Endoscopic biliary sphincterotomy in patients under antithromboembolic therapy.

 Endoscopic sphincterotomy (EST) carries several risks (e. g., pancreatitis and bleeding).

Biliary-Pancreatic Endoscopic and Surgical Procedures in Patients under Dual Antiplatelet Therapy: A Single-Center Study.

Background/aims: Dual antiplatelet therapy has to be used for at least 1 month after placement of bare metal coronary stents and for a minimum of 1 year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines strongly recommend to delay elective surgery until dual antiplatelet therapy is ended. However, no data are available regarding the bleeding risk in patients on combined aspirin/clopidogrel therapy undergoing surgical or high-risk endoscopic procedures.

Risk factors and management of anticoagulant-induced intramural hematoma of the gastrointestinal tract.

Introduction: Intramural intestinal hematoma is considered a rare complication of overanticoagulation in elderly patients. Nevertheless, this clinical entity is increasingly being reported in the literature, and its incidence is predicted to increase further as a result of the wide use of long-term anticoagulation in an aging population. However, data regarding the risk factors and optimal management of this unusual complication in patients on phenprocoumon/warfarin are scarce.

Endoscopic procedures in patients under clopidogrel/dual antiplatelet therapy: to do or not to do?

Background: Dual antiplatelet therapy has to be used for at least one month after placement of bare metal coronary stents and for a minimum of one year after placement of drug eluting stents. Because of the higher risk of bleeding, guidelines recommend cessation of clopidogrel seven days prior to high-risk endoscopic procedures and to delay elective surgery/endoscopy until dual antiplatelet therapy is ended. Premature cessation of clopidogrel however, may lead to catastrophic cardiovascular sequelae.

Risk factors for recurrence of clostridium difficile-associated diarrhoea.

Background/aims: Clostridium difficile associated disease (CDAD) is one of the most common causes of hospital-acquired diarrhea. Despite increasing incidence of clostridium difficile-associated diarrhea, there are few data on risk factors associated with its relapse.

Methodology: We studied retrospectively possible risk factors for the recurrence of CDAD; 124 patients fulfilled the criteria of CDAD during the study period between January 2006 and July 2009.

Fully covered self-expandable metal stents for treatment of malignant and benign biliary strictures.

Aim: To present a series of covered self-expandable metal stents (CSEMS) placed for different indications and to evaluate the effectiveness, complications and extractability of these devices.

Methods: We therefore retrospectively reviewed the courses of patients who received CSEMS due to malignant as well as benign biliary strictures and post-sphincterotomy bleeding in our endoscopic unit between January 2010 and October 2011.

Results: Twenty-six patients received 28 stents due to different indications (20 stents due to malignant biliary strictures, six stents due to benign biliary strictures and two stents due to post-sphincterotomy bleeding).

Detection and management of spontaneous intramural small bowel hematoma secondary to anticoagulant therapy.

Intestinal hematoma, once considered a rare complication of anticoagulation, has recently been increasingly reported. Spontaneous small bowel hematomas most commonly involve the jejunum, followed by the ileum and duodenum. They occur in patients who receive excessive anticoagulation with vitamin K antagonists or who have additional risk factors for bleeding.

Fully Covered Self-Expandable Metal Stents for Treatment of Malignant Biliary Strictures due to Pancreatic Carcinoma.

Background: Transpapillary stents are used to treat malignant biliary strictures. However, there are different stent types and data are controversial in respect to success and complications. Recently, completely covered self-expandable metal stents (CSEMS) have become available.

Fully Covered Self-Expandable Metal Stents for Treatment of Post-Sphincterotomy Bleeding.

Endoscopic biliary sphincterotomy (ES) is the cornerstone of therapeutic endoscopic retrograde cholangiopancreatography (ERCP); however, serious complications are not uncommon. Post-sphincterotomy bleeding is one of the most frequent complications following ES and may occur in up to 10% of the patients. The spectrum of presentation may range from self-limited to severe live threatening hemorrhage.

Fully covered self-expandable metal stents for treatment of both benign and malignant biliary disorders.

Transpapillary stents are increasingly being used for biliary strictures, whether benign or malignant. However, there are different stent types and available data is controversial. Recently, completely covered self-expandable metal stents (CSEMSs) have been proposed as an alternative therapeutic option in different biliary indications, including strictures of the distal bile duct, anastomotic stenosis after orthotopic liver transplantation, bile duct leaks, periampullary perforation following endoscopic sphincterotomy (ES), and postsphincterotomy bleeding.

[Gallstone ileus in underlying stenosis of the sigmoid due to recurrent diverticulitis--a rare complication of cholelithiasis].

Background: Gallstone ileus is a rare complication of cholelithiasis and an uncommon cause of intestinal obstruction. It accounts for about 1-4% of all mechanical bowel obstructions. The clinical symptoms and signs of gallstone ileus are mostly nonspecific.

[Severe microangiopathic hemolytic anemia as first manifestation of a CUP syndrome. Rapid hematologic remission under polychemotherapy].

Background: Microangiopathic hemolytic anemia (MAHA) represents a rare manifestation of malignant tumors. This complication, which is mainly lethal within a few weeks, is most commonly observed in association with mucin-producing adenocarcinomas, especially gastric cancer. The pathogenesis of tumor-associated mechanical hemolysis remains unclear.

[Acute symptomatic hyponatremia in a 70-year-old patient. Insufficient ADH secretion syndrome].

Case Report: A 70-year-old male was admitted to the hospital with anorexia, nausea, headache, and apathy. Serologically remarkable were a severe hyponatremia, serum hypoosmolality and urine hyperosmolality with normal renal function. After excluding adrenal insufficiency, hypothyroidism and other possible causes of hypoosmolar hyponatremia, the diagnosis of a syndrome of inadequate ADH secretion (SIADH) was confirmed through a nonsuppressed ADH level and a rise in of serum sodium after fluid restriction.