prasad, Rahul, Rajneesh Singh
    The Korean Journal of Gastroenterology.2023; 81(5): 221.     CrossRef
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    Md. Imran Hasan, Md. Arju Hossain, Md Habibur Rahman, Md Sohel, Asif Ahsan, Md. Sadat Hossain Soikot, Md. Nazrul Islam, Mohammad Ruhul Amin, Deepak Kumar Jain
    Network Modeling Analysis in Health Informatics and Bioinformatics.2023;[Epub]     CrossRef
  • Opportunistic Fungal Invasion in COVID-19 Pandemic: A Critical Review in Diagnosis and Management
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    Avicenna Journal of Medicine.2023; 13(03): 131.     CrossRef
  • Effect of antifungal drugs against mucormycosis and impact on human health
    Shivangi Giri, Sujata Sharma, Kumud Kant Awasthi, Lata Shahani
    Materials Today: Proceedings.2023; 95: 43.     CrossRef
  • Epidemiology, Risk Factors, Diagnosis and Treatment of Mucormycosis (Black Fungus): A Review
    Pragati Upadhayay, Keshav Bansal, Ahsas Goyal
    Current Pharmaceutical Biotechnology.2023; 24(13): 1645.     CrossRef
  • View of mucormycosis during the era of COVID-19 infection: A cross-sectional study
    Ossama M. Zakaria, Dana W. Alkuwaity
    Journal of Family Medicine and Primary Care.2023; 12(11): 2608.     CrossRef
  • An Update on COVID‐19 Associated Mucormycosis Characteristics, Risk Factors, and Outcomes: a Systematic Review and Meta-Analysis
    Kazem Khiabani, Mohammad Hosein Amirzade-Iranaq, Hanie Ahmadi
    Current Fungal Infection Reports.2023; 17(4): 282.     CrossRef
  • CT Findings of COVID-19–associated Pulmonary Mucormycosis: A Case Series and Literature Review
    Mandeep Garg, Nidhi Prabhakar, Valliappan Muthu, Shameema Farookh, Harsimran Kaur, Vikas Suri, Ritesh Agarwal
    Radiology.2022; 302(1): 214.     CrossRef
  • Mucormycosis (black fungus) ensuing COVID-19 and comorbidity meets - Magnifying global pandemic grieve and catastrophe begins
    Karthika Pushparaj, Haripriya Kuchi Bhotla, Vijaya Anand Arumugam, Manikantan Pappusamy, Murugesh Easwaran, Wen-Chao Liu, Utthapon Issara, Kannan R.R. Rengasamy, Arun Meyyazhagan, Balamuralikrishnan Balasubramanian
    Science of The Total Environment.2022; 805: 150355.     CrossRef
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    Indian Journal of Critical Care Medicine.2022; 25(10): 1193.     CrossRef
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    Shringika Soni, Ramesh Namdeo Pudake, Utkarsh Jain, Nidhi Chauhan
    Journal of Medical Virology.2022; 94(1): 99.     CrossRef
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    Shabbir Syed-Abdul, A. Shoban Babu, Raja Shekhar Bellamkonda, Ramaiah Itumalla, GVRK Acharyulu, Surya Krishnamurthy, Y. Venkat Santosh Ramana, Naresh Mogilicharla, Shwetambara Malwade, Yu-Chuan Li
    Journal of Infection.2022; 84(3): 351.     CrossRef
  • Bilateral Renal Mucor Mycosis Presenting as Anuria in a Covid 19 Recovered Patient: A Case Report and Review of Literature
    Surya Prakash Vaddi, Seshu Mohan Khetavath, Dilip M. Babu, Nagarjuna Maturu, Bhulaxmi, Swathi, Krithika Mohan, Datta Prasad M, Jawahar B, Rajesh Reddy KRV
    Urology.2022; 161: 12.     CrossRef
  • Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients
    Kerri Basile, Catriona Halliday, Jen Kok, Sharon C-A. Chen
    Journal of Fungi.2022; 8(1): 58.     CrossRef
  • Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021
    Mojtaba Didehdar, Zahra chegini, Alireza Moradabadi, Ali Arash Anoushirvani, Seidamir Pasha Tabaeian, Milad Yousefimashouf, Aref Shariati
    Microbial Pathogenesis.2022; 163: 105388.     CrossRef
  • Gastrointestinal Mucormycosis: A Challenge during COVID-19 Pandemic
    Jagdish Chander
    Journal of Gastrointestinal Infections.2022; 11(1): 30.     CrossRef
  • COVID-19 associated mucormycosis – An emerging threat
    Chien-Ming Chao, Chih-Cheng Lai, Wen-Liang Yu
    Journal of Microbiology, Immunology and Infection.2022; 55(2): 183.     CrossRef
  • The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries
    Martin Hoenigl, Danila Seidel, Agostinho Carvalho, Shivaprakash M Rudramurthy, Amir Arastehfar, Jean-Pierre Gangneux, Nosheen Nasir, Alexandro Bonifaz, Javier Araiza, Nikolai Klimko, Alexandra Serris, Katrien Lagrou, Jacques F Meis, Oliver A Cornely, John
    The Lancet Microbe.2022; 3(7): e543.     CrossRef
  • Fatal allograft mucormycosis complicating severe COVID‐19 infection and bacterial pyelonephritis
    Abhilash Chandra, Namrata Rao S., Kiran Preet Malhotra
    Transplant Infectious Disease.2022;[Epub]     CrossRef
  • Mucormycosis in COVID-19 pandemic: study at tertiary hospital in India
    Reshma P. Chavan, Shivraj M. Ingole, Hamna Abdul Nazir, Wilson V. Desai, Gajanan S. Kanchewad
    European Archives of Oto-Rhino-Laryngology.2022; 279(6): 3201.     CrossRef
  • Mucormycosis and COVID-19 pandemic: Clinical and diagnostic approach
    Asim Azhar, Wajihul Hasan Khan, Parvez Anwar Khan, Khaled Alhosaini, Mohammad Owais, Aijaz Ahmad
    Journal of Infection and Public Health.2022; 15(4): 466.     CrossRef
  • COVID19 associated mucormycosis: A review
    PriyadharsiniR Palanisamy, Dhivya Elango
    Journal of Family Medicine and Primary Care.2022; 11(2): 418.     CrossRef
  • Mucormycosis: risk factors, diagnosis, treatments, and challenges during COVID-19 pandemic
    Ayushi Sharma, Anjana Goel
    Folia Microbiologica.2022; 67(3): 363.     CrossRef
  • Retracted: Mucormycosis infection in patients with COVID‐19: A systematic review
    SeyedAhmad SeyedAlinaghi, Amirali Karimi, Alireza Barzegary, Zahra Pashaei, Amir Masoud Afsahi, Sanam Alilou, Nazanin Janfaza, Alireza Shojaei, Fatemeh Afroughi, Parsa Mohammadi, Yasna Soleimani, Newsha Nazarian, Ava Amiri, Marcarious M. Tantuoyir, Shahra
    Health Science Reports.2022;[Epub]     CrossRef
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Original Articles
Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding
Kazuki Yamamoto, Yasutoshi Shiratori, Takashi Ikeya
Clin Endosc 2021;54(2):256-260.   Published online August 11, 2020
DOI: https://doi.org/10.5946/ce.2020.081
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: In Asia, right-sided diverticular bleeding is more common than that of the left side. It often causes massive bleeding and difficulties in identifying the stigmata of recent hemorrhage (SRH) of colonic diverticular bleeding (CDB). This case series demonstrates the efficacy of the gel immersion method using OS-1 Jelly (Otsuka Pharmaceuticals Factory, Tokushima, Japan) in patients with CDB.
Methods
This retrospective case series analyzed data of patients with CDB who underwent the gel immersion method from April 2016 to February 2020 at St. Luke’s International Hospital, Japan. All patients diagnosed with CDB who underwent the gel immersion method were included. We collected data on the site of bleeding, identification of SRH, and efficacy of the method from the electronic medical records.
Results
A total of 9 patients (including 7 with right-sided CDB) underwent gel immersion method and were included in this study. SRH were successfully found in 66.7% (6/9) of patients. Moreover, effective hemostasis was achieved in 85.7% (6/7) of patients with right-sided CDB. There were no adverse events.
Conclusions
The gel immersion method was found to be effective, especially for massive right-sided CDB.

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    Clinical Journal of Gastroenterology.2021; 14(3): 796.     CrossRef
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    Shuichi Miyamoto, Kazuharu Suzuki, Kenji Kinoshita
    Digestive Endoscopy.2021;[Epub]     CrossRef
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    Tomonori Yano, Atsushi Ohata, Yuji Hiraki, Makoto Tanaka, Satoshi Shinozaki, Alan Kawarai Lefor, Hironori Yamamoto
    Endoscopy International Open.2021; 09(06): E918.     CrossRef
  • Gel immersion endoscopy: Innovation in securing the visual field – Clinical experience with 265 consecutive procedures
    Tomonori Yano, Takahito Takezawa, Kousei Hashimoto, Ayako Ohmori, Satoshi Shinozaki, Manabu Nagayama, Hirotsugu Sakamoto, Yoshimasa Miura, Yoshikazu Hayashi, Keijiro Sunada, Alan Kawarai Lefor, Hironori Yamamoto
    Endoscopy International Open.2021; 09(07): E1123.     CrossRef
  • 5,333 View
  • 177 Download
  • 10 Web of Science
  • 9 Crossref
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Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs
Hiroya Sakaguchi, Toshitatsu Takao, Yoshitaka Takegawa, Yuki Koga, Kazunori Yamanaka, Masataka Sagata, Shinwa Tanaka, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
Clin Endosc 2021;54(1):64-72.   Published online July 16, 2020
DOI: https://doi.org/10.5946/ce.2020.014
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

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    Kai Korekawa, Atsushi Kunimitsu
    Clinical Journal of Gastroenterology.2024;[Epub]     CrossRef
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    Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama
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    Yoshitaka Takegawa, Toshitatsu Takao, Hiroya Sakaguchi, Tatsuya Nakai, Kazuhiro Takeo, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
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    Meng Li, Haifeng Jin, Changpei Shi, Bin Lyu, Xiao Ying, Yuan Shi
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  • 5,013 View
  • 120 Download
  • 5 Web of Science
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Endoscopic Findings in Patients Under the Age of 40 Years with Hematochezia in Singapore
Man Hon Tang, Fung Joon Foo, Chee Yung Ng
Clin Endosc 2020;53(4):466-470.   Published online June 18, 2020
DOI: https://doi.org/10.5946/ce.2019.029
AbstractAbstract PDFPubReaderePub
Background
/Aims: Sigmoidoscopy is performed in most medical centers to evaluate the distal colons of young adults presenting with hematochezia who are at risk of developing proximal lesions. Colonoscopies offer more complete evaluations but are associated with a higher incidence of complications and possible low yield.
Methods
An analysis was conducted on colonoscopies performed in our center on patients 40 years of age or younger. The study population was sub-divided into 2 age groups for analysis: <30 years of age and 30–39 years of age.
Results
We recruited 453 patients for the study. Patients were 115 and 338 individuals that were <30 and 30–39 years of age, respectively. Hemorrhoids was identified as the cause of bleeding in the majority of cases. The overall incidence of polyps was 6.5%; this was significantly higher in the 30–39 age group (7.4% vs. 1.7%, p=0.026). There were two cases of advanced/malignant polyps. While the majority of the polyps were in the distal colon, 28% of the polyps in the older age group were found in the proximal colon. There was one case of colonic perforation.
Conclusions
Colonic polyps are more prevalent in patients aged 30–39. Colonoscopies should be considered for patients over the age of 30 with rectal bleeding.

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    Zhiang Li, Fei Yu, Chaoqian Wang, Zhang Du
    Medicine.2023; 102(37): e34941.     CrossRef
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    Tuane Colles, Patrícia K. Ziegelmann, Daniel C. Damin
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    Hee Chan Yang, Sang Wook Kim
    Clinical Endoscopy.2020; 53(4): 385.     CrossRef
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  • 3 Crossref
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Case Report
Endoscopic Ultrasound-Guided Vascular Therapy for Portoduodenal Fistula
Tanyaporn Chantarojanasiri, Apichet Sirinawasatien, Chalermrat Bunchorntavakul, Aroon Siripun, Sa-ard Treepongkaruna, Thawee Ratanachu-ek
Clin Endosc 2020;53(6):750-753.   Published online February 13, 2020
DOI: https://doi.org/10.5946/ce.2019.167
AbstractAbstract PDFPubReaderePub
Portoenteric fistula is a rare cause of massive upper gastrointestinal bleeding. Most cases can be treated with radiointervention or surgery, but portoenteric fistula is associated with a high mortality. We reported a case of intermittent massive upper gastrointestinal bleeding in a 33-year-old man with cholangiocarcinoma who underwent surgical resection followed by chemoradiation. A portoduodenal fistula due to chronic duodenal ulceration was identified. The bleeding was successfully controlled by endoscopic ultrasound-guided coil placement through the duodenal bulb using the anchoring technique. Follow-up endoscopy and computed tomography scan showed multiple coil placements between a part of the portal vein and the duodenal bulb without any evidence of portal vein thrombosis. There were no complications, and bleeding did not recur during the 8-month follow-up period.

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    Chaoqun Han, Xin Ling, Jun Liu, Rong Lin, Zhen Ding
    Therapeutic Advances in Gastroenterology.2022; 15: 175628482110561.     CrossRef
  • A Case of an Internal Pancreatic Stent Penetrating the Portal Vein after Pancreaticoduodenectomy for Ampullary Carcinoma
    Masanobu Taniguchi, Atsushi Mitsunaka, Yumi Zen, Takayuki Higashiguchi, Masaru Nagato, Yasuhisa Tango, Ichiro Nakamura, Tomoaki Nakamura, Hisanori Shiomi
    The Japanese Journal of Gastroenterological Surgery.2022; 55(2): 99.     CrossRef
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    Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair
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Original Article
Endoscopic Management with a Novel Over-The-Scope Padlock Clip System
Mahesh Kumar Goenka, Gajanan Ashokrao Rodge, Indrajeet Kumar Tiwary
Clin Endosc 2019;52(6):574-580.   Published online November 26, 2019
DOI: https://doi.org/10.5946/ce.2019.122
AbstractAbstract PDFPubReaderePub
Background
/Aims: The Padlock clip is a recently introduced over-the-scope clip (OTSC) that requires the use of an alternate technique and has a different design from previous OTSCs. However, data regarding its clinical use are limited. The aim of this study is to present our clinical experience using this novel Padlock clip system.
Methods
Between September 2018 and June 2019, 7 consecutive patients underwent Padlock clip application at our center by an experienced endoscopist. A Padlock clip was used for achieving hemostasis in 4 patients presenting with gastrointestinal (GI) bleeding, as well as for endoscopic full-thickness resection in the remaining 3 patients.
Results
All 7 patients achieved technical as well as clinical success, with absence of complications or rebleeding, during a follow-up of a minimum of 3 weeks. All patients were hospitalized post procedure for a minimum of 48 hours, and an absence of adverse events was noted in our patient population throughout the procedure and post-procedure period. Antiplatelet therapy was reinstated shortly after the application of the Padlock clip, with no GI bleeding observed.
Conclusions
The Padlock clip is a novel OTSC, with benefits that include safe, simple, and rapid deployment. Antiplatelet therapy may be reinstated for patients, when necessary, shortly after applying the Padlock clip due to full-thickness closure of the tissue.

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  • Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
    Hisham Wehbe, Aditya Gutta, Mark A. Gromski
    Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 363.     CrossRef
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    Xue Jing Li, Brian M Fung
    World Journal of Gastrointestinal Endoscopy.2024; 16(7): 376.     CrossRef
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    Daniyal Abbas, Mohamed Abdallah, Khalid Ahmed, Abubaker O. Abdalla, Nicholas McDonald, Shifa Umar, Brian J. Hanson, Mohammad Bilal
    Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(2): 106.     CrossRef
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    Sneha Annie Sebastian, Edzel Lorraine Co, Venkatesh Panthangi, Radha Bansal, Vaishnavi Narayanan, Shachi Paudel, Rabab Raja, Inderbir Padda, Babu P Mohan
    Disease-a-Month.2023; 69(11): 101543.     CrossRef
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    Natalie Wilson, Moamen Gabr, Mohammad Bilal
    Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(4): 385.     CrossRef
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    Alexandra Menni, George Stavrou, Georgios Tzikos, Anne D. Shrewsbury, Katerina Kotzampassi
    Gastrointestinal Disorders.2023; 5(3): 383.     CrossRef
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    Arulprakash Sarangapani, TarunJ George, S Malathi
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    M. Reyes Busta Nistal, Lourdes del Olmo Martínez, Benito Velayos Jimenez, Luis Fernández Salazar, Miguel Durà Gil
    Gastroenterología y Hepatología.2022; 45: 99.     CrossRef
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    Guoxiang Wang, Yanli Xiang, Yangde Miao, Honggang Wang, Meidong Xu, Guang Yu
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    Luiza L. Ramos, Ravi C. Marques, Hugo G. Guedes
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    Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
    Clinical Endoscopy.2021; 54(5): 633.     CrossRef
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    Lian Yong Li, Bai Wen Li, Parit Mekaroonkamol, Hui Min Chen, Shan Shan Shen, Hui Luo, Sunil Dacha, Yue Xue, Sarah Cristofaro, Steven Keilin, Field Willingham, Qiang Cai
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    Awf Mouchli, Vikas Chitnavis
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    Darshan Suthar, Elisabeth H Kramer, Harshit S Khara
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Focused Review Series: Endoscopic Hemostasis: An Overview of Principles and Recent Applications
Endoscopic Hemostasis for Non-Variceal Upper Gastrointestinal Bleeding: New Frontiers
Adam Kichler, Sunguk Jang
Clin Endosc 2019;52(5):401-406.   Published online July 16, 2019
DOI: https://doi.org/10.5946/ce.2018.103
AbstractAbstract PDFPubReaderePub
Non-variceal upper gastrointestinal bleeding (NVUGIB) refers to blood loss from the gastrointestinal tract proximal to the ligament of Treitz due to lesions that are non-variceal in origin. The distinction of the bleeding source as non-variceal is important in numerous aspects, but none more so than endoscopic approaches for successful hemostasis. When a patient presents with acute overt blood loss, NVUGIB is a medical emergency, which requires immediate intervention. There have been major strides in pharmacologic and endoscopic interventions for successful induction and remission of hemostasis in the last two decades. Despite achieving tangible improvements, the burden of the disease and the consequent mortality remain high. To address endoscopic outcomes better, several new technologies have emerged and have been subsequently incorporated to the armamentarium of hemostatic tools. This study aims to provide a succinct review on novel technologies for endoscopic hemostasis.

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    Xiao-Juan Wang, Yu-Peng Shi, Li Wang, Ya-Ni Li, Li-Juan Xu, Yue Zhang, Shuang Han
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    Priyesh Patel, Pravallika Chadalavada, Amandeep Singh, Ram Kishore Gurajala, Jean-Paul Achkar
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    Yunho Jung, Gwang Ho Baik, Weon Jin Ko, Bong Min Ko, Seong Hwan Kim, Jin Seok Jang, Jae-Young Jang, Wan-Sik Lee, Young Kwan Cho, Sun Gyo Lim, Hee Seok Moon, In Kyung Yoo, Joo Young Cho
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    Myeongjin Kim, Van Gia Truong, Sungwon Kim, Hyejin Kim, Thomas Hasenberg, Hyun Wook Kang
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    Tamer Akay, Metin Leblebici
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    Claudio Giovanni De Angelis, Pablo Cortegoso Valdivia, Stefano Rizza, Ludovica Venezia, Felice Rizzi, Marcantonio Gesualdo, Giorgio Maria Saracco, Rinaldo Pellicano
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    E. N. Maevskaia, E. N. Dresvyanina, A. S. Shabunin, I. P. Dobrovol’skaya, M. B. Paneyah, A. M. Fediuk, P. L. Sushchinskii, G. P. Smirnov, V. E. Yudin, E. V. Zinoviev
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Case Report
Acquired Hemophilia A with Gastrointestinal Bleeding
Narae Park, Jin Seok Jang, Jae Hwang Cha
Clin Endosc 2020;53(1):90-93.   Published online July 8, 2019
DOI: https://doi.org/10.5946/ce.2019.036
AbstractAbstract PDFPubReaderePub
Peptic ulcer disease is the most common cause of acute gastrointestinal bleeding, followed by variceal bleeding, Mallory–Weiss syndrome, and malignancy. On the contrary, acquired hemophilia A is a very rare hemorrhagic disease, which usually manifests with musculocutaneous bleeding, caused by autoantibodies against coagulation factor VIII.
A 78-year-old man presented to the Emergency Department with melena. Dieulafoy’s lesions were observed on esophagogastroduodenoscopy, and endoscopic cauterization was performed. However, the patient complained of back pain and symptoms indicative of upper gastrointestinal bleeding. Abdominopelvic computed tomography was performed, and hematoma in the psoas muscle was detected. Antibodies against coagulation factor VIII were confirmed with a blood test, and the diagnosis of acquired hemophilia A was made. Here, we report a case of acquired hemophilia A presenting with upper gastrointestinal bleeding symptoms and present a brief review of literature.

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    Rafael Gregorio Peña Amaya, María del Carmen Figueredo Peña
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Close layer
Original Article
Endoscopy Timing in Patients with Acute Upper Gastrointestinal Bleeding
Gonçalo Alexandrino, Tiago Dias Domingues, Rita Carvalho, Mariana Nuno Costa, Luís Carvalho Lourenço, Jorge Reis
Clin Endosc 2019;52(1):47-52.   Published online October 5, 2018
DOI: https://doi.org/10.5946/ce.2018.093
AbstractAbstract PDFPubReaderePub
Background
/Aims: The role of very early (≤12 hours) endoscopy in nonvariceal upper gastrointestinal bleeding is controversial. We aimed to compare results of very early and early (12–24 hours) endoscopy in patients with upper gastrointestinal bleeding demonstrating low-risk versus high-risk features and nonvariceal versus variceal bleeding.
Methods
This retrospective study included patients with nonvariceal and variceal upper gastrointestinal bleeding. The primary outcome was a composite of inpatient death, rebleeding, or need for surgery or intensive care unit admission. Endoscopy timing was defined as very early and early. We performed the analysis in two subgroups: (1) high-risk vs. low-risk patients and (2) variceal vs. nonvariceal bleeding.
Results
A total of 102 patients were included, of whom 59.8% underwent urgent endoscopy. Patients who underwent very early endoscopy received endoscopic therapy more frequently (p=0.001), but there was no improvement in other clinical outcomes. Furthermore, patients at low risk and with nonvariceal bleeding who underwent very early endoscopy had a higher risk of the composite outcome.
Conclusions
Very early endoscopy does not seem to be associated with improved clinical outcomes and may lead to poorer outcomes in specific populations with upper gastrointestinal bleeding. The actual benefit of very early endoscopy remains controversial and should be further clarified.

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  • Acute Nonvariceal Upper Gastrointestinal Bleeding in Patients Using Anticoagulants: Does the Timing of Endoscopy Affect Outcomes?
    Tiago Lima Capela, Vítor Macedo Silva, Marta Freitas, Tiago Cúrdia Gonçalves, José Cotter
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    István Rácz
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    H.G. Bilder, C. Soccini, J.S. Lasa, I. Zubiaurre
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    Jia-lun Guan, Ying-ying Han, Dan Fang, Mu-ru Wang, Ge Wang, De-an Tian, Pei-yuan Li
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    Katherine Haggan, Gerri Mortimore
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    N Mousa, A Abdel-Razik, T Sheta, A G Deiab, A Habib, M Diasty, A Eldesoky, A Taha, E Mousa, A Yassen, A Fathy, A Elgamal
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    Elettra Merola, Andrea Michielan, Giovanni de Pretis
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    Quchuan Zhao, Tianyu Chi
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    Ziad Aljarad, Bashir Badawi Mobayed
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Case Reports
Gastric Ulceration and Bleeding with Hemodynamic Instability Caused by an Intragastric Balloon for Weight Loss
Larrite Reed, Hawa Edriss, Kenneth Nugent
Clin Endosc 2018;51(6):584-586.   Published online June 1, 2018
DOI: https://doi.org/10.5946/ce.2018.038
AbstractAbstract PDFPubReaderePub
Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015–2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.

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Congenital Jejunal Diverticular Bleeding in a Young Adult
Ji-Yung Lee, Jae-Young Jang, Min-Je Kim, Tae-In Lee, Jung-Wook Kim, Young-Woon Chang
Clin Endosc 2017;50(5):495-499.   Published online June 14, 2017
DOI: https://doi.org/10.5946/ce.2016.154
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel’s diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel’s diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding (OOGIB). This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel’s diverticulum after surgical resection.

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  • Diverticular hemorrhage of terminal ileum successfully treated by ultra-selective transcatheter arterial embolization using triaxial system: a case report
    Yuki Yaginuma, Kenichi Utano, Yuka Utano, Daiki Nemoto, Masato Aizawa, Hajime Matsuida, Noriyuki Isohata, Shungo Endo, Kazutomo Togashi
    Clinical Journal of Gastroenterology.2021; 14(2): 517.     CrossRef
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    Lidia Ciobanu, Oliviu Pascu, Marcel Tanțău
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  • 4 Web of Science
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Combined Endoscopic and Surgical Treatment of Severe Gastrointestinal Bleeding in a Patient with Heart Assist Device under Therapeutic Anticoagulation
Edris Wedi, Mohamed Bounnah, Riccardo Memeo, Carlo Jung
Clin Endosc 2017;50(6):598-601.   Published online June 1, 2017
DOI: https://doi.org/10.5946/ce.2017.024
AbstractAbstract PDFPubReaderePub
Gastrointestinal (GI) bleeding is a common complication after heart assist device placement. Reasons for bleeding are multifactorial. Endoscopic therapy is the treatment of choice, whereas invasive procedures are avoided in these critically ill patients. We present the case of a 65-year-old male patient experiencing severe GI bleeding after left ventricular assist device (LVAD) and right ventricular assist device (RVAD) placement with therapeutic anticoagulation. Endoscopically, multiple gastric bleeding sources were found but could not be treated effectively due to a large blood clot. A combined endoscopic and surgical treatment was initiated, including gastrotomy for blood clot removal, surgical transgastric suturing, endoscopic over-the-scope clip (OTSC) placement and hemospray application. Postoperative endoscopic visualization showed effective bleeding control. The patient unfortunately died due to causes unrelated to the treatment. This case shows that a minimal invasive combination of endoscopic and surgical techniques can be an alternative treatment for severe upper GI bleeding in critically ill and anticoagulated patients.
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Original Article
Endoscopic Management of Gastrointestinal Leaks and Bleeding with the Over-the-Scope Clip: A Prospective Study
Mahesh Kumar Goenka, Vijay Kumar Rai, Usha Goenka, Indrajit Kumar Tiwary
Clin Endosc 2017;50(1):58-63.   Published online October 31, 2016
DOI: https://doi.org/10.5946/ce.2016.028
AbstractAbstract PDFPubReaderePub
Background
/Aims: The over-the-scope clip (OTSC) is a device used for endoscopic closure of perforations, leaks and fistulas, and for endoscopic hemostasis. To evaluate the clinical effectiveness and safety of OTSC.
Methods
Between October 2013 and November 2015, 12 patients underwent OTSC placement by an experienced endoscopist. OTSC was used for the closure of gastrointestinal (GI) leaks and fistula in six patients, three of which were iatrogenic (esophageal, gastric, and duodenal) and three of which were inflammatory. In six patients, OTSC was used for hemostasis of non-variceal upper GI bleeding. Endoscopic tattooing using India ink was used to assist the accurate placement of the clip.
Results
All subjects except one with a colonic defect experienced immediate technical success as well as long-term clinical success, during a mean follow-up of 6 weeks. Only one clip was required to close each of the GI defects and to achieve hemostasis in all patients. There were no misfirings or complications of clips. The procedure was well tolerated, and patients were hospitalized for an average of 8 days (range, 3 to 10). Antiplatelet therapy was continued in patients with GI bleeding.
Conclusions
In our experience, OTSC was safe and effective for the closure of GI defect and to achieve hemostasis of non-variceal GI bleeding.

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Review
Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding
Ari Garber, Sunguk Jang
Clin Endosc 2016;49(5):421-424.   Published online September 30, 2016
DOI: https://doi.org/10.5946/ce.2016.110
AbstractAbstract PDFPubReaderePub
Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical), EndoClot (EndoClot Plus Inc.), and Ankaferd Blood Stopper (Ankaferd Health Products), in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

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Case Report
Multiple Polypoid Angiodysplasia with Obscure Overt Bleeding
Jooyoung Lee, Sung Wook Hwang, Jihye Kim, Jinwoo Kang, Gyeong Hoon Kang, Kyu Joo Park, Jong Pil Im, Joo Sung Kim
Clin Endosc 2016;49(1):91-96.   Published online January 28, 2016
DOI: https://doi.org/10.5946/ce.2016.49.1.91
AbstractAbstract PDFPubReaderePub
Angiodysplasia (AD) is increasingly being recognized as a major cause of gastrointestinal bleeding. Morphologically flat lesions are common types of AD, whereas the polypoid types are rare. We report a case of multiple polypoid AD in the small bowel causing severe anemia and requiring surgical treatment. A 60-year-old male patient visited our hospital with dyspnea and hematochezia. He had a history of myocardial infarction and was taking both aspirin and clopidogrel. Capsule endoscopy, enteroscopy, computed tomography, and angiography revealed multifocal vascular lesions with a polypoid shape in the jejunum. Surgical resection was performed because endoscopic treatment was considered impossible with the number and the location of lesions. The risk of recurrent bleeding related to the use of antiplatelet agents also contributed to the decision to perform surgery. AD was histologically diagnosed from the surgical specimen. He resumed taking both aspirin and clopidogrel after surgery. He fully recovered and has been doing well during the several months of follow-up.

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Original Articles
The AIMS65 Score Is a Useful Predictor of Mortality in Patients with Nonvariceal Upper Gastrointestinal Bleeding: Urgent Endoscopy in Patients with High AIMS65 Scores
Sun Wook Park, Young Wook Song, Dae Hyun Tak, Byung Moo Ahn, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Hyun Yong Jeong
Clin Endosc 2015;48(6):522-527.   Published online November 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.6.522
AbstractAbstract PDFPubReaderePub
Background
/Aims: To validate the AIMS65 score for predicting mortality of patients with nonvariceal upper gastrointestinal bleeding and to evaluate the effectiveness of urgent (<8 hours) endoscopic procedures in patients with high AIMS65 scores.
Methods
This was a 5-year single-center, retrospective study. Nonvariceal, upper gastrointestinal bleeding was assessed by using the AIM65 and Rockall scores. Scores for mortality were assessed by calculating the area under the receiver-operating characteristic curve (AUROC). Patients with high AIMS65 scores (≥2) were allocated to either the urgent or non-urgent endoscopic procedure group. In-hospital mortality, success of endoscopic procedure, recurrence of bleeding, admission period, and dose of transfusion were compared between groups.
Results
A total of 634 patients were analyzed. The AIMS65 score successfully predicted mortality (AUROC=0.943; 95% confidence interval [CI], 0.876 to 0.99) and was superior to the Rockall score (AUROC=0.856; 95% CI, 0.743 to 0.969) in predicting mortality. The group with high AIMS65 score included 200 patients. The urgent endoscopic procedure group had reduced hospitalization periods (p<0.05)
Conclusions
AIMS65 score may be useful in predicting mortality in patients with nonvariceal upper gastrointestinal bleeding. Urgent endoscopic procedures in patients with high scores may be related to reduced hospitalization periods.

Citations

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    Farahnaz Joukar, Raheleh Sadat Hosseini Basti, Fakhrieh Sadat Hosseini Basti, Fatemeh Mosafer, Hoorieh Sadat Hosseini Basti, Zahra Hedayatzadeh, Afshin Shafaghi
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Predictors of Rebleeding in Upper Gastrointestinal Dieulafoy Lesions
Sang-Hun Park, Du-Hyeon Lee, Chang-Hwan Park, Jin Jeon, Ho-Jun Lee, Sung-Uk Lim, Seon-Young Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew
Clin Endosc 2015;48(5):385-391.   Published online September 30, 2015
DOI: https://doi.org/10.5946/ce.2015.48.5.385
AbstractAbstract PDFPubReaderePub
Background/Aims

Dieulafoy lesions (DLs) are a rare but significant cause of upper gastrointestinal bleeding. We aimed to define the clinical significance of rebleeding and identify the predictors of rebleeding and mortality in upper gastrointestinal Dieulafoy lesions (UGIDLs).

Methods

Patients diagnosed with UGIDLs between January 2004 and June 2013 were retrospectively evaluated. Multivariate logistic regression analyses were performed to define the predictors of rebleeding and mortality in patients with UGIDLs.

Results

The study group consisted of 81 male and 36 female patients. Primary hemostasis was achieved in 115 out of 117 patients (98.3%) with various endoscopic therapies. Rebleeding occurred in 10 patients (8.5%). The mortality rate was significantly higher in patients with rebleeding than in those without rebleeding (30.0% vs. 4.7%, p=0.020). Multivariate logistic regression analysis revealed that kidney disease (p=0.006) and infection (p=0.005) were significant predictors of rebleeding in UGIDLs and that kidney disease (p=0.004) and platelet count (p=0.013) were significant predictors of mortality.

Conclusions

Rebleeding has an important prognostic significance in patients with UGIDLs. Kidney disease and infection are major predictors of rebleeding and mortality in patients with UGIDLs.

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    S.E. Voskanyan, M.V. Shabalin, A.I. Artemyev, I.Yu. Kolyshev, Z. Bogoevich, A.N. Bashkov, E.V. Naidenov
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    Paulo Massinha, Inês Cunha, Luís Tomé
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Case Report
Eosinophilic Gastroenteritis Due to Rhus Ingestion Presenting with Gastrointestinal Hemorrhage
Wonsuk Choi, Seon-Young Park, Chan Choi, Kyuman Cho, Chang-Hwan Park, Hyun-Soo Kim, Sung-Kyu Choi, Jong-Sun Rew
Clin Endosc 2015;48(2):174-177.   Published online March 27, 2015
DOI: https://doi.org/10.5946/ce.2015.48.2.174
AbstractAbstract PDFPubReaderePub

Rhus-related illnesses in Korea are mostly caused by ingestion of parts of the Rhus tree. Contact dermatitis occurrence after ingestion of Rhus-related food is very common in Korea. However, Rhus-related gastrointestinal disease is very rare. Herein, we present a case of eosinophilic gastroenteritis caused by Rhus ingestion. A 75-year-old woman was admitted with hematemesis and hematochezia after Rhus extract ingestion. Routine laboratory tests revealed leukocytosis without eosinophilia. Endoscopy showed friable and granular mucosal changes with touch bleeding in the second portion of the duodenum. Abdominal computed tomography revealed edematous wall thickening of the duodenum and proximal jejunal loops. Patch testing with Rhus extracts showed a strong positive reaction, suggesting Rhus as the allergen. Her symptoms improved after avoidance of the allergen.

Citations

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  • Systemic contact dermatitis induced by Rhus allergens in Korea: exercising caution in the consumption of this nutritious food
    S. J. Park, J. W. Park, K. Y. Park, K. Li, S. J. Seo, B. J. Kim, K. H. Yoo
    Clinical and Experimental Dermatology.2021; 46(2): 324.     CrossRef
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    Elif Ozdogan, Latife Doganay Caglayan, Ozlem Mizikoglu, Cigdem Arikan
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    Valentín Gonzalez-Canalizo, Nerea Segues, Andrea Medina, Silvia Torrente, Vanessa Aguilar-Gama, Paula Ortega, Luis Bujanda
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    Valentín Gonzalez-Canalizo, Nerea Segues, Andrea Medina, Silvia Torrente, Vanessa Aguilar-Gama, Paula Ortega, Luis Bujanda
    Gastroenterología y Hepatología (English Edition).2019; 42(5): 307.     CrossRef
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Review
Should Capsule Endoscopy Be the First Test for Every Obscure Gastrointestinal Bleeding?
Chung Hyun Tae, Ki-Nam Shim
Clin Endosc 2014;47(5):409-414.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.409
AbstractAbstract PDFPubReaderePub

Obscure gastrointestinal bleeding (OGIB) refers to gastrointestinal (GI) bleeding of unclear origin that persists or recurs after negative findings on esophagogastroduodenoscopy and colonoscopy. OGIB accounts for approximately 5% of all types of GI bleeding. More than 80% of OGIB cases originate in the small bowel. The ability to detect OGIB in the small bowel has significantly advanced and been revolutionized since the introduction of the capsule endoscopy and double-balloon enteroscopy techniques in 2000 and 2001, respectively. With these new methods for small-bowel evaluation, new guidelines have been proposed for the diagnosis and management of OGIB. However, some issues remain unsolved. The purpose of this article is to review the various modalities used for evaluating OGIB, including capsule endoscopy and double-balloon enteroscopy, and to help guide clinicians in their decisions on which modality will be the most effective.

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    Mahmoud Aryan, Krishna V R Venkata, Tyler Colvin, Lauren Daley, Parth Patel, T. Mark Beasley, Benjamin Nunley, Nicholas Baldwin, Ali M Ahmed, Kondal R Kyanam Kabir Baig, Klaus Mönkemüller, Shajan Peter
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Case Reports
Endoscopic Management of Rectal Dieulafoy's Lesion: A Case Series and Optimal Treatment
Jung Gil Park, Jung Chul Park, Yong Hwan Kwon, Sun Young Ahn, Seong Woo Jeon
Clin Endosc 2014;47(4):362-366.   Published online July 28, 2014
DOI: https://doi.org/10.5946/ce.2014.47.4.362
AbstractAbstract PDFSupplementary MaterialPubReaderePub

Rectal Dieulafoy's lesion (DL) is rare cause of lower gastrointestinal bleeding. Because of its rarity, there is no consensus on the optimal endoscopic hemostasis technique for rectal DL. We analyzed six patients who underwent endoscopic management for rectal DL after presenting with hematochezia at a single institute over 10 years. Of the six patients, three underwent endoscopic band ligation (EBL) and three underwent endoscopic hemoclip placement (EHP). Only one patient was treated with thermocoagulation. There were no immediate complications in any of the patients. None of the patients required a procedure or surgery for the treatment of rebleeding. Mean procedure times of EBL and EHP were 5.25 minutes and 7 minutes, respectively. Both EHP and EBL are shown to be effective in the treatment of bleeding rectal DL. We suggest that EBL may have potential as the preferred therapy owing to its superiority in technical and economic aspects, especially in elderly and high-risk patients.

Citations

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    Ping Han, Demin Li, Qiaozhen Guo, Yu Lei, Jingmei Liu, Dean Tian, Wei Yan
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    Mario Rene Pineda-De Paz, Massiel Madelin Rosario-Morel, Jose Guadalupe Lopez-Fuentes, Luis Ariel Waller-Gonzalez, Rodrigo Soto-Solis
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  • Georges-Paul Dieulafoy (1839–1911) de l’ulcération…
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    Omar N Nadhem, Omar A Salh, Omar H Bazzaz
    SAGE Open Medical Case Reports.2017; 5: 2050313X1774498.     CrossRef
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Two Cases of Ileal Dieulafoy Lesion with Massive Hematochezia Treated by Single Balloon Enteroscopy
Young Chul Choi, Sang Hyun Park, Byoung Wook Bang, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin
Clin Endosc 2012;45(4):440-443.   Published online November 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.4.440
AbstractAbstract PDFPubReaderePub

Ileal Dieulafoy lesion is an unusual vascular abnormality that can cause gastrointestinal bleeding. It can be associated with massive, life-threatening hemorrhage and requires urgent angiographic intervention or surgery. Ileal Dieulafoy lesion is hard to recognize due to inaccessibility and normal-appearing mucosa. With advances in endoscopy, aggressive diagnostic and therapeutic approaches including enteroscopy have recently been performed for small bowel bleeding. We report two cases of massive ileal Dieulafoy lesion bleeding diagnosed and treated successfully by single balloon enteroscopy with a review of the literature.

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Special Issue Articles of IDEN 2012
Management of Non-Variceal Upper Gastrointestinal Bleeding
Seung Young Kim, Jong Jin Hyun, Sung Woo Jung, Sang Woo Lee
Clin Endosc 2012;45(3):220-223.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.220
AbstractAbstract PDFPubReaderePub

Upper gastrointestinal bleeding (UGIB) is a critical condition that demands a quick and effective medical management. Non-variceal UGIB, especially peptic ulcer bleeding is the most significant cause. Appropriate assessment and treatment have a major influence on the prognosis of patients with UGIB. Initial fluids resuscitation and/or transfusion of red blood cells are necessary in patients with clinical evidence of intravascular volume depletion. Endoscopy is essential for diagnosis and treatment of UGIB, and should be provided within 24 hours after presentation of UGIB. Pre-endoscopic use of intravenous proton pump inhibitor (PPI) can downstage endoscopic signs of hemorrhage. Post-endoscopic use of high-dose intravenous PPI can reduce the risk of rebleeding and further interventions such as repeated endoscopy and surgery. Eradication of Helicobacter pylori and withdrawal of non-steroidal anti-inflammatory drugs are recommended to prevent recurrent bleeding.

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    Jun Shen, Lingna Ni, Changhong Zhu, Chunying Jiang, Wenyu Zhu, Yanzhi Bi
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    Abed H AlLehibi, Faisal F Alsubaie, Rayan H Alzahrani, Hussain A Ekhuraidah, Mohammed A Koshan, Nasser F Alotaibi, Fahad M Alotaibi, Hamdan S Alghamdi, Abdulrahman A Aljumah
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    Sreeja Ankireddypalli
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    C. B. Eke, J. O. T. Onyia, A. L. Eke
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    Minoru Tomizawa, Fuminobu Shinozaki, Rumiko Hasegawa, Yoshinori Shirai, Yasufumi Motoyoshi, Takao Sugiyama, Shigenori Yamamoto, Naoki Ishige
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    MINORU TOMIZAWA, FUMINOBU SHINOZAKI, RUMIKO HASEGAWA, YOSHINORI SHIRAI, YASUFUMI MOTOYOSHI, TAKAO SUGIYAMA, SHIGENORI YAMAMOTO, NAOKI ISHIGE
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    Roberto Grassia, Pietro Capone, Elena Iiritano, Katerina Vjero, Fabrizio Cereatti, Mario Martinotti, Gabriele Rozzi, Federico Buffoli
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    Minoru Tomizawa
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    Minoru Tomizawa
    World Journal of Gastroenterology.2015; 21(24): 7500.     CrossRef
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    Ki Bae Kim, Soon Man Yoon, Sei Jin Youn
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    Il Ju Choi
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Case Report
Ectopic Pancreas Bleeding in the Jejunum Revealed by Capsule Endoscopy
Mi-Jeong Lee, Jae Hyuck Chang, Il Ho Maeng, Jin Young Park, Yun Sun Im, Tae Ho Kim, Sok-Won Han, Do Sang Lee
Clin Endosc 2012;45(3):194-197.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.194
AbstractAbstract PDFPubReaderePub

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.

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