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Endoscopy in the Centenarians: Is it Worth the Trouble?
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Abstracts
Clinical Gastroenterology and Hepatology Vol. 15, No. 1
was 1,3% including hemothorax, hematoma and pleural effusion. CONCLUSION: RFA is a safe and effective therapy for HCC patients. Factors correlated with survival were etiologies, mRECIST response and number of tumors. Hepatocellular carcinoma frequency Ablation (RFA)
Keywords:
(HCC);
Radio-
Conflicts of interest: The authors disclose no conflicts.
Endoscopy in the Centenarians: Is it Worth the Trouble? Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Endoscopy in the very elderly is generally considered risk prone. Centenarians are people who are 100 years of age. Little is known about endoscopy in the centenarians. This retrospective study aimed to explore this. METHODS: A retrospective study analysing endoscopy in centenarians presenting to a University Hospital from 01/2005 to 01/2015 was undertaken. Endoscopy reports were retrieved from the Hospital’s Endoscopy Reporting tool and patients’ details were confirmed using the Trust’s patient database. RESULTS: 11 procedures (7 Gastroscopies, 3 sigmoidoscopies and 1 Colonoscopy) were undertaken in 10 patients (4 male and 6 female). Age: 101 to 119 years. Mean 105.2 years. 7 (Caucasians), 2 (Indians) and 1 (Afro-Caribbean). 72% (urgent basis). 70% (inpatients) and majority were undertaken by Consultants (82%). Indications included Dysphagia (36.3%), Melena (27.2%), Rectal Bleeding (27.2%) and previous Cancer (9%). Procedural yield (81.8%) and endoscopic intervention performed in 2 cases (Duodenal ulcer injected with adrenaline and hemorrhoids banded). 2 procedures were performed under sedation (midazolam). 100% completion rate without immediate complications. CONCLUSION: To the best of the author’s knowledge this is the only study analysing endoscopic practice in centenarians. While the sample size is small it demonstrates that endoscopy can be performed safely and diagnostic yield is high. A patients’ age should not be the sole factor when deciding suitability for endoscopic procedures. Larger studies are required to gain a better understanding of endoscopic suitability for patients in this age group. Conflicts of interest: The authors disclose no conflicts.
Haemostasis After Endoscopic Intervention in Upper Gastrointestinal Bleeding: A Retrospective Study Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Acute
Upper Gastrointestinal Bleeding (AUGIB) is a medical emergency with 10% mortality rate.
European Society of Gastrointestinal Endoscopy (ESGE) 2015 guidance advises dual modalities of treatment in non-variceal bleeding. This retrospective audit looks at endoscopic practice at a tertiary hospital. METHODS: The Endoscopy Reporting Tool was used to select patients who had underwent endoscopic intervention (EI) after presenting with haematemesis and/or malena from 09/2012 to 08/2013. Endoscopy report were analysed for operator, pathology, modality of treatment, haemostasis, repeat endoscopy, nature of bleeding, adrenaline injected and stigmata of bleeding. RESULTS: Out of 969 patients, 168(17.3%) required EI. 107 (64%) were performed by Consultant Gastroenterologists, 55 (33%) Specialist Registrars and 6(3%) Other professionals. Varices (31%), Duodenal Ulcers (30%), Gastric Ulcers (14%) and Mallory Weiss Tears (5%) were the main causes of bleeding. In 71 (42%) the lesion was oozing, 6 (3.5%) cases were spurting. 61 (55%) of non-variceal bleeds had a visible vessel, 43 (39%) adherent clot and 9 (8%) pigmented bases. 58% received Dual Therapy and 42% monotherapy. 6 (5.4%) received mechanical therapy only. Haemostasis was achieved in all but 3 cases. 26 (15.5%) underwent repeat endoscopy; 11 (6.5%) required repeat EI. 23% of the non-variceal bleeds had 5mls adrenaline injected, 46% 6-10mls and 26% > 11mls. CONCLUSION: Peptic ulcers and Oesophageal Varices remain the leading causes of AUGIB. Around 1/6 patients with AUGIB require EI. Dual modalities of EI were under utilised and should be advocated in line with ESGE guidance. Conflicts of interest: The authors disclose no conflicts.
A Comparison of Albumin vs Albumin Combined With Terlipressin for Treating Hepatorenal Syndrome: An Evidence Based Case Report Emilina Faradila Cornain and Irsan Hasan 1
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, and 2Hepatobiliary Division of the Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia BACKGROUND: Type 1 Hepatorenal syndrome (HRS) is an
acute deterioration of the circulatory, renal and hepatic function characterized by rapid, progressive renal impairment with doubling of serum creatinine level > 2.5 mg/dL in less than two weeks.1,2 About 18% of patients with cirrhosis develop hepatorenal syndrome after a year.3 Intravenous albumin was the therapy of choice as it increases total plasma volume and cardiac output. It was revealed that vasoconstrictors and albumin may improve patient’s renal function. The rationale of adding vasoconstrictors needs to be based on evidence. The aim of this study is to determine whether the combination of albumin and terlipressin compared to albumin alone were able to improve renal function in patients with type 1 HRS.
Abstracts
Clinical Gastroenterology and Hepatology Vol. 15, No. 1
was 1,3% including hemothorax, hematoma and pleural effusion. CONCLUSION: RFA is a safe and effective therapy for HCC patients. Factors correlated with survival were etiologies, mRECIST response and number of tumors. Hepatocellular carcinoma frequency Ablation (RFA)
Keywords:
(HCC);
Radio-
Conflicts of interest: The authors disclose no conflicts.
Endoscopy in the Centenarians: Is it Worth the Trouble? Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Endoscopy in the very elderly is generally considered risk prone. Centenarians are people who are 100 years of age. Little is known about endoscopy in the centenarians. This retrospective study aimed to explore this. METHODS: A retrospective study analysing endoscopy in centenarians presenting to a University Hospital from 01/2005 to 01/2015 was undertaken. Endoscopy reports were retrieved from the Hospital’s Endoscopy Reporting tool and patients’ details were confirmed using the Trust’s patient database. RESULTS: 11 procedures (7 Gastroscopies, 3 sigmoidoscopies and 1 Colonoscopy) were undertaken in 10 patients (4 male and 6 female). Age: 101 to 119 years. Mean 105.2 years. 7 (Caucasians), 2 (Indians) and 1 (Afro-Caribbean). 72% (urgent basis). 70% (inpatients) and majority were undertaken by Consultants (82%). Indications included Dysphagia (36.3%), Melena (27.2%), Rectal Bleeding (27.2%) and previous Cancer (9%). Procedural yield (81.8%) and endoscopic intervention performed in 2 cases (Duodenal ulcer injected with adrenaline and hemorrhoids banded). 2 procedures were performed under sedation (midazolam). 100% completion rate without immediate complications. CONCLUSION: To the best of the author’s knowledge this is the only study analysing endoscopic practice in centenarians. While the sample size is small it demonstrates that endoscopy can be performed safely and diagnostic yield is high. A patients’ age should not be the sole factor when deciding suitability for endoscopic procedures. Larger studies are required to gain a better understanding of endoscopic suitability for patients in this age group. Conflicts of interest: The authors disclose no conflicts.
Haemostasis After Endoscopic Intervention in Upper Gastrointestinal Bleeding: A Retrospective Study Shivkumar Budihal University Hospitals Leicester, United Kingdom BACKGROUND: Acute
Upper Gastrointestinal Bleeding (AUGIB) is a medical emergency with 10% mortality rate.
European Society of Gastrointestinal Endoscopy (ESGE) 2015 guidance advises dual modalities of treatment in non-variceal bleeding. This retrospective audit looks at endoscopic practice at a tertiary hospital. METHODS: The Endoscopy Reporting Tool was used to select patients who had underwent endoscopic intervention (EI) after presenting with haematemesis and/or malena from 09/2012 to 08/2013. Endoscopy report were analysed for operator, pathology, modality of treatment, haemostasis, repeat endoscopy, nature of bleeding, adrenaline injected and stigmata of bleeding. RESULTS: Out of 969 patients, 168(17.3%) required EI. 107 (64%) were performed by Consultant Gastroenterologists, 55 (33%) Specialist Registrars and 6(3%) Other professionals. Varices (31%), Duodenal Ulcers (30%), Gastric Ulcers (14%) and Mallory Weiss Tears (5%) were the main causes of bleeding. In 71 (42%) the lesion was oozing, 6 (3.5%) cases were spurting. 61 (55%) of non-variceal bleeds had a visible vessel, 43 (39%) adherent clot and 9 (8%) pigmented bases. 58% received Dual Therapy and 42% monotherapy. 6 (5.4%) received mechanical therapy only. Haemostasis was achieved in all but 3 cases. 26 (15.5%) underwent repeat endoscopy; 11 (6.5%) required repeat EI. 23% of the non-variceal bleeds had 5mls adrenaline injected, 46% 6-10mls and 26% > 11mls. CONCLUSION: Peptic ulcers and Oesophageal Varices remain the leading causes of AUGIB. Around 1/6 patients with AUGIB require EI. Dual modalities of EI were under utilised and should be advocated in line with ESGE guidance. Conflicts of interest: The authors disclose no conflicts.
A Comparison of Albumin vs Albumin Combined With Terlipressin for Treating Hepatorenal Syndrome: An Evidence Based Case Report Emilina Faradila Cornain and Irsan Hasan 1
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia, and 2Hepatobiliary Division of the Internal Medicine Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia BACKGROUND: Type 1 Hepatorenal syndrome (HRS) is an
acute deterioration of the circulatory, renal and hepatic function characterized by rapid, progressive renal impairment with doubling of serum creatinine level > 2.5 mg/dL in less than two weeks.1,2 About 18% of patients with cirrhosis develop hepatorenal syndrome after a year.3 Intravenous albumin was the therapy of choice as it increases total plasma volume and cardiac output. It was revealed that vasoconstrictors and albumin may improve patient’s renal function. The rationale of adding vasoconstrictors needs to be based on evidence. The aim of this study is to determine whether the combination of albumin and terlipressin compared to albumin alone were able to improve renal function in patients with type 1 HRS.