8/12/2019 Factores de Riesgo Despus de La Ingesta de Causticos

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Prospective Single-Arm Trial of Two-Week Rabeprazole

Treatment for Ulcer Healing After Gastric Endoscopic

Submucosal DissectionKeiko Niimi1, Mitsuhiro Fujishiro2, Osamu Goto1, Shinya Kodashima3,Chihiro Minatsuki1, Maki Shimizu1, Itsuko Hirayama1,Satoshi Mochizuki1, Satoshi Ono1, Nobutake Yamamichi1,Naomi Kakushima4, Kazuhiko Koike11Department of Gastroenterology, The University of Tokyo, Tokyo,

Japan; 2

Department of Endoscopy and Endoscopic Surgery, TheUniversity of Tokyo, Tokyo, Japan; 3Center for Epidemiology and

Preventive Medicine, The University of Tokyo, Tokyo, Japan;4Endoscopy Division, Shizuoka Cancer Center, Shizuoka, JapanObjectives: Endoscopic submucosal dissection (ESD) causes artificial ulcers, andthere is no consensus regarding the degree of healing in ESD-induced ulcers orthe optimal duration of proton pump inhibitor (PPI) treatment. The aim of ourstudy was to investigate the healing rates of post-ESD ulcers in response to theprotective effect of 2-week PPI treatment. Methods: Between February 2007 andMarch 2010, 75 patients/75 lesions and 55 patients/55 lesions were enrolled asthe interim and per-protocol groups, respectively. All patients were prescribedrabeprazole (10 mg/day) orally for 16 days beginning on the day before ESD.The follow-up endoscopy was performed 8 weeks after ESD to evaluate ulcerhealing. The primary endpoint was the healing rate of post-ESD ulcers at 8

weeks after ESD. Secondary endpoints were the rate of post-ESD bleeding withemergency endoscopy and the rate of other severe adverse effects during thestudy period. Results: The transitional rate to scarring-stage ulcers was 80.0%

(44/55). Only a location in the lesser curve was a statistically significant riskfactor for delayed ulcer healing. Post-ESD bleeding occurred within 2 weeks intwo cases, but both cases were successfully managed with only endoscopichemostasis. Severe adverse effects did not occur. Conclusions: Two-weekadministration of PPI is sufficient to help ESD-induced ulcers heal. This strategy

will lead not only to reduced costs of post-ESD management but also to a betterunderstanding of the difference between the healing processes of peptic ulcersand artificial ulcers.

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Use of Anticoagulant or Antiplatelet Medication Not Related to

Epistaxis During TransNasal EsophagogastroduodenoscopyYoshinori Komazawa, Mika Yuki, Hiroyuki Fukuhara,

Tomoko Mishiro, Aya Otani, Toshihiro Shizukuinternal medicine, izumo-city general medical center, Izumo, JapanBackground and study aims: Although transnasal esophagogastroduodenoscopy(EGD) has become widely used in clinical practice because of its feasibility andtolerability, epistaxis is a potential complication. There are few detailed reportsregarding epistaxis, thus its rate of occurrence in association with transnasal EGDis unknown. It is generally considered that patient use of anticoagulant orantiplatelet medication is associated with an elevated risk of epistaxis duringtransnasal EGD. The aim of this prospective study was to assess risk factors forepistaxis during transnasal EGD, especially in patients receiving anticoagulant orantiplatelet medication. Patients and methods: From September 2009 to August2010, 4251 consecutive patients who underwent transnasal EGD were enrolled inthe study and prospectively monitored for the potential occurrence of epistaxis.Two thin-caliber type endoscopes (5.9 and 5.5 mm in diameter) were used inthis study. Patients under antithrombotic treatment (warfarin, n47; aspirin,n98; others, n64) comprised 4.6% of the total. We evaluated the effects ofendoscope diameter, patient gender and age, and type of anticoagulant or

antiplatelet medication on the occurrence of epistaxis during the procedure usingmultivariate analysis. Results: The overall rate of epistaxis during the procedureswas 5.6%. Factors associated with a high risk of epistaxis included female gender(p0.001) and age younger than 65 years (p0.001). In contrast, the differentendoscope diameters and use of anticoagulant or antiplatelet medication weredetermined to not be risk factors for the occurrence of epistaxis. In all cases ofepistaxis, the condition was self-limited and a hemostatic procedure was notrequired by a otolaryngologist, even in those being treated with anticoagulant orantiplatelet medication. Conclusions: During transnasal EGD, the risk factorsassociated with epistaxis were female gender and age younger than 65 years,

whereas the use of anticoagulant and antiplatelet medication was not associatedwith epistaxis. Our results indicate that transnasal EGD in patients receivingantithrombotic treatment is safe. In addition, they may support the use of atransnasal endoscopy, which puts less strain on the cardiopulmonary system, onpatients being treated with anticoagulant or antiplatelet medication for cardiac orcerebrovascular diseases.

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Fators Influencing the Clinical Outcome of Patients After

Caustic IngestionYi-Chun Chiu, Keng-Liang WuHepato-Gastroenterology, Chang Gung Memorial Hospital, Kaohsiung

Medical Center, Chang Gung University College of Medicine, Taiwan,

Kaohsiung, TaiwanBackground: The ingestion of corrosive agents can cause extensive damage tothe gastrointestinal tract. In the acute state, the damage may be so severe thatperforation of the esophagus and the stomach as well as death can ensue.

Long-term complications of the upper gastrointestinal strictures, includingesophageal stricture (ES) and gastric outlet obstruction (GOO). Aim: Thepurpose of the present study was to investigate the factors influencingclinical outcome of patients after corrosive injury. Methods: From July 2000 toOctober 2007, patients of ingesting corrosive substance admitted to ourhospital. PES was performed within 48 hours after the corrosive substance

was ingest ed. The mucos al burns were grade d accor ding to the severi ty ofinjury, and extent of damage over esophagus, stomach, and duodenum.Informations such as the kind of corrosive ingested, early endoscopicfindings, hospital course and clinical outcome were analyzed. Result: Ninty-three patients (43 men and 50 women) with average age of 49.6 years (range18 to 86). Eighty patients had ingested acids and 13 had ingested alkalis. Thecase number of Grade III injury was 37 (39.8%) in esophagus, 50 (53.8%) instomach and 7 (9.7%) in duodenum. Ten patients (10.8%) died at the acutestage due to gastrointestinal tract perforation, aspiration pneumonia,respiratory failure or sepsis. Thirty-one patients developed intake problemsincluding ES alone in 17 (20.2%) patients, GOO alone in 6 (7.1%), and

combination of ES and GOO in 8 (9.5%). Multivariate analysis revealed thatonly age 60 years (OR 12.905, p0.002) was the independent risk factorfor mortality after corrosive injury of GI tract. (Table 1) Multivariate analysisrevealed that only Grade III injury of esophagus (OR 3.34, p0.015) was theindependent risk factor for ES. (Table 2) Multivariate analysis revealed thatGrade III injury of stomach (OR 16, p0.011) and duodenum (OR 4,p0.049) were the independent risk factors for GOO. Conclusion: Age 60

years was the indep enden t risk facto r for morta lity after corro sive injur y of GItract. Grade III injury of esophagus was the independent risk factor fordevelopment of ES. Grade III injury of stomach and Grade III injury ofduodenum both were the independent risk factor for development of GOO.

Table1. Univariate and multivariate analyses of mortality for individual

parameters in patients with corrosive injury of gastrointestinal tract.

Parameter* Univariate Multivariate

Risk 95% CI p Risk 95% CI p

Age 11.356 1.965-65.625 0.006 12.905 2.411-69.062 0.002

Sex 0.346 0.052-2.292 0.271

Acid/Alk ali 0. 794 0.045-13.882 0.874

Grade of esophagus

injury

2.043 0.300-13.909 0.465

Grade of stomach injury 9.220 1.117-76.069 0.039 8.670 0.976-76.961 0.052

Grade of duodenum

injury

1.386 0.184-10.432 0.750

*Cut-off: Age: 60 or60 years; sex: male or female; type of ingestion substance:acid or alkali; Grade of esophagus injury: grade III or not; Grade of stomach injury:

grade III or not; Grade of duodenum injury: grade III or not

Table2. Univariate and multivariate analyses of esophagealstricturefor

individualparameters in patients with corrosive injury of gastrointestinal tract.

Parameter* Univariate Multivariate

Risk 95% CI p Risk 95% CI p

Age 0.304 0.0726-1.277 0.104 0.447 0.122-1.630 0.222

Sex 0.428 0.139-1.315 0.138 0.538 0.193-1.498 0.236

Acid/Alkali 0.461 0.098-2.155 0.325

Grade of esophagus

injury

3.237 1.023-10.245 0.045 3.340 1.257-8.877 0.015

Grade of stomach injury 2.369 0.672-8.339 0.179 1.705 0.585-4.968 0.328

Grade of duodenum

injury

0.917 0.196-4.285 0.912

*Cut-off: Age: 60 or60 years; sex: male or female; type of ingestion substance:acid or alkali; Grade of esophagus injury: grade III or not; Grade of stomach injury:

grade III or not; Grade of duodenum injury: grade III or not

Abstracts

AB404 GASTROINTESTINAL ENDOSCOPY Volume 73, No. 4S : 2011 www.giejournal.org