Chi-Pin Lin

Endoscopic ligation vs. nadolol in the prevention of first variceal bleeding in patients with cirrhosis

BACKGROUND The value of band ligation for prevention of the first episode of variceal bleeding has not been fully evaluated. This study compared the efficacy and safety of band ligation vs. treatment with a beta-blocker for the prophylactic prevention of first bleeding in patients with cirrhosis and high-risk esophageal varices. METHODS A total of 100 patients with cirrhosis and endoscopically determined high-risk esophageal varices but no history of bleeding were randomized to band ligation (50 patients) or treatment with nadolol (50 patients). In the ligation group, two to 4 elastic bands were deployed during each session. Ligation was repeated at intervals of 3 to 4 weeks until variceal obliteration was achieved. In the nadolol group, the dose of the drug, administered once daily, was sufficient to reduce the pulse rate by 25%. RESULTS In the ligation group, variceal obliteration was achieved in 41 patients (82%), at a mean of 2.7 (1.1) ligation sessions. In the nadolol group, the mean daily dose of nadolol administered was 60 (20) mg. During follow-up (median approximately 22 months), 10 patients (20%) in the ligation group and 16 (32%) in the nadolol group had upper-GI bleeding (p=0.23). Esophageal variceal bleeding occurred in 5 patients (10%) in the ligation group and 9 (18%) in the nadolol group (p=0.31). By multivariate Cox analysis, Child-Pugh class was the only factor predictive of variceal bleeding. Minor complications were noted in 9 patients (18%) in the ligation group and 4 (8%) in the nadolol group (p=0.35). No serious complication was encountered. Twelve patients in the ligation group and 11 in the nadolol group died (p=0.62). One patient in the ligation group and 3 in the nadolol group died from uncontrollable variceal hemorrhage. CONCLUSIONS Variceal ligation is as effective and as safe as treatment with nadolol for prevention of first variceal bleeding in patients with cirrhosis.

Gastrointestinal metastasis in hepatocellular carcinoma: Radiological and endoscopic studies of 11 cases

Background : From October 1990 to January 1999, 11 of 2237 hepatoma patients at our hospital had gastrointestinal tract metastasis. We describe the radiological and endoscopic features, clinical course and prognoses of those patients.

Comparison of clinical, serological and histological findings between non‐ulcer dyspepsia patients with and without Helicobacter pylori infection

Background and Aims: The role of Helicobacter pylori (H. pylori) infection in non‐ulcer dyspepsia (NUD) remains controversial. This study investigates the clinical, serological and histological differences between patients with H. pylori‐positive and ‐negative NUD.

Upper Gastrointestinal Bleeding Caused by Rupture of Aortic Mycotic Aneurysm: Report of a Case

Aortoesophageal fistula is a rare cause of fatal gastrointestinal bleeding. Mycotic aortic aneurysm is the rare cause of aortic aneurysm and frequently had ruptured at surgery. However, mycotic aneurysm eroding into the esophagus and resulting in lethal gastrointestinal bleeding was rarely reported at literature review. We reported an 83 year old housewife experiencing general malaise and anorexia for 2 months. She presented as upper gastrointestinal bleeding at home. She was diagnosed by panendoscopy and computered tomography scan as aortoesophageal fistula caused by mycotic aneurysm and received only medical treatment because poor general condition. She died suddenly several days later despite of resuscitation efforts. The blood culture finally yielded Salmonella enteriditis.

Hepatic Tuberculosis: An Analysis of 11 Cases

Tuberculosis (TB) usually involves the liver in the form of miliary TB as part of generalized miliary TB. Localized liver TB in the form of tumor or abscess is very rare. The aim of this study is to review and analyse the clinical presentation of hepatic TB. Eleven pathologically-proven hepatic TB cases were reviewed at Kaohsiung Veterans General Hospital between the years of 1990 and 1999. Definitive diagnosis was established with the presence of either a caseous necrosis, granuloma, or acid-fast bacillus. The mean age of the patients was 65 years old. Fever was the most common symptom. Elevated alkaline-phosphatase and hypoalbuminemia were the most frequent laboratory findings. Of the 11 cases, eight were found to have diffuse infiltrative lesions of the liver (73%), while three (27%) had lesions that mimicked liver tumor or abscess. Four patients received at least six months of anti-TB medications, and of these, three resulted in complete recoveries. Three patients died of other diseases, and four patients were lost to follow-up. The most common presentation of hepatic TB is in miliary form. Liver biopsy should be carried out in every suspected case to obtain a definitive diagnosis, and prompt anti-TB treatment can be very effective in compliant patients.