Tag Archives: Platelet Aggregation Inhibitors

Risk factors for postoperative bleeding and early death in percutaneous endoscopic gastrostomy

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“Gastrostomy is a method of tube feeding for patients incapable of oral intake. Percutaneous endoscopic gastrostomy (PEG) is performed in many hospitals in Japan. However, reports of postoperative bleeding or early postoperative death after PEG are limited.
Compared with nasogastric tube feeding, gastrostomy feeding has a favorable outcome, decreases treatment failure, decreases the frequency of gastrointestinal bleeding, and leads to increased serum albumin levels. However, as PEG is an invasive procedure, adverse events such as bleeding, local infection, peritonitis, and pulmonary aspiration may occur, thus worsening patient prognosis. Aspiration pneumonia has long been recognized as the
most common cause of death after PEG. However, there are no recent large-scale studies investigating the association between postoperative adverse events and early postoperative death in PEG.”

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Treatment methodologies of carotid stenosis

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Bae C, et al. Comparative Review of the Treatment Methodologies of Carotid Stenosis. Int J Angiol. 2015 Sep;24(3):215-22. .

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The treatment of carotid stenosis entails three methodologies, namely, medical management, carotid angioplasty and stenting (CAS), as well as carotid endarterectomy (CEA). The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic Carotid Stenosis Trial (ACST) trials. When CAS is compared with CEA, the CREST resulted in similar rates of ipsilateral stroke and death rates regardless of symptoms. However, CAS not only increased adverse effects in women, it also amplified stroke rates and death in elderly patients compared with CEA. CAS can maximize its utility in treating focal restenosis after CEA and patients with overwhelming cardiac risk or prior neck irradiation. When performing CEA, using a patch was equated to a more durable result than primary closure, whereas eversion technique is a new methodology deserving a spotlight. Comparing the three major treatment strategies of carotid stenosis has intrinsic drawbacks, as most trials are outdated and they vary in their premises, definitions, and study designs. With the newly codified best medical management including antiplatelet therapies with aspirin and clopidogrel, statin, antihypertensive agents, strict diabetes control, smoking cessation, and life style change, the current trials may demonstrate that asymptomatic carotid stenosis is best treated with best medical therapy. The ongoing trials will illuminate and reshape the treatment paradigm for symptomatic and asymptomatic carotid stenosis.

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