European journal of gastroenterology & hepatology
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Eur J Gastroenterol Hepatol · Dec 2007
Review Meta Analysis Comparative StudyDo the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction.
A variety of stent designs has been studied for endoscopic stenting of the bile duct in patients with malignant biliary obstruction. Although metal stents are associated with longer patency, their costs are significantly higher than plastic stents. ⋯ Endoscopic metal stents for malignant biliary obstruction are associated with significantly higher patency rates than plastic stents as early as 4 months after insertion. Metal stents will be cost-effective if the unit cost of additional endoscopic retrograde cholangiopancreatographies per patient exceeds $1820.
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Eur J Gastroenterol Hepatol · Dec 2007
ReviewPrediction of outcome in acute lower gastrointestinal hemorrhage: role of artificial neural network.
Acute lower gastrointestinal hemorrhage (LGIH) has traditionally been defined as bleeding that occurs distal to the ligament of Treitz. More recently, however, it has been subdivided into mid-intestinal (small bowel) hemorrhage and bleeding that originates from the colon. ⋯ Nonetheless, extrapolating from what is known in UGIH, the development of reliable predictive models in LGIH may lead to improved patient care and outcome, by enhancing clinical triage, and by the more cost-effective use of limited healthcare resources. In this review, we discuss the technical development and potential use of artificial neural network in patients presenting with acute LGIH.
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Eur J Gastroenterol Hepatol · Dec 2007
Case ReportsInhaled iloprost for hepatopulmonary syndrome: improvement of hypoxemia.
Hepatopulmonary syndrome is characterized by advanced liver disease, hypoxemia, and intrapulmonary shunting. The only reported curative option is orthotopic liver transplantation. We describe here a beneficial effect of inhaled prostacyclin including a decrease in respiratory symptoms and improved oxygenation in this clinical situation, with no approved pharmacological long-term therapy. ⋯ After liver transplantation, restitution of hepatopulmonary syndrome did not occur immediately. Inhaling iloprost resulted in improved physical condition and better clinical rehabilitation potential until hypoxemia finally resolved 3 months after transplantation. Therefore, iloprost could improve quality of life in patients with hepatopulmonary syndrome waiting for liver transplantation and post surgery until the resolution of the hypoxemia.