AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).METHODS: This double-blind randomized control trial ...AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).METHODS: This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen (500 mg; n = 162) or a placebo (n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to > 3 × the upper normal limit (60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, > 10 d and/or necessitated surgical or intensive treatment, or contributed to death.RESULTS: PEP occurred in 12% (40/324) of participants, and was significantly more frequent in the placebo group compared to the naproxen group (P < 0.01). Of the participants, 25.9% (84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group (P < 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min (Ps < 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in the 展开更多
Background:Endoscopic cyanoacrylate(glue)injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts(GRSs).Balloon-occluded retrograde transvenous occlusion...Background:Endoscopic cyanoacrylate(glue)injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts(GRSs).Balloon-occluded retrograde transvenous occlusion(BRTOcc)of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt.This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic(BRTOcc)approach for the treatment of bleeding fundal varices.Methods:We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018.Data were extracted for patient demographics,clinical and endoscopic findings,technical details,and adverse events of the endoscopic–BRTOcc approach and patient outcomes.Results:We identified 30 patients(13[43.3%]women;median age 58[range,25–92]years)with gastroesophageal varices type 2(53.3%,16/30)and isolated gastric varices type 1(46.7%,14/30)per Sarin classification,and median clinical and endoscopic follow-up of 151(range,4–2,513)days and 98(range,3–2,373)days,respectively.The median volume of octylcyanoacrylate:Lipiodol injected was 7(range,4–22)mL.Procedure-related adverse events occurred in three(10.0%)patients,including transient fever,non-life-threatening pulmonary glue embolism,and an injection-site ulcer bleed.Complete gastric variceal obturation was achieved in 18 of 21 patients(85.7%)at endoscopic follow-up.Delayed variceal rebleeding was confirmed in one patient(3.3%)and suspected in two patients(6.7%).Although no procedure-related deaths occurred,the overall mortality rate was 46.7%,primarily from liver-disease progression and co-morbidities.Conclusion:The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices,with a high rate of variceal obturation and a low rate of serious adverse events.展开更多
Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.D...Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.展开更多
The gas field in the Bohai Bay Basin is a fractured metamorphic buried-hill reservoir with dual-media characteristics. The retrograde vaporization mechanism observed in this type of gas condensate reservoir differs si...The gas field in the Bohai Bay Basin is a fractured metamorphic buried-hill reservoir with dual-media characteristics. The retrograde vaporization mechanism observed in this type of gas condensate reservoir differs significantly from that observed in sand gas condensate reservoirs. However, studies on improving the recovery of fractured gas condensate reservoirs are limited;thus, the impact of retrograde vaporization on condensate within fractured metamorphic buried-hill reservoirs remains unclear. To address this gap, a series of gas injection experiments are conducted in pressure-volume-temperature(PVT) cells and long-cores to investigate the retrograde vaporization effect of condensate using different gas injection media in fractured gas condensate reservoirs. We analyze the variation in condensate volume, gas-to-oil ratio, and condensate recovery during gas injection and examine the influence of various gas injection media(CO_(2), N_(2), and dry gas) under different reservoir properties and varying gas injection times. The results demonstrate that the exchange of components between injected gas and condensate significantly influences condensate retrograde vaporization in the formation. Compared with dry gas injection and N_(2) injection,CO_(2) injection exhibits a superior retrograde vaporization effect. At a CO_(2) injection volume of 1 PV, the percentage shrinkage volume of condensate is 13.82%. Additionally, at the maximum retrograde condensation pressure, CO_(2) injection can increase the recovery of condensate by 22.4%. However, the condensate recovery is notably lower in fractured gas condensate reservoirs than in homogeneous reservoirs, owing to the creation of dominant gas channeling by fractures, which leads to decreased condensate recovery. Regarding gas injection timing, the effect of gas injection at reservoir pressure on improving condensate recovery is superior to that of gas injection at the maximum retrograde condensation pressure. This research provides valuable guidance for designing gas inj展开更多
文摘AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).METHODS: This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen (500 mg; n = 162) or a placebo (n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to > 3 × the upper normal limit (60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, > 10 d and/or necessitated surgical or intensive treatment, or contributed to death.RESULTS: PEP occurred in 12% (40/324) of participants, and was significantly more frequent in the placebo group compared to the naproxen group (P < 0.01). Of the participants, 25.9% (84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group (P < 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min (Ps < 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in the
文摘Background:Endoscopic cyanoacrylate(glue)injection of fundal varices may result in life-threatening embolic adverse events through spontaneous gastrorenal shunts(GRSs).Balloon-occluded retrograde transvenous occlusion(BRTOcc)of GRSs during cyanoacrylate injection may prevent serious systemic glue embolization through the shunt.This study aimed to evaluate the efficacy and safety of a combined endoscopic–interventional radiologic(BRTOcc)approach for the treatment of bleeding fundal varices.Methods:We retrospectively analysed the data of patients who underwent the combined procedure for acutely bleeding fundal varices between January 2010 and April 2018.Data were extracted for patient demographics,clinical and endoscopic findings,technical details,and adverse events of the endoscopic–BRTOcc approach and patient outcomes.Results:We identified 30 patients(13[43.3%]women;median age 58[range,25–92]years)with gastroesophageal varices type 2(53.3%,16/30)and isolated gastric varices type 1(46.7%,14/30)per Sarin classification,and median clinical and endoscopic follow-up of 151(range,4–2,513)days and 98(range,3–2,373)days,respectively.The median volume of octylcyanoacrylate:Lipiodol injected was 7(range,4–22)mL.Procedure-related adverse events occurred in three(10.0%)patients,including transient fever,non-life-threatening pulmonary glue embolism,and an injection-site ulcer bleed.Complete gastric variceal obturation was achieved in 18 of 21 patients(85.7%)at endoscopic follow-up.Delayed variceal rebleeding was confirmed in one patient(3.3%)and suspected in two patients(6.7%).Although no procedure-related deaths occurred,the overall mortality rate was 46.7%,primarily from liver-disease progression and co-morbidities.Conclusion:The combined endoscopic–BRTOcc procedure is a relatively safe and effective technique for bleeding fundal varices,with a high rate of variceal obturation and a low rate of serious adverse events.
文摘Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.
文摘The gas field in the Bohai Bay Basin is a fractured metamorphic buried-hill reservoir with dual-media characteristics. The retrograde vaporization mechanism observed in this type of gas condensate reservoir differs significantly from that observed in sand gas condensate reservoirs. However, studies on improving the recovery of fractured gas condensate reservoirs are limited;thus, the impact of retrograde vaporization on condensate within fractured metamorphic buried-hill reservoirs remains unclear. To address this gap, a series of gas injection experiments are conducted in pressure-volume-temperature(PVT) cells and long-cores to investigate the retrograde vaporization effect of condensate using different gas injection media in fractured gas condensate reservoirs. We analyze the variation in condensate volume, gas-to-oil ratio, and condensate recovery during gas injection and examine the influence of various gas injection media(CO_(2), N_(2), and dry gas) under different reservoir properties and varying gas injection times. The results demonstrate that the exchange of components between injected gas and condensate significantly influences condensate retrograde vaporization in the formation. Compared with dry gas injection and N_(2) injection,CO_(2) injection exhibits a superior retrograde vaporization effect. At a CO_(2) injection volume of 1 PV, the percentage shrinkage volume of condensate is 13.82%. Additionally, at the maximum retrograde condensation pressure, CO_(2) injection can increase the recovery of condensate by 22.4%. However, the condensate recovery is notably lower in fractured gas condensate reservoirs than in homogeneous reservoirs, owing to the creation of dominant gas channeling by fractures, which leads to decreased condensate recovery. Regarding gas injection timing, the effect of gas injection at reservoir pressure on improving condensate recovery is superior to that of gas injection at the maximum retrograde condensation pressure. This research provides valuable guidance for designing gas inj
