ABSTRACT: Background and Study Aim
Esophageal stricture (ES) and gastric outlet obstruction (GOO) can occurred in
patients injured by the ingestion of corrosive agents. These complications may occur
concurrently but has not been reported in the literature. The aims of this study are to
assess the effects and complications of endoscopic-guided balloon dilations (EBD) in
patients with corrosive-induced upper gastrointestinal strictures, either ES or GOO
alone and simultaneous occurrences of both (ES+GOO).
Patients and Methods
From July 2002 to December 2009, 36 patients with corrosive-induced upper
gastrointestinal strictures in a tertiary hospital were recruited into this study. The
patients were divided into three groups, ES group (n=18), GOO (n=7), and ES + GOO
group (n=11). All strictures were dilated under direct visualization by using
through-the-scope balloon catheters to the end point of 15 mm. The end-point of
treatment was successful ingestion of a solid or semisolid diet without additional
dilation for more than 12 months.
These 36 patients included 15 males and 21 females with average age of 47 years
ranging from 25 to 79 years. The success rates for ES group is significantly better
than GOO and ES + GOO group (83.3% vs. 57.1% vs. 36.4% p=0.035). Less
complications were observed in ES group than in GOO and ES + GOO group (16.7%
vs. 42.9% vs. 36.4%, p=0.041). GOO group needed more sessions of dilations in
order to achieve success dilations than ES and GOO groups (13.7±4.9 vs. 6.1±4.7 vs.
Corrosive injuries complicated with ES can be effectively and safely treated by EBD.
However, the success rates declined significantly in patients with GOO with or
without ES and amore complications occurred.
BMC Gastroenterology 01/2013; · 2.42 Impact Factor
ABSTRACT: Large meta-analyses of second-line Helicobacter pylori eradication with fluoroquinolone triple therapy have shown that neither 7-day nor 10-day therapy provides 90% or better treatment success. Reports describing second-line H. pylori eradication using 14-day fluoroquinolone-containing triple therapy are few. Current study aimed to determine the efficacy of a 14-day levofloxacin/amoxicillin/proton-pump inhibitor regimen as second-line therapy and the clinical factors influencing the outcome.
One-hundred and one patients who failed H. pylori eradication using the standard triple therapy for 7 days were randomly assigned to either a levofloxacin/amoxicillin/esomeprazole group (levofloxacin 500 mg once daily, amoxicillin 1 g twice daily, and esomeprazole 40 mg twice daily for 14 days) or a esomeprazole/metronidazole/bismuth salt/tetracycline group (esomeprazole 40 mg twice daily, metronidazole 250 mg four times daily, tripotassium dicitrate bismuthate 300 mg four times daily, and tetracycline 500 mg four times daily for 14 days). Follow-up to assess treatment response consisted of either endoscopy or a urea breath test, which were carried out 8 weeks later.
Eradication rates attained by levofloxacin/amoxicillin/esomeprazole and esomeprazole/metronidazole/bismuth salt/tetracycline treatments in the per-protocol analysis were 44/47 (93.6%; 95% CI = 86-99.8) and 43/47 (91.8%; 95% CI = 83.2-98.5). In the intention-to-treat analysis, these were 43/47 (86.3%; 95% CI = 76.5-96.1) in the LAE group (four lost to follow-up) and 43/50 (86%; 95% CI = 76-96) in the EMBT groups. The observed adverse events were 25.5% and 38.5% among the two groups. There was 100% drug compliance among the levofloxacin/amoxicillin/esomeprazole group. Levofloxacin-resistant strains occurred at a frequency of 32.3%. H. pylori eradication rates for the levofloxacin-susceptible strains and levofloxacin-resistant strains were 92% (11/12) and 33% (1/3) in the per-protocol analysis.
A 14-day levofloxacin/amoxicillin/esomeprazole triple therapy approach provides a >90% per-protocol report card with the caveat that this approach is markedly less effective in the presence of fluoroquinolone resistance. Levofloxacin-resistant strains are increasing in Taiwan.
Helicobacter 10/2012; 17(5):374-81. · 3.15 Impact Factor
ABSTRACT: : There are no accepted means of identifying patients in whom colonoscopy is likely to be more difficult and allocate time accordingly.
: To identify patient-related, endoscopist-related, and procedure-related factors associated with difficult cecal intubation.
: This was a prospective study performed at the Kaohsiung Chang Gung Memorial Hospital, Kaohsiung Medical Center, from January to December 2009. Data pertaining to patient information (age, sex, weight, waist circumference and buttock girth, bowel habit, and abdomen surgery history) were recorded prospectively. Procedure-specific information including the need to alter patient position, application of external compression, and cecal intubation time (CIT) was documented.
: A total of 859 consecutive patients were enrolled. The mean age of the patients was 50.5±11.4 years. CIT was longer in women compared with men (410±195 vs. 376±224 s; P=0.021). Older patients had longer CITs-an additional 2.1 seconds for each incremental year (P=0.001), and poor bowel preparation increased CIT (P=0.019). Patients who required a position change or abdominal compression took longer to reach the cecum (P<0.001).
: Our findings emphasize the importance of colon preparation and the need for abdominal compression and a change of position when performinga difficult colonoscopy.
Surgical laparoscopy, endoscopy & percutaneous techniques 10/2012; 22(5):443-6. · 1.23 Impact Factor
ABSTRACT: Many studies have shown that high-dose proton-pumps inhibitors (PPI) do not further reduce the rate of rebleeding compared to non-high-dose PPIs but we do not know whether intravenous non-high-dose PPIs reduce rebleeding rates among patients at low risk (Rockall score < 6) or among those at high risk, both compared to high-dose PPIs. This retrospective case-controlled study aimed to identify the subgroups of these patients that might benefit from treatment with non-high-dose PPIs.
Subjects who received high dose and non-high-dose pantoprazole for confirmed acute PU bleeding at a tertiary referral hospital were enrolled (n = 413). They were divided into sustained hemostasis (n = 324) and rebleeding groups (n = 89). The greedy method was applied to allow treatment-control random matching (1:1). Patients were randomly selected from the non-high-dose and high-dose PPI groups who had a high risk peptic ulcer bleeding (n = 104 in each group), and these were then subdivided to two subgroups (Rockall score ≥ 6 vs. < 6, n = 77 vs. 27).
An initial low hemoglobin level, serum creatinine level, and Rockall score were independent factors associated with rebleeding. After case-control matching, the significant variables between the non-high-dose and high-dose PPI groups for a Rockall score ≥ 6 were the rebleeding rate, and the amount of blood transfused. Case-controlled matching for the subgroup with a Rockall score < 6 showed that the rebleeding rate was similar for both groups (11.1% in each group).
Intravenous non-high-dose pantoprazole is equally effective as high-dose pantoprazole when treating low risk patients with a Rockall sore were < 6 who have bleeding ulcers and high-risk stigmata after endoscopic hemostasis.
BMC Gastroenterology 03/2012; 12:28. · 2.42 Impact Factor