Symptoms and General Pathology

All Conditions

Digestive System Diseases

Neoplasms

Rare Diseases

Emergencies

Hemorrhage

Ulcer

Gastrointestinal Hemorrhage

Gastrointestinal Neoplasms

Digestive System Neoplasms

Disease Attributes

Gastrointestinal Diseases

Acute Graft Versus Host Disease

Gianluca Costa, MD, PhD

Gabriella Teresa Capolupo, MD, PhD

Filippo Carannante, MD

Gastrointestinal Emergency Surgery: Evaluation of Morbidity and Mortality

Background: Gastrointestinal emergencies (GE) are frequently encountered in the emergency department (ED), and patients can present with wide-ranging symptoms. Symptoms that suggest an underlying GE can include: abdominal pain; nausea; vomiting; diarrhoea; melaena; haematemesis; constipation; jaundice; and abdominal distension. Abdominal pain is a common ED presentation and can be the cause of a wide variety of GE. The acute abdomen (AB) is a term given to sudden severe pain in the abdomen requiring fast diagnosis and treatment usually requiring emergency surgical procedures. Causes of AB may include: appendicitis; pancreatitis; peptic ulcer disease (PUD); gall bladder pathology; intestinal ischemia; diverticulitis; intestinal obstruction; and ruptured ectopic pregnancy. Emergency gastrointestinal surgery (EGS) is burdened by significant mortality and morbidity rates because it is performed with little to no advance planning or preparation, on patients who are in dire straits. Scott JW et al report that there are more than 3 million patients admitted to US hospitals each year for EGS diagnoses, more than the sum of all new cancer diagnoses. (Scotte JW) In addition to the complexity of the urgent surgical patient (often suffering from multiple co-morbidities), there is the unpredictability and the severity of the event. Frequently, it is necessary rapid decision-making that allows a correct diagnosis and an adequate and timely treatment. (See Ref.) Moreover, another study by Havens JM et al reported that patients undergoing EGS operation are up to 8 times more likely to die postoperatively than are patients undergoing the same procedures electively. Furthermore, the increase in average life will lead more and more people over 65 to face surgical pathologies in an emergency setting, and in the elderly EGS is characterized by greater morbidity and mortality as well as by a global worsening of the residual quality of life (QoL). The explanation for the high percentage of acute complications could be found in the inevitable reduction of the functional reserve related to age. An example is the reduction of the body's immune defenses in the humoral response of B cells, in the cell-mediated immune function and macrophage activity which explains the susceptibility to infectious complications, facilitated by the altered integrity of the skin barrier and mucous membranes too. Is in this setting that tools capable to help the surgeon in the decision-making process in order to reduce mortality and morbidity linked to the EGS could become very useful. To do this, it is necessary to study the greatest number of risk factors associated with EGS, considering all age groups and all types of diseases.

AIM: To analyze the clinicopathological findings, management strategies, and short-term outcomes of gastrointestinal emergency procedures; to evaluate the prognostic role of existing risk-scores; to define the most suitable scoring system or gastro-intestinal surgical emergency; to identify any specific parameters that may be used as variables for a new scoring system, peri-operative variables predicting adverse results and any critical issues in the management of these patients.

STUDY DESIGN: both retrospective and prospective cohort, multicenter, observational, no profit clinical study. All the study participants will collect data on \> 18 y. o. patients underwent general emergency surgery during an 18 month period, guaranteeing whole completeness of the picked data \> 95%. This study was approved by the Health Sciences Research Ethics Board of the University Campus Biomedio of Rome

Mortality and Morbidity in Emergency Gastrointestinal Surgery: Comparison of Different Incidence of Interventions According to the ICD-9-CM Classification in Relation to the Age Groups

any cause of mortality related to surgical procedure

Morbidity defined by mean of the Clavien's Classification scoring system

Calculation and evaluation of its predictive value for morbidity and mortality

Calculation and evaluation of its predictive value for mortality

Calculation and evaluation of its predictive value for post-operative complications

Campus Bio-Medico University

MD, PhD

Infections

Communicable Diseases

Fistula

Intestinal Diseases

Pancreatic Diseases

Bile Duct Diseases

Digestive System Fistula

Pathological Conditions, Anatomical

Biliary Tract Diseases

Coagulants

All Drugs and Chemicals

Anti-Infective Agents

Central Nervous System Depressants

Hemostatics

Ethanol

Procedures that will be captured include:

EUS- ERCP, Endoscopic Hepatology - EUS, EUS-Coils placement, EUS Glue injection, EUS-Fiducial placement, EUS-Neurolysis, EUS-Stent placement, EUS-alcohol injection, EUS-guided Ablation, EUS-guided anastomosis, EUS Guided ERCP for gallbladder, pancreatic duct or biliary duct drainage, EUS guided - Hemostasis, EUS guided- Therapy for cancer or premalignant lesion (Injection, neurolysis, fiducial, aspiration, RFA ), EUS - Fluid Collection, abscess or cavity drainage, EUS - Guided Ductal Drainage, EUS - Guided Anastomosis

Therapeutic Endoscopic Ultrasound or Interventional Endoscopy for Gastrointestinal Indications

Therapeutic Endoscopic Ultrasound

Michel Kahaleh, MD

The purpose of this retrospective chart-review registry study is to evaluate the safety profile, efficacy profile and cost-effectiveness of the various therapeutic endoscopic ultrasound (EUS) procedures (for benign and malignant gastrointestinal disorders).

1. To assess the clinical and technical success rates of EUS-Guided interventions
2. To document the impact of therapeutic EUS procedures on the management of gastrointestinal disorders including malignancies through cost effective analyses.
3. Compare endoscopic interventions to non-endoscopic interventions for the same clinical indications and evaluate safety and efficacy.

Our tertiary-care institution performs clinically-indicated therapeutic Endoscopic Ultrasound (TEUS) guided interventions, including biliary and pancreatic drainage, for both malignant and benign gastrointestinal indications in more than 2000 patients annually.

Procedures such as biliary and/or pancreatic sphincterotomy, stents placement (metallic or plastic) and removal for revision, cysts and pseudocysts drainage are conducted in patients suffering from pancreatico-biliary disorders, gastrointestinal disorders and esophageal disorders.

TEUS procedures are less invasive approach than surgery. Moreover, they can be available to patients who are ineligible for surgery or who have refused more aggressive surgical intervention.

They improve quality of life and extend survival duration.

Currently, there is limited multi-center data on therapeutic endoscopy clinical outcomes and standardized treatment algorithms in western populations. Due to continuing variations in therapeutic EUS procedures, as well as introduction of some TEUS procedure accessories; it is necessary to periodically evaluate the efficacy and safety of specific TEUS procedures and accessories for several indications to check for improved clinical outcomes.

Evaluation of these clinical details would help us compare them to conventional treatment modalities within our current facility and scope of practice; and consequently, help us identify safe and cost-effective treatment techniques, develop treatment algorithms and improve clinical management of patients at RWJMS and other tertiary-care centers.

Therapeutic Endoscopic Ultrasound for Gastrointestinal Disorders: A Multicenter Registry Study

Therapeutic Endoscopic Ultrasound for Gastrointestinal Disorders: A Multicenter Registry

Data will not be made available to other out-of-site researchers

Type, frequency and intensity of adverse events

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Gastrointestinal Emergency Surgery: Evaluation of Morbidity and Mortality	NCT05226221	Gastrointestina... Gastrointestina... Gastrointestina... Gastrointestina... Gastrointestina... Gastrointestina...		18 Years -	Campus Bio-Medico University
Therapeutic Endoscopic Ultrasound for Gastrointestinal Disorders: A Multicenter Registry Study	NCT05051358	Therapeutic End... Advanced Endosc... Therapeutic End... Interventional ... Interventional ... Gastro-Intestin... Gastrointestina... Gastrointestina... Gastrointestina... Gastrointestina... Gastrointestina... Gastrointestina... Pancreatic Dise... Bile Duct Disea...	Therapeutic End...	-	Advanced Endoscopy Research, Robert Wood Johnson Medical School Rutgers University

Spots Global Cancer Trial Database for gastrointestinal injury