Clinical Endoscopy

Original Articles

The Additive Effect of Platelet-Rich Plasma in the Treatment of Actively Bleeding Peptic Ulcer: Waseem M. Seleem, Amr Shaaban Hanafy; Clin Endosc 2021;54(6):864-871. Published online May 25, 2021; DOI: https://doi.org/10.5946/ce.2021.004

Background
/Aims: Peptic ulcer bleeding is the most common cause of upper gastrointestinal tract bleeding. Platelet-rich plasma (PRP) enhances tissue repair, and is therefore used in various medical treatments. A combination of mechanical or electrothermal hemostasis has been recommended for upper gastrointestinal tract bleeding treatment. This study evaluated the additive efficacy of PRP in bleeding peptic ulcer hemostasis and recovery.
Methods
Eighty patients with peptic ulcer bleeding were initially treated by hemoclipping, and were randomly chosen for either additional PRP (n=40) or additional epinephrine (n=40) injections. Both groups were compared with regard to achieving hemostasis and the frequency of complications.
Results
Hemostasis was immediately achieved in both groups. Two patients (5%) in the PRP group and 8 (20%) patients in the epinephrine group experienced rebleeding after 15.9±2.8 and 12.3±3.7 days, respectively. They were managed by PRP injection in addition to proton pump inhibitor infusion. Hemoglobin was substantially increased in the PRP-treated group with full recovery occurring in 60.5% compared to 31.3% of patients in the epinephrine group (p=0.001). There was no recurrent bleeding in the PRP group, but 4/32 (12.5%) patients in the epinephrine group exhibited rebleeding.
Conclusions
PRP showed additional benefit in reducing peptic ulcer bleeding with no reported significant complications. Clinical trial (NCT03733171).

Citations

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The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial
Konstantina Dinaki, Nikolaos Grigoriadis, Ioannis S. Vizirianakis, Jannis Constantinidis, Stefanos Triaridis, Petros Karkos
European Archives of Oto-Rhino-Laryngology.2024; 281(7): 3587. CrossRef

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Prospective Comparison of the AIMS65 Score, Glasgow-Blatchford Score, and Rockall Score for Predicting Clinical Outcomes in Patients with Variceal and Nonvariceal Upper Gastrointestinal Bleeding: Arunchai Chang, Chokethawee Ouejiaraphant, Keerati Akarapatima, Attapon Rattanasupa, Varayu Prachayakul; Clin Endosc 2021;54(2):211-221. Published online July 16, 2020; DOI: https://doi.org/10.5946/ce.2020.068

Abstract PDF PubReader ePub

Background
/Aims: This study aimed to determine the performance of the AIMS65 score (AIMS65), Glasgow-Blatchford score (GBS), and Rockall score (RS) in predicting outcomes in patients with upper gastrointestinal bleeding (UGIB), and to compare the results between patients with nonvariceal UGIB (NVUGIB) and those with variceal UGIB (VUGIB).
Methods
We conducted a prospective observational study between March 2016 and December 2017. Receiver operating characteristic curve analysis was performed for all outcomes for comparison. The associations of all three scores with mortality were evaluated using multivariate logistic regression analysis.
Results
Of the total of 337 patients with UGIB, 267 patients (79.2%) had NVUGIB. AIMS65 was significantly associated (odds ratio [OR], 1.735; 95% confidence interval [CI], 1.148–2.620), RS was marginally associated (OR, 1.225; 95% CI, 0.973–1.543), but GBS was not associated (OR, 1.017; 95% CI, 0.890–1.163) with mortality risk in patients with UGIB. However, all three scores accurately predicted all other outcomes (all p<0.05) except rebleeding (p>0.05). Only AIMS65 precisely predicted mortality, the need for blood transfusion and the composite endpoint (all p<0.05) in patients with VUGIB.
Conclusions
AIMS65 is superior to GBS and RS in predicting mortality in patients with UGIB, and also precisely predicts the need for blood transfusion and the composite endpoint in patients with VUGIB. No scoring system could satisfactorily predict rebleeding in all patients with UGIB.

Citations

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The Prediction and Treatment of Bleeding Esophageal Varices in the Artificial Intelligence Era: A Review
María Isabel Murillo Pineda, Tania Siu Xiao, Edgar J Sanabria Herrera, Alberto Ayala Aguilar, David Arriaga Escamilla, Alejandra M Aleman Reyes, Andreina D Rojas Marron, Roberto R Fabila Lievano, Jessica J de Jesús Correa Gomez, Marily Martinez Ramirez
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Sun Gyo Lim
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ASSESSMENT OF PATIENTS WITH NON-VARICEAL UPPER GASTROINTESTINAL BLEEDING USING AIMS65 SCORE
Farahnaz Joukar, Raheleh Sadat Hosseini Basti, Fakhrieh Sadat Hosseini Basti, Fatemeh Mosafer, Hoorieh Sadat Hosseini Basti, Zahra Hedayatzadeh, Afshin Shafaghi
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Zie Hae Lim, Seung In Seo, Dae-Seong Myung, Seung Han Kim, Han Hee Lee, Selen Kim, Bo-In Lee
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Rifaldy Nabiel, Al Munawir, Jauhar Firdaus
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Comparison of Four Scoring Systems for Patients With Nonvariceal Upper Gastrointestinal Bleeding
Elrasheed M Elsabani, Badr A Badr, Mohammad Dhalaan , Anwar Alotaibi, Abdulrahman Alrujaib , Rabab Alahmed, Abdulrahman Alabbadi, Omer Kheir
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Wei Gao, Yu-Shuang Huang, Ying-De Wang
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Bahadır TAŞLIDERE, Elmas BİBERCİ KESKİN, Serdar ÖZDEMİR, Ahmet ATSIZ, Ertan SÖNMEZ
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Omar Kherad, Sophie Restellini, Majid Almadi, Myriam Martel, Alan N. Barkun
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Xu Wang, Meiling Yang, Jianhua Xu, Yaxian Kuai, Bin Sun
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Age, blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding
Bianca-Codrina Morarasu, Victorita Sorodoc, Anca Haisan, Stefan Morarasu, Cristina Bologa, Raluca Ecaterina Haliga, Catalina Lionte, Emilia Adriana Marciuc, Mohammed Elsiddig, Diana Cimpoesu, Gabriel Mihail Dimofte, Laurenţiu Sorodoc
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Ah Young Yoo, Moon Kyung Joo, Jong-Jae Park, Beom Jae Lee, Seung Han Kim, Won Shik Kim, Hoon Jai Chun
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Modified N score is helpful for identifying patients who need endoscopic intervention among those with black stools without hematemesis
Nobuhito Ito, Kohei Funasaka, Toshihisa Fujiyoshi, Kazuhiro Furukawa, Naomi Kakushima, Satoshi Furune, Eri Ishikawa, Yasuyuki Mizutani, Tsunaki Sawada, Keiko Maeda, Takuya Ishikawa, Takeshi Yamamura, Eizaburo Ohno, Masanao Nakamura, Hiroki Kawashima, Ryoj
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Case Reports

Massive Duodenal Bleeding after the Migration of Endovascular Coils into the Small Bowel: Chung-Jo Choi, Hyun Lim, Dong-Suk Kim, Yong-Seol Jeong, Sang-Young Park, Jeong-Eun Kim; Clin Endosc 2019;52(6):612-615. Published online May 20, 2019; DOI: https://doi.org/10.5946/ce.2019.020

Abstract PDF PubReader ePub

Among gastrointestinal emergencies, acute upper gastrointestinal bleeding remains a challenging clinical problem owing to significant patient morbidity and costs involved in management. Endoscopic hemostatic therapy is the mainstay of treatment and decreases the incidence of re-bleeding, the need for surgery, morbidity, and mortality. However, in 8%–15% of patients with upper gastrointestinal bleeding, endoscopic hemostatic therapy does not successfully control bleeding. Trans-arterial coil embolization is an effective alternative treatment for endoscopic hemostatic failure; however, this procedure can induce adverse outcomes, such as non-target vessel occlusion, vessel dissection and perforation, and coil migration. Coil migration is rare but causes severe complications, such as re-bleeding and bowel ischemia. However, in most cases, coil migration is local and involves spontaneous healing without serious complications. Here, we report the case of a patient who underwent trans-arterial coil embolization of the gastroduodenal artery with the purpose of controlling massive duodenal bleeding, resulting in a fatal outcome caused by coil migration.

Citations

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Pulsation of visible vessel or adherent clot in duodenal ulcer may indicate pseudoaneurysm: Case series
Jiayu Ju, Ziyao Cheng, Qingliang Zhu, Mingming Deng, Hailong Zhang
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Rare but critical: Aberrant vascular communication leading to multiorgan ischemia after prophylactic gastroduodenal artery embolization for refractory upper gastrointestinal bleeding
Muhammad Ibrahim Saeed, Amna Subhan Butt, Jahanzeb Shahid, Junaid Iqbal
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Gastric Bleeding Caused by Migrated Coil: A Rare Complication of Splenic Artery Coil Embolization
Tian Li, Bayan Alsuleiman, Manuel Martinez
Gastro Hep Advances.2022; 1(1): 67. CrossRef
Intraluminal Endovascular Coil Migration: A Rare Complication Post-Embolization of the Gastroduodenal Artery for a Previously Bleeding Duodenal Ulcer
Yassin Naga, Mahendran Jayaraj, Yousif Elmofti, Annie Hong, Gordon Ohning
Cureus.2021;[Epub] CrossRef
Management of Gastroduodenal Artery Pseudoaneurysm Rupture With Duodenal Ulcer Complicated by Coil Migration
Dennis Chang, Purvi Patel, Seth Persky, Joseph Ng, Alan Kaell
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Persisting bleeding from the duodenal ulcer in patients with occlusion of the celiac trunk: a case report
Andrzej Żyluk, Samir Zeair, Janusz Kordowski, Ewa Gabrysz-Trybek
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Esophageal Involvement of Pemphigus Vulgaris Associated with Upper Gastrointestinal Bleeding: Sooyun Chang, Soo Jung Park, Sun Wook Kim, Moo-Nyun Jin, Jung-Hee Lee, Hyun Ju Kim, Sung Pil Hong, Tae Il Kim; Clin Endosc 2014;47(5):452-454. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.452

Abstract PDF PubReader ePub

Esophageal involvement of pemphigus vulgaris is rare, and when present, the most common presenting symptoms reported in the medical literature are odynophagia and dysphagia. Here, we present two cases of pemphigus vulgaris presenting with upper gastrointestinal hemorrhage because of esophageal involvement of the disease. In case 1, a 41-year-old female patient with a prior diagnosis of pemphigus vulgaris presented with hematemesis. Esophagogastroduodenoscopy showed diffuse mucosal exfoliation and oozing bleeding of the oropharynx and esophagus. The patient recovered after the administration of high-dose corticosteroids and immunosuppressants. In case 2, a 30-year-old female patient with known pemphigus vulgaris also presented with hematemesis, showing similar endoscopic findings to the first case. She also responded to the same treatment. Esophageal involvement of pemphigus vulgaris responds to high-dose corticosteroids and immunosuppressants. Thus, in patients with pemphigus vulgaris with signs or symptoms of upper gastrointestinal bleeding, an early endoscopy for the evaluation of esophageal involvement is beneficial.

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Maninder Kaur, Nagbhushan Hedge, Ashish Agarwal, Vikarn Vishwajeet, Suman Patra, Saurabh Singh
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Wei-Feng Huang, Wei Liu
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Connor Cole, Kyle Amber
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Victoria Malone, Kieran Sheahan
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Jennifer Rose F. Del Castillo, Muhammad Nadeem Yousaf, Fizah S. Chaudhary, Nahar Saleh, Lawrence Mills, Yoshiro Kawahara
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Mohammed Hassan Hussain, Faiz Tanweer, Georgios Sakagiannis, Manish Mair, Sara Mahmood, Sithamparappillai Ashokkumar
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Gastrointestinal involvement of primary skin diseases
C.‐Y. Lu, M.‐S. Hsieh, K.‐C. Wei, M. Ezmerli, C.‐H. Kuo, W. Chen
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Michael McFarlane, Ayesha Azam, David Snead, Ben Disney
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Melanie E. Johncilla, Amitabh Srivastava
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Angelo Gualberto de Macedo, Erika Ruback Bertges, Luiz Carlos Bertges, Renata Alvim Mendes, Thais Abranches Bueno Sabino Bertges, Klaus Ruback Bertges, Fernando Monteiro Aarestrup
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Khalaf Kridin, Shira Zelber-Sagi, Doron Comaneshter, Arnon D. Cohen
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99 Download
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Review

Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding: Ki Bae Kim, Soon Man Yoon, Sei Jin Youn; Clin Endosc 2014;47(4):315-319. Published online July 28, 2014; DOI: https://doi.org/10.5946/ce.2014.47.4.315

Abstract PDF PubReader ePub

Endoscopy for acute nonvariceal upper gastrointestinal bleeding plays an important role in primary diagnosis and management, particularly with respect to identification of high-risk stigmata lesions and to providing endoscopic hemostasis to reduce the risk of rebleeding and mortality. Early endoscopy, defined as endoscopy within the first 24 hours after presentation, improves patient outcome and reduces the length of hospitalization when compared with delayed endoscopy. Various endoscopic hemostatic methods are available, including injection therapy, mechanical therapy, and thermal coagulation. Either single treatment with mechanical or thermal therapy or a treatment that combines more than one type of therapy are effective and safe for peptic ulcer bleeding. Newly developed methods, such as Hemospray powder and over-the-scope clips, may provide additional options. Appropriate decisions and specific treatment are needed depending upon the conditions.

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Special Issue Articles of IDEN 2012

New Endoscopic Hemostasis Methods: En-Ling Leung Ki, James Y W Lau; Clin Endosc 2012;45(3):224-229. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.224

Abstract PDF PubReader ePub

Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension.

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Poudres hémostatiques et hémorragies digestives
M. Vincent
Acta Endoscopica.2015; 45(1-2): 2. CrossRef
Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer
Young-Il Kim, Il Ju Choi
Clinical Endoscopy.2015; 48(2): 121. CrossRef
Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art
Naoki Muguruma, Shinji Kitamura, Tetsuo Kimura, Hiroshi Miyamoto, Tetsuji Takayama
Clinical Endoscopy.2015; 48(2): 96. CrossRef
Hemostatic powder spray: a new method for managing gastrointestinal bleeding
Kinesh Changela, Haris Papafragkakis, Emmanuel Ofori, Mel A. Ona, Mahesh Krishnaiah, Sushil Duddempudi, Sury Anand
Therapeutic Advances in Gastroenterology.2015; 8(3): 125. CrossRef
Endoscopy for Nonvariceal Upper Gastrointestinal Bleeding
Ki Bae Kim, Soon Man Yoon, Sei Jin Youn
Clinical Endoscopy.2014; 47(4): 315. CrossRef
Spontaneous Healing of Gastric Perforation after Endoscopic Ligation for Gastric Varices
Jung Ho Kim, Hong Dae Ahn, Kwang An Kwon, Yoon Jae Kim, Jun-Won Chung, Dong Kyun Park, Ju Hyun Kim
Journal of Korean Medical Science.2013; 28(4): 624. CrossRef
Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer
Young‐Il Kim, Il Ju Choi, Soo‐Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Mi‐Jung Kim, Keun Won Ryu, Young‐Woo Kim, Young Iee Park
Journal of Gastroenterology and Hepatology.2013; 28(9): 1489. CrossRef
Neue Optionen der endoskopischen Blutstillung bei gastrointestinalen Blutungen
A. Hoffman, J.W. Rey, R. Kiesslich
Der Gastroenterologe.2013; 8(2): 140. CrossRef
Gastrointestinal bleeding with the new oral anticoagulants – defining the issues and the management strategies
Jay Desai, Jennifer Kolb, Jeffrey Weitz, James Aisenberg
Thrombosis and Haemostasis.2013; 110(08): 205. CrossRef
Upper Endoscopy in International Digestive Endoscopy Network 2012: Towards Upper End of Quality
Il Ju Choi
Clinical Endoscopy.2012; 45(3): 217. CrossRef

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An Ampulla of Vater Carcinoid Tumor that Presented with Upper Gastrointestinal Bleeding: Jae Serk Park, M.D., Sung Jo Bang, M.D., Seok Won Jung, M.D., Sung Ho Kwon, M.D., Byung Chul Kim, M.D., Dong Ha Han, M.D., Hyun Soo Kim, M.D., Young Min Kim, M.D.*, Chang Woo Nam, M.D.^† and Do Ha Kim, M.D.; Korean J Gastrointest Endosc 2007;35(6):420-423. Published online December 30, 2007

Abstract PDF: A Carcinoid tumor of the ampulla of Vater is extremely rare, accounting for less than 0.3% of all gastrointestinal carcinoids. Most reported cases have arisen from the gallbladder. An ampullary carcinoid most commonly presents with jaundice or upper abdominal discomfort, and bleeding from the tumor is exceedingly rare. A diagnosis is most frequently made postoperatively due to submucosal spread of the tumor. As the metastatic potential cannot be predicted by tumor size, a Whipple pancreaticoduodenectomy rather than local excision is considered the treatment of choice. We herein report a case of a primary carcinoid tumor located at the ampulla of Vater that presented as gastrointestinal bleeding; the tumor was diagnosed by an endoscopic biopsy after a papillary sphinterotomy. (Korean J Gastrointest Endosc 2007;35:420-423)

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Massive Upper Gastrointestinal Bleeding from a Traction Type of Diverticulum in the Midesophagus: Chang Soo Jang, M.D., Kwang An Kwon, M.D., Soo Jin Choi, M.D.*, Yeon Suk Kim, M.D., Yang Suh Ku, M.D., Kee Sup Song, M.D., Uk Sun Chang, M.D., Sang Kyun Yu, M.D., Dong Kyun Park, M.D., Yu Kyung Kim, M.D. and Ju Hyun Kim, M.D.; Korean J Gastrointest Endosc 2007;34(4):200-204. Published online April 30, 2007

Abstract PDF: The common sites of esophageal diverticula are the pharyngoesophageal junction, midesophagus and epiphrenic. The pathophysiological mechanisms of acquired esophageal diverticula are traction and pulsion forces. Traction diverticula of the midesophagus are usually asymptomatic, and found incidentally on an esophagogastroduodenoscopy or barium contrast esophagogram. Midesophageal traction diverticula are caused by inflammatory processes between the external wall of the esophagus and the adjacent structure. Pneumonia, bronchoesophageal fistula and gastrointestinal bleeding can occur due to an extension of inflammatory process into the lung or blood vessels. There are a few reports of midesophageal diverticular bleeding. We present a case of massive upper gastrointestinal bleeding from a traction diverticulum of the midesophagus that was successfully managed by endoscopic treatment. (Korean J Gastrointest Endosc 2007;34:200⁣204)

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Risk Factors for Upper Gastrointestinal Rebleeding in Critically Ill Patients: Seong Joon Koh, M.D., Jae Hee Cheon, M.D., Joo Sung Kim, M.D., Byong Duk Ye, M.D., Hae Yeon Kang, M.D., Bo Hyun Kim, M.D., Jeong Hoon Lee, M.D., Ki Young Yang, M.D., Sang Gyun Kim, M.D., Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2006;32(5):320-325. Published online May 30, 2006

Abstract PDF: Background
/Aims: To determine the incidence and risk factors associated with rebleeding after upper gastrointestinal bleeding (UGIB) in critically ill patients. Methods: This study retrospectively reviewed the medical records of 60 patients undergoing bedside esophagogastroduodenoscopy between April 2000 and February 2004 for UGIB that developed whilst in the intensive care unit (ICU). Results: Eight out of 60 patients died within 7 days, and an additional 7 patients died within 30 days after the initial bleeding. Two of these 15 patients (13.3%), died from GI bleeding. The 7-day and 30-day rebleeding rates were 34.6% (18/52 patients), and 51.1% (23/45 patients), respectively. Multiple logistic regression using the significant variables revealed, anemia (Hb＜9.0 g/dL) and hypoalbuminemia (＜3.0 g/dL) to be significant factor for 7-day rebleeding, and hypoxia (＜80 mmHg), anemia (Hb＜9.0 g/dL), blood transfusion (≥3 units) to be significant independent risk factor for 30-day rebleeding. Conclusions: The rebleeding rates in the ICU setting were as high as 34.6% at 7 days and 51.1% at 30 days. This suggests that the underlying conditions of the critically ill patients affect the rebleeding rate more than the endoscopic features. Therefore, adequate general ICU care including the prevention and correction of hypoxia, anemia, and hypoalbuminemia, and minimizing blood loss can reduce the risk of rebleeding after UGIB in an ICU setting. (Korean J Gastrointest Endosc 2006;32:320⁣325)

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A Case of Gastric Syphilis Manifested by Upper Gastrointestinal Bleeding: Seung Woo Lee, M.D., Sang Beom Kang, M.D., Soon Woo Nam, M.D., Joo Yong Song, M.D., Sung Jin Moon, M.D., Dong Soo Lee, M.D. and Hye Kyung Lee, M.D.*; Korean J Gastrointest Endosc 2006;32(2):124-127. Published online February 27, 2006

Abstract PDF: Syphilis is a chronic systemic infection caused by Treponema pallidum; it is sexually transmitted and characterized by episodes of active disease interrupted by periods of latency. Syphilitic involvement of the stomach can occur via the blood flow in the primary or secondary period of syphilis, but its incidence is very rare. Because gastric syphilis has no pathognomic clinical findings and it shows variable gastroscopic findings, it's not so easy to diagnose. After gastric syphilis is correctly diagnosed, it can be easily cured by appropriate antibiotic therapy. The clinicians need to be aware of this disease entity when the patient has mucosal inflammation and ulceration of stomach with the past history of syphilis, or if the patient has lived in edemic areas of syphilis. We report on a case of gastric syphilis that manifested with upper gastrointestinal bleeding. It was initially thought to be stomach cancer, but it was correctly diagnosed by serologic testing and the histopathologic findings. (Korean J Gastrointest Endosc 2006;32:124⁣127)

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The Clinical Features of Upper Gastrointestinal Bleeding after Acute Burn Injury: Geun Sook Kim, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D.,Woo Jung Park, M.D., Wook Chun, M.D.*, Jong Hyun Kim, M.D.* and Jin Lee, M.D.; Korean J Gastrointest Endosc 2005;31(2):77-83. Published online August 30, 2005

Abstract PDF: Background
/Aims: Upper gastrointestinal (UGI) bleeding is one of the most common and serious complications in major burns. However, the clinical features of UGI bleeding have rarely been studied, and no report of UGI bleeding after burn injury has been presented in Korea. The aim of this study was to evaluate the clinical features of the UGI bleeding after acute burn injury. Methods: Among 2,340 patieats with acute burn injury who have admitted from January 2000 to June 2004, 33 patients had UGI bleeding. We retrospectively reviewed the medical records of these 33 patients. Results: The causes of bleeding were gastric ulcer (45.5%), duodenal ulcer (36.4%), esophageal ulcer (6%), Mallory-Weiss tear (6%), hemorrhagic gastritis (3%), and gastric varix (3%). Endoscopic intervention and medical treatment were taken in 13 patients (39.4%), and 20 patients (60.6%) were managed with medical treatment only. Mortality rate of post-burn UGI bleeding patients was 30.3%. In logistic regression analysis, burn size (p=0.047) and Rockall score (p=0.019) were independent risk factors of mortality in patients with UGI bleeding. Conclusions: The most common cause of UGI bleeding in burn patients is peptic ulcer. Treatment of systemic complications of burn as well as UGI bleeding itself may be important in clinical course of UGI bleeding after burn. Large, randomized, and prospective study of prophylactic proton pump inhibitor for the prevention of post-burn UGI bleeding is needed. (Korean J Gastrointest Endosc 2005;31:77⁣83)

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A Case of a Y-shaped Pedunculated Gastric Polyp Presenting as an Upper Gastrointestinal Bleeding in a Patient with Chronic Renal Failure: Jin Seok Ko, M.D., In Sang Yun, M.D., Myong Sik Kim, M.D., Ilhyun Baek, M.D., Myung Seok Lee, M.D. and Chong Woo Yoo, M.D.*; Korean J Gastrointest Endosc 2003;27(4):225-228. Published online October 31, 2003

Abstract PDF: Upper gastrointestinal bleeding is one of the most common complications in patients with chronic renal failure. Common causes are peptic ulcer, gastritis, duodenitis, esophagitis, Mallory-Weiss tear, and angiodysplasia. However, gastric polyp is a rare cause of upper gastrointestinal bleeding. We diagnosed a bleeding hyperplastic polyp in chronic renal failure patient with melena. He had a bleeding polyp with a Y-shaped stalk. This polyp was treated effectively by endoscopic snare polypectomy.

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Clinical Findings of Upper Gastrointestinal Bleeding and Risk Factors for Early Rebleeding in Patients with Bleeding Peptic Ulcers: 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.; Korean J Gastrointest Endosc 2003;27(2):57-63. Published online August 30, 2003

Abstract PDF: 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;27:57⁣63)

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A Case of Metastatic Gastric Cancer Resulting from Mixed Germ Cell Tumor: Do Young Kim, M.D., Seong-Eun Yang, M.D., Chang-Whan Kim, M.D., Ji-Hoon Kim, M.D., Soon-Woo Nam, M.D., Jin Il Kim, M.D., Soo-Heon Park, M.D., Joon-Yeol Han, M.D., Jae Kwang Kim, M.D., Kyu Won Chung, M.D., Hee Sik Sun, M.D. and Kyo Young Lee, M.D.*; Korean J Gastrointest Endosc 2003;26(6):431-434. Published online June 30, 2003

Abstract PDF: Majority of metastatic stomach tumor is direct invasion from adjacent malignant lesions such as pancreatic carcinoma, hepatoma, colonic carcinoma which invade the stomach via gastrocolic ligament. Otherwise, metastatic involvement of the stomach as a result of solid tumors of extra-gastrointestinal origin is a rare occurrence, in about 0.2% to 1.7% of patients dying of solid tumors. The tumors which were most commonly reported hematogenous metastatic malignancy of the stomach are melanoma, lung carcinoma, breast carcinoma. We have experienced an unusual case in which a metastatic gastric germ cell tumor presented as an upper gastrointestinal bleeding in a 29-year-old man. He was hospitalized with complaints of melena and severe anemic appearance. We performed gastroscopy which revealed an fungating mass covered with dark pigmentation at the anterior wall of lower body of the stomach. Pathologic findings of the biopsy showed a metastatic mixed germ cell tumor of the stomach. We report this unusual metastatic mixed germ cell tumor of the stomach with a review of literatures. (Korean J Gastrointest Endosc 2003;26:431⁣434)

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원저 : 식도 위장관 ; O형 고무 밴드 결찰법을 이용한 Mallory - Weiss 증후군의 치료 ( Original Articles : Esophagus , Stomach & Intestine ; Management of Mallory - Weiss Syndrome by 0-ring Band Ligation ): Korean J Gastrointest Endosc 1998;18(2):152-160. Published online November 30, 1997

Abstract PDF: Background
/Aims: Mallory-Weiss syndrome refers to a laceration or lacerations in the region of the gastroesophageal junction due to vomiting, retching, or coughing induced by several causes, and preceding hematemesis. In the last several years, endoscopic therapies have dramatically changed the need for emergency surgery in patients with upper gastrointestinal bleeding. There is only little information however, regarding the indication criteria and the efficacy of endoscopic therapies in severe upper gastrointestinal bleeding, due to Mallory-Weiss syndrome. This study was designed to assess the usefulness and the indications of endoscopic O-ring band ligation. Methods: Thirty patients with Mallory- Weiss syndrome who were experiencing a related hemorrhage were studied. Among these, 5 patients with active bleeding or a visible vessel revealed during an endoscopic examination were treated with O-ring band ligation. Patients with blood clots or linear tears received only conservative treatment. (Korean J Gastrointest Endosc 18: 152-160, 1998) (continue)

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원저 : 간경변증 환자에서 상부소화관 출혈에 대한 임상적 고찰 ( Original Articles : Upper Gastrointestinal Bleeding in Liver Cirrhosis : clinical and endoscopic findings ): Korean J Gastrointest Endosc 1995;15(1):33-39. Published online November 30, 1994

Abstract PDF: It is well known that the main source of upper gastrointestinal(UGI) bleeding in patients with liver cirrhosis is the variceal rupture of esophagus. But, peptic ulcer disease, congestive gastrophathy, and gastric varices are frequently found by endoscopic examination in patients with liver cirrhosis. These lesions are related to UGI bleeding. It is necessary to verify the causes of bleeding in liver cirrhosis, and evaluate the influencing factors related with UGI bleeding, and define the endoscopic findings of bleeding in liver cirrhosis. We reviewed the records of 145 episodes of UGI bleeding in cirrhosis, with endoscopy performed within 24 hours of entry, and report here the bleeding sites, influencing factors related with UGI bleeding, and endoscopic findings. The most common bleeding site was the esophageal varices(66.9%). Other bleeding lesions included gastric ulcer(8.3%), congestive gastrophathy(6.9%), undetermined origin(6.9%), duodenal ulcer(6.2%), gastric varices(2.1%), esophageal varices+gastric ulcer(1.4%), and esophageal varices+duodenal ulcer(1.4%). Endoscopic features of bleeding esophageal varices were identified as Spurting(2.1%), Oozing(11.3%), Red plugh(10,3 %), White plugh(14.4%), and Red-color sign(61.9%). In bleeding esophageal varices, gradeIV varices(41.2%) had a significantly higher association with bleeding than gradeI varices(2.1%), gradeII varices(22.7%), and gradeIII varices(34.0%). Endoscopic features of bleeding gastric ulcer were identified as Spurting(8.3%), Oozing(25.0%), Blood clots(58.3%), and Exposed blood vessels on ulcer base(41.7%). Endoscopic features of bleeding duodenal ulcer were identified as Oozing(44.4%), Blood clots(55.6 %), and Exposed blood vessels on ulcer base(55.6%). We found no difference in the bleeding sources according to etiology of cirrhosis(P>0.05). Bleedings due to the variceal rupture of esophagus were more frequently found in Child class B(71.2%) and C(75.0%) than A(34.8%)(P<0.05).

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소화성궤양 출혈에 대한 Hypertonic Saline - Epinephrine 용액의 내시경적 국소주사의 지혈효과 ( Hemostatic Effect of Endoscopic Local Injection of Hypertonic Saline - Epinephrine Solution in Peptic Ulcer Bleeding ): Korean J Gastrointest Endosc 1993;13(4):663-672. Published online November 30, 1992

Abstract PDF: To date several agents have been used to achieve hemostasis in patients with bleeding peptic ulcers using endoscopic sclerotherapy techniques. In this study, the efficacy of endoscopic local injections of hypertonie saline-epinephrine(HS-E) solution, consisting of 9 volume of 3% sodium chloride and 1 volume of 1: 1000 epinephrine, on the base of the ulcer around bleeding vessel was assessed. During the period between April 1989 and July l992, 127 patients were admitted to the study. Ninety-six of these patients underwent endoscopic treatmeat(endoscopic treatment group), while the other 31 cases received conservative treatment only(conservative treatment group). (continue...)

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