xxxxxxxxxxxxxxx Original Article Turk J Gastroenterol 2014; 25 (Suppl.-1):
|
|
|
- Ann Owen
- 7 years ago
- Views:
Transcription
1 Turk J Gastroenterol 014; 5 (Suppl.-1): Diagnosis and of Helicobacter pylori for peptic ulcer bleeding in clinical practice - factors associated with non-diagnosis and non-, and diagnostic yield in various settings xxxxxxxxxxxxxxx Lee Guan Lim, Khek Yu Ho, Jimmy BY So, Christopher JL Khor, Li Lin Lim, Pui Li Teoh, Khay Guan Yeoh Department of Gastroenterology and Hepatology National University Health System, Singapore, Singapore ABSTRACT Background/Aims: To study the practice of clinicians in the diagnosis and of for peptic ulcer bleeding, and the diagnostic yield of tests in various situations. Materials and Methods: All consecutive patients aged 18 years who underwent esophagogastroduodenoscopy for the indications of coffee-grounds vomitus, hematemesis or melena with endoscopically diagnosed peptic ulcers were included. Results: 4 patients were included. testing was performed during acute bleeding for 96 patients. 80% of patients who tested for during the acute episode were planned for repeat testing. 11/88 patients who tested for during the acute episode were for during repeat testing (diagnostic yield 1.5%). Prior proton-pump inhibitor and antibiotic ingestion within 4 weeks of presentation was associated with lower diagnostic yield for. On multivariate analysis, patient s age, systolic blood pressure, heart rate, activated partial thromboplastin time, and need for endoscopic were associated with failure to take biopsies for testing during acute episode. 100/106 patients tested for during the acute episode of gastrointestinal bleeding had. Conclusion: Repeat testing after index testing during acute episodes gave a diagnostic yield of 1.5%, reinforcing the importance of repeat testing. Keywords:, gastrointestinal bleeding, peptic ulcer INTRODUCTION Upper gastrointestinal bleeding is an important cause of mortality worldwide (1-4). Peptic ulcer disease is the most common cause of upper gastrointestinal bleeding (4-5), and a significant proportion of peptic ulcers are caused by Helicobacter pylori () (6). Guidelines recommend the diagnosis and of H. pylori in upper gastrointestinal bleeding secondary to peptic ulcers (-9), but the preferred diagnostic test and the optimal timing of testing (during acute bleeding or after that) is not clear. Diagnostic tests for include rapid urease test, histology and culture which requires endoscopic tissue biopsies, and non-endoscopic methods such as urea breath test, serology and rapid blood tests (10). Culture is usually used to determine the resistance after failure to eradicate. Rapid blood tests have variable accuracy for the diagnosis of, but most kits perform poorly (11). Rapid urease test, histology, urea breath test and serology are more commonly used in the clinical setting. Diagnosis of during the episode of acute bleeding has been reported to be less accurate (1). A recent international consensus recommends caution in the interpretation of initially tests during the acute bleeding episode and the need for repeated testing at follow-up (). Therefore, this might prompt one to question the role of testing in the acute setting, as it appears that performing testing only after the acute episode is a viable option. This international consensus stated that the optimal diagnostic approach remains unclear, but may include acute testing for infection, followed by a confirmatory test outside the acute context of bleeding if the initial results are. This approach has not been previously Address for Correspondence: Khay Guan Yeoh, Department of Gastroenterology and Hepatology National University Health System, Singapore, Singapore khay_guan_yeoh@nuhs.edu.sg Received: June 9, 01 Accepted: August 05, 01 Copyright 014 by The Turkish Society of Gastroenterology Available online at DOI: /tjg
2 Lim et al. Helicobacter pylori in peptic ulcer bleeding Turk J Gastroenterol 014; 5 (Suppl.-1): studied, and there is limited data on the diagnostic yield of repeat testing for after initial tests during the acute episode. The pattern of testing by clinicians managing peptic ulcer bleeding in real-life clinical practice has not been extensively studied. We aim to study the percentage of upper gastrointestinal bleeding secondary to peptic ulcer disease which received diagnosis and of in the real-life setting of a tertiary centre, factors associated with non-diagnosis and non- of, and the diagnostic yield of testing during and after the acute bleeding episode in this real-life setting, as well as during repeat testing after initial tests in the acute testing. MATERIALS AND METHODS Patients Over an 18-month period in a university hospital, all consecutive patients aged at least 18 years who underwent esophagogastroduodenoscopy for the indications of coffee-grounds vomitus, hematemesis or melena and diagnosed endoscopically with peptic ulcers were included. Informed consent was obtained before EGD. All data, such as patient demographic data, indication for EGD, laboratory investigation results, comorbidities, symptoms at presentation, endoscopic findings, test results and, length of hospital stay, need for intervention, and all-cause in-hospital mortality, were prospectively collected and entered into the database by a research assistant (P.L.T.). The research assistant was trained in medical and endoscopic terminology, and given a template of medical information to collect. The study was conducted in a tertiary hospital with a 4-hour endoscopy service for gastrointestinal bleeding. The on-call emergency endoscopy team consisted of a consultant endoscopist, a trainee endoscopist, and a trained endoscopy nurse. All endoscopies were performed with monitoring of vital signs. High-risk lesions with active bleeding or visible vessels were with hemoclips, heater probe, argon plasma coagulation (APC), alone or in combination with adrenaline injection. When hemostasis was not achieved with adrenaline injection plus another method, a third endoscopic modality was added. Histoacryl glue injection was used when standard modalities of hemostasis failed. Blood clots were irrigated and underlying lesions were. Patients for whom endoscopic hemostasis could not be achieved were referred for surgery. Following endoscopy, patients with high-risk endoscopic stigmata (active bleeding or visible vessels) were continued on intravenous infusion of PPIs for hours which was converted to oral PPIs for a total of 8 weeks. Patients with no high risk endoscopic stigmata were with oral PPIs for 8 weeks. All patients with gastric ulcers were scheduled for repeat esophagogastroduodenoscopy to confirm gastric ulcer healing, as per the recommendations by the British Society of Gastroenterology (9). There was no standard protocol for H. pylori testing. Biopsies were taken for rapid urease test or histology during endoscopy if deemed appropriate by the endoscopist, and patients might be sent for urea breath test postendoscopy if deemed appropriate by the physician. Patients who were not tested for during the index endoscopy were planned for testing during follow-up endoscopy to check gastric ulcer healing or scheduled for urea breath test months after the index endoscopy, giving a 4-week PPI-free period after 8 weeks of PPI therapy. Definitions In-hospital all-cause mortality referred to death during the hospital stay from any cause. Weekend was defined as between midnight on Friday and midnight on Sunday, as per the definition of weekend in previous studies (,1-16). A patient was considered to have tested for if he was tested with at least one of the three tests (rapid urease test, histology and/or urea breath test), with at least one result. A patient was considered to have tested for infection if he was tested with at least one of the three tests (rapid urease test, histology and/or urea breath test), with none of the performed test being. A patient was considered to have not been tested for infection if he did not receive any of the tests (rapid urease test, histology and/or urea breath test). Ethics approval We viewed this evaluation as an assessment of service quality rather than research. All patients received current standard of care, without randomization or experimental intervention. All data collected were anonymized. Our Institutional Review Board approved the protocol, and deemed that apart from standard consent for EGD, no additional consent was required. Statistical methods Data were analyzed with SPSS 15.0 (SPSS Inc., Chicago, Illinois, USA). Data are presented as mean values with SDs, unless otherwise stated. Differences in categorical variables were evaluated using Pearson s χ test. Differences in continuous variables were evaluated using Student s t test for independent samples, after verifying homogeneity of variance with Levene s test. Multivariate analysis was performed on variables which were significant on univariate analysis. A p value <0.05 was considered as statistically significant. RESULTS Patients During the study period, 4 patients who presented with coffee-grounds vomitus, hematemesis or melena were diagnosed endoscopically with peptic ulcers. The mean age was years. There were 64 (0.6%) males and 5 (.5%) Chinese. The mean length of stay was days. 0 (5.%) patients were in intensive care unit at the time of endoscopy. 159 patients had at least one significant co-morbidities. All-cause in-hospital mortality was 4.5% (1/4). 0 patients (54.%) 158
3 Turk J Gastroenterol 014; 5 (Suppl.-1): required endoscopic, and 4 patients required surgery. 181 patients (48.4%) had gastric ulcers, 14 (9.%) had duodenal ulcers, 4 (11.%) had gastric and duodenal ulcers, and 4 (1.1%) had anastomotic ulcers. Diagnosis of Helicobacter pylori (Figure 1) testing was performed during the acute episode of gastrointestinal bleeding for 96 patients (9.1%). 16 patients received empirical without getting any diagnostic tests for. The remaining 48 patients who survived were planned for testing after the acute episode. Diagnosis during the acute bleeding episode In total, 96 patients were tested for infection with either rapid urease test, histology or urea breath test during the episode of acute gastrointestinal bleeding. Rapid urease test was done for 9 patients and histology was done was patients. 18 patients had urea breath test. The diagnostic yield for was 5 out of 9 (.1%) for rapid urease tests, 6 out of (8.4%) for histological examinations, and 6 out of 18 (.%) for urea breath tests. In total, 106 patients tested for on at least one of the three tests (rapid urease test, histology and/or urea breath test), and 190 patients tested for infection (none of the performed test was ). Delayed index testing for Of the 6 patients scheduled for delayed testing, 4 patients were planned for testing during follow-up oesophagogastroduodenoscopy for confirmation of gastric ulcer healing, and 15 patients were planned to receive urea breath tests during follow-up outpatient clinic visits. 0 patients defaulted esophagogastroduodenoscopy, with only patients Lim et al. Helicobacter pylori in peptic ulcer bleeding turning up for esophagogastroduodenoscopy, and all were tested with rapid urease test. The diagnostic yield for was out of (5.9%) for rapid urease test. Of the 15 patients planned for urea breath tests, only patients (46.%) did the tests, with a diagnostic yield for of 4.8% ( out of ). When the patients who defaulted were included, the intentionto diagnose diagnostic yield was 14.9% (/4) for rapid urease test and 0% (/15) for urea breath test. Repeat testing after initial tests Of the 190 patients who tested for during the acute episode, 4 patients received empirical eradication. 8 out of the remaining 156 patients had repeat esophagogastroduodenoscopy, with 6 patients getting repeat H.pylori testing, of whom 9 tested for (5 on rapid urease tests, on histology, and on both rapid urease test and histology). 0 out of these 8 patients who had oesophagogastroduodenoscopy did not have biopsies taken for repeat testing. 4 of the 69 patients who did not have repeat esophagogastroduodenoscopy were sent for urea breath test, with testing and testing for. Overall, 11 patients out of 1 patients tested on during delayed testing although they tested during the acute episode, giving a diagnostic yield of 15.5%. Factors associated with failure to take biopsies during index esophagogastroduodenoscopy 8 patients (5.%) had biopsies taken during endoscopy for rapid urease test and/or histology. On univariate analysis, factors associated with failure to take biopsies for testing included patient s age, systolic blood pressure, heart rate, intensive care unit at time of endoscopy, presentation on a week- 4 patients included tested during acute episode 96 not tested during acute episode 8 40 GU and GUDU Treated DU Not 6 No 4 5 Empiric 4 Repeat Not 15 done 4 Died Planned Not for Planned 6 for 0 done Planned for repeat Planned for delayed 10 done 4 Empiric 16 Died 14 8 Figure 1. Flow chart showing the diagnosis and of in our study cohort. 159
4 Lim et al. Helicobacter pylori in peptic ulcer bleeding Turk J Gastroenterol 014; 5 (Suppl.-1): end, haemoglobin, prothrombin time, activated partial thromboplastin time, and need for endoscopic (Table 1). On multivariate analysis, patient s age, systolic blood pressure, heart rate, activated partial thromboplastin time, and need for endoscopic were associated with failure to take biopsies for testing (Table ). Treatment of Of the 106 patients tested for during the acute episode of gastrointestinal bleeding, 100 patients (94.%) were given eradication therapy for, of whom 68 patients had subsequent confirmation of successful eradication, patients failed eradication, and 5 patients defaulted testing to confirm eradication. Six patients who were tested for during the acute episode did not get because they were lost to follow-up after the histology came back for infection. 4 out of 190 patients (1.9%) who Table 1. Univariate analysis of factors associated with endoscopic biopsies not being taken for testing during the acute episode Biopsy No biopsy taken for taken for p testing testing value Age (years) 6.1± ± Intensive care unit (%) Weekend presentation (%) Systolic blood 1.0± ±0.5 <0.001 pressure (mmhg) Heart rate (/min) 81.± ±16.9 <0.001 Hemoglobin (g/dl) 9.9± ± Platelet 9.0± ± Prothrombin time (sec) 15.0±4.0 1.± Activated partial 9.9±5.9.8±8.0 <0.001 thromboplastin time (sec) Need for endoscopic <0.001 (%) Table. Multivariate analysis of factors associated with endoscopic biopsies not being taken for testing during the acute episode Odds ratio p value 95% CI Age (years) Intensive care unit (%) Weekend presentation (%) Systolic blood pressure (mmhg) Heart rate (/min) Hemoglobin (g/dl) Prothrombin time (sec) Activated partial thromboplastin time (sec) Need for endoscopic (%) tested for infection and 16 out of 8 patients (0.5%) who were not tested for infection were given empirical for. DISCUSSION In our study, all patients were tested for during the acute episode, scheduled for delayed testing, or empirically for without prior testing. All patients who were tested for received eradication therapy except for 5% who defaulted follow-up after histology showed infection. These were consistent with the current recommendations. However, only 58% of the patients who tested for during the acute bleeding episode received repeat testing, which was suboptimal as a recent international consensus recommended repeat testing if the initial tests were []. This recommendation was based on the variable evidence showing the poor predictive value of testing in the setting of acute bleeding. The poor rate of repeat testing was due to defaulters and to endoscopists not taking biopsies for repeat testing during repeat endoscopy. In our cohort, 15.5% of patients were subsequently diagnosed with infection despite prior tests during the acute episode. Clinicians should be made aware of the benefits of repeat testing after the acute episode in order to increase the rate of repeat testing. In our cohort, all patients with gastric ulcers were scheduled for repeat oesophagogastroduodenoscopy after the acute episode. This was in accordance with the British Society of Gastroenterology guidelines (9). There was no such recommendation for duodenal ulcers, although selected patients with refractory symptoms despite might need repeat endoscopy, as pancreatic malignancies had been reported to present as duodenal ulcers (1). Repeat endoscopy provided an opportunity to check for ulcer healing, biopsy non-healing ulcers, and repeat testing for. However, almost half of our patients did not return for repeat endoscopy. Similarly, half of the patients who were scheduled for urea breath test did not turn up. This might be because most patients felt better symptomatically after and did not see a need for another endoscopy or a urea breath test. In addition, our local medical system requires patients to pay for the oesophagogastroduodenoscopy or urea breath test themselves, as these are not funded by the state, adding further disincentives for getting delayed or repeat testing. This highlighted the importance of informing and educating patients regarding the repeat endoscopy and urea breath test. This study describes real life clinical setting, and the tests for are therefore not standardized, as is the case in most centres. Although this is a limitation of the study, it is provides an opportunity to study the situation as it is in clinical practice, in particular the compliance to testing and. Although index endoscopy provided an excellent opportunity for testing, only 80% of our cohort was tested for 160
5 Turk J Gastroenterol 014; 5 (Suppl.-1): during index endoscopy. On multivariate analysis, patient s age, systolic blood pressure, heart rate, activated partial thromboplastin time, and need for endoscopic were associated with failure to take biopsies for testing. Severe coagulopathy is a contraindication to obtaining tissue biopsies. However, in the absence of bleeding tendencies, ulcers which need endoscopic do not preclude biopsy for histology or rapid urease test if the gastric mucosa away from the ulcer is biopsied. Given the possibility of loss to follow-up for another chance at testing, endoscopists should take biopsies for testing during index endoscopy whenever possible. The large majority of patients either got tested for during acute gastrointestinal bleeding or were scheduled for delayed testing. However, 40% of patients initially tested for did not receive repeat testing. 16% of patients who tested initially during the acute episode subsequently tested, reinforcing the importance of repeat testing in this group. A significant proportion of patients defaulted delayed or repeat testing, which support the algorithm of testing for during the acute setting whenever possible, as well as repeat or delayed testing for patients who complies with follow-up. Conflict of Interest: No conflict of interest was declared by the authors.. REFERENCES 1. Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit. Gut 010; 59: Targownik LE, Nabalamba A. Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: Clin Gastroenterol Hepatol 006; 4: Lim LG, Ho KY, Chan YH, Teoh PL, Khor C, Rajnakova A, et al. Urgent endoscopy is associated with lower mortality in high-risk but not low-risk non-variceal upper gastrointestinal bleeding. Endoscopy 011; 4: van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, et al. Acute upper GI bleeding: did anything change? Lim et al. Helicobacter pylori in peptic ulcer bleeding Time trend analysis of incidence and outcome of acute upper GI bleeding between 199/1994 and 000. Am J Gastroenterol 00; 98: Enestvedt BK, Gralnek IM, Mattek N, et al. An evaluation of endoscopic indications and findings related to nonvariceal upper-gi hemorrhage in a large multicenter consortium. Gastrointest Endosc 008; 6: de Vries AC, Kuipers EJ. Helicobacter pylori infection and nonmalignant diseases. Helicobacter 010; 15 Suppl 1:9-.. Barkun AN, Bardou M, Kuipers EJ, at al; International consensus upper gastrointestinal bleeding conference group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 010; 15: Adler DG, Leighton JA, Davila RE, et al. ASGE guideline: The role of endoscopy in acute non-variceal upper-gi hemorrhage. Gastrointest Endosc 004; 60: British Society of Gastroenterology Endoscopy Committee. Nonvariceal upper gastrointestinal haemorrhage: guidelines. Gut 00; 51 Suppl 4:iv Calvet X, Lehours P, Lario S, Mégraud F. Diagnosis of Helicobacter pylori infection. Helicobacter 010 Sep;15 Suppl 1: Lim LG, Yeoh KG, Ho B, Lim SG. Validation of four Helicobacter pylori rapid blood tests in a multi-ethnic Asian population. World J Gastroenterol 005; 11: Gisbert JP, Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: a systematic review and meta-analysis. Am J Gastroenterol 006; 101: Ananthakrishnan AN, McGinley EL, Saeian K. Outcomes of weekend admissions for upper gastrointestinal hemorrhage: a nationwide analysis. Clin Gastroenterol Hepatol 009; : Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 001; 45: Kostis WJ, Demissie K, Marcella SW, et al. Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med 00; 56: Saposnik G, Baibergenova A, Bayer N, et al. Weekends: a dangerous time for having a stroke? Stroke 00; 8: Lim LG, Yeoh KG, Wai CT. Metastatic pancreatic cancer presenting as a bleeding duodenal ulcer 0 months after initial diagnosis of duodenal ulcer. Should duodenal ulcers be biopsied or followed up with repeat endoscopy? Acta Gastroenterol Belg 008; 1:
American Journal of Gastroenterology ISSN 0002-9270
American Journal of Gastroenterology ISSN 0002-9270 C 2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00399.x Published by Blackwell Publishing Role of Intravenous Omeprazole in Patients
Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial
Combined epinephrine and bipolar probe coagulation vs. bipolar probe coagulation alone for bleeding peptic ulcer: a randomized, controlled trial Maria Antonia Bianco, MD, Gianluca Rotondano, MD, Riccardo
GI Bleed. Steven Lichtenstein, D.O. Chief, Division of Gastroenterology Mercy Health System. Director, Endoscopy/GI Lab Mercy Fitzgerald Hospital
October 3, 2015 GI Bleed Steven Lichtenstein, D.O. Chief, Division of Gastroenterology Mercy Health System Director, Endoscopy/GI Lab Mercy Fitzgerald Hospital Clinical Associate Professor of Medicine
British Society of Gastroenterology. St. Elsewhere's NHS Foundation Trust. National Comparative Audit of Blood Transfusion
British Society of Gastroenterology UK Com parat ive Audit of Upper Gast roint est inal Bleeding and t he Use of Blood December 2007 St. Elsewhere's NHS Foundation Trust National Comparative Audit of Blood
Optimal injection volume of epinephrine for endoscopic treatment of peptic ulcer bleeding
PO Box 2345, Beijing 100023, China World J Gastroenterol 2006 May 21; 12(19): 3108-3113 World Journal of Gastroenterology ISSN 1007-9327 wjg@wjgnet.com 2006 The WJG Press. All rights reserved. RAPID COMMUNICATION
Endoscopic Treatment of Bleeding Peptic Ulcers Panagiotis Katsinelos, MD, PhD
Endoscopic Treatment of Bleeding Peptic Ulcers Panagiotis Katsinelos, MD, PhD Department of Endoscopy and Motility Unit G. Gennimatas General Hospital of Thessaloniki Endoscopic diagnosis for UGI bleeding
Rob Enns University of British Columbia, Vancouver. Grigorios Leontiadis McMaster University, Hamilton
Rob Enns University of British Columbia, Vancouver Grigorios Leontiadis McMaster University, Hamilton Accreditation This event has been approved as an accredited (Section1) group learning activity as defined
Gastrointestinal bleeding: the management of acute upper gastrointestinal bleeding
Gastrointestinal bleeding: the management of acute upper gastrointestinal bleeding NICE guideline Draft for consultation, December 2011 If you wish to comment on this version of the guideline, please be
Cost-Saving Approach to Patients on Long-Term Anticoagulation Who Need Endoscopy: A Decision Analysis
THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 98, No. 8, 2003 2003 by Am. Coll. of Gastroenterology ISSN 0002-9270/03/$30.00 Published by Elsevier Inc. doi:10.1016/s0002-9270(03)00445-3 Cost-Saving Approach
New Anticoagulants and GI bleeding
New Anticoagulants and GI bleeding DR DANNY MYERS MD FRCP(C) CLINICAL ASSISTANT PROFESSOR OF MEDICINE, UBC Conflicts of Interest None I am unbiased in the use of NOAC s vs Warfarin based on risk benefit
What is Barrett s esophagus? How does Barrett s esophagus develop?
Barrett s Esophagus What is Barrett s esophagus? Barrett s esophagus is a pre-cancerous condition affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth
Captivator EMR Device
Device Clinical Article and Abstract Summary Endoscopic Mucosal Bergman et al: EMR Training Tips Bergman et al: EMR Learning Curve ASGE: EMR & ESD Guidelines Bergman et al: Captivator EMR vs Cook Duette
Approved: Acute Stroke Ready Hospital Advanced Certification Program
Approved: Acute Stroke Ready Hospital Advanced Certification Program The Joint Commission recently developed a new Disease- Specific Care Advanced Certification program for Acute Stroke Ready Hospitals
Peptic Ulcer. Anatomy The stomach is a hollow organ. It is located in the upper abdomen, under the ribs.
Peptic Ulcer Introduction A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. Peptic ulcers may also develop in the esophagus. Nearly
Management by the intensivist of gastrointestinal bleeding in adults and children
Osman et al. Annals of Intensive Care 2012, 2:46 REVIEW Open Access Management by the intensivist of gastrointestinal bleeding in adults and children David Osman 1*, Michel Djibré 2, Daniel Da Silva 3,
AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005
AORTOENTERIC FISTULA Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA diagnosis and management Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Aortoenteric
Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose
Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology
Determination of Clinical Decision Rules and Risk Stratification of Patients Admitted with Acute Lower Gastrointestinal Hemorrhage
Determination of Clinical Decision Rules and Risk Stratification of Patients Admitted with Acute Lower Gastrointestinal Hemorrhage Brian P. Bosworth A. Outcomes in Lower Gastrointestinal Bleeding Acute
ESCMID Online Lecture Library. by author
Do statins improve outcomes of patients with sepsis and pneumonia? Jordi Carratalà Department of Infectious Diseases Statins for sepsis & community-acquired pneumonia Sepsis and CAP are major healthcare
How to Effectively Code for Endoscopic Procedures in Gastroenterology
How to Effectively Code for Endoscopic Procedures in Gastroenterology Ariwan Rakvit, MD Associate Professor Interim Chief, Division of Gastroenterology Texas Tech University Health Science Center All rights
The digestive system. Medicine and technology. Normal structure and function Diagnostic methods Example diseases and therapies
The digestive system Medicine and technology Normal structure and function Diagnostic methods Example diseases and therapies The digestive system An overview (1) Oesophagus Liver (hepar) Biliary system
If several different trials are mentioned in one publication, the data of each should be extracted in a separate data extraction form.
General Remarks This template of a data extraction form is intended to help you to start developing your own data extraction form, it certainly has to be adapted to your specific question. Delete unnecessary
By Anne C. Travis, M.D., M.Sc. and John R. Saltzman, M.D., FACG Brigham and Women's Hospital Harvard Medical School Boston, MA
SMALL BOWEL BLEEDING: CAUSES, DIAGNOSIS AND TREATMENT By Anne C. Travis, M.D., M.Sc. and John R. Saltzman, M.D., FACG Brigham and Women's Hospital Harvard Medical School Boston, MA 1. What is the small
SIGN. Management of acute upper and lower gastrointestinal bleeding. September 2008. A national clinical guideline
SIGN Scottish Intercollegiate Guidelines Network Help us to improve SIGN guidelines - click here to complete our survey 105 Management of acute upper and lower gastrointestinal bleeding A national clinical
What is Helicobacter pylori? hat problems can H. pylori cause? Does H. pylori cause cancer? ight H. pylori even be good for us?
In association with: Primary Care Society for Gastroenterology INFORMATION ABOUT Helicobacter pylori? What is Helicobacter pylori? hat problems can H. pylori cause? Does H. pylori cause cancer? ight H.
After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH
After the Cure: Long-Term Management of HCV Liver Disease Norah A. Terrault, MD, MPH Professor of Medicine Department of Gastroenterology Director, Viral Hepatitis Center University of California San Francisco
Prognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
Drug treatments in upper gastrointestinal bleeding: value of endoscopic findings as surrogate end points
372 Gut 2001;49:372 379 Drug treatments in upper gastrointestinal bleeding: value of endoscopic findings as surrogate end points G M Hawkey, A T Cole, A S McIntyre, R G Long, C J Hawkey Division of Gastroenterology,
Epi procolon The Blood Test for Colorectal Cancer Screening
Epi procolon The Blood Test for Colorectal Cancer Screening Epi procolon is an approved blood test for colorectal cancer screening. The US Preventive Services Task Force, the American Cancer Society and
Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute
Dual Antiplatelet Therapy Stephen Monroe, MD FACC Chattanooga Heart Institute Scope of Talk Identify the antiplatelet drugs and their mechanisms of action Review dual antiplatelet therapy in: The medical
ORIGINAL ARTICLE: Clinical Endoscopy
ORIGINAL ARTICLE: Clinical Endoscopy Immediate unprepared hydroflush colonoscopy for severe lower GI bleeding: a feasibility study Aparna Repaka, MD, Matthew R. Atkinson, MD, Ashley L. Faulx, MD, Gerard
What are peptic ulcers?
Information about Peptic ulcers www.corecharity.org.uk What are the symptoms? What are the causes? What are peptic ulcers? When should I consult a doctor? What will the doctor do? How should I treat peptic
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,
A list of FDA-approved testosterone products can be found by searching for testosterone at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.
FDA Drug Safety Communication: FDA cautions about using testosterone products for low testosterone due to aging; requires labeling change to inform of possible increased risk of heart attack and stroke
Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009
Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy M. Arvanitakis SRBG June 2009 Outline Antibiotic prophylaxis during endoscopy Upper GI endoscopy Lower
What can I eat? Peptic ulcers. What are peptic ulcers? What tests are needed? Will the ulcer come back? What causes a peptic ulcer?
In association with: INFORMATION ABOUT Peptic ulcers www.corecharity.org.uk What are peptic ulcers? What causes a peptic ulcer? How are NSAIDs and aspirin involved? How do I know if I ve got an ulcer?
Antimicrobial Stewardship for Hospital Acquired Infection Prevention: Focus on C. difficile infection
Antimicrobial Stewardship for Hospital Acquired Infection Prevention: Focus on C. difficile infection Emi Minejima, PharmD Assistant Professor of Clinical Pharmacy USC School of Pharmacy minejima@usc.edu
A rapid-release 50-mg tablet-based 13 C-urea breath test for the diagnosis of Helicobacter pylori infection
Aliment Pharmacol Ther 2003; 17: 253 257. doi: 10.1046/j.0269-2813.2003.01417.x A rapid-release 50-mg tablet-based 13 C-urea breath test for the diagnosis of Helicobacter pylori infection W.M.WONG*,S.K.LAM*,K.C.LAI*,K.M.CHU,
Management and Prevention of Upper GI Bleeding
Management and Prevention of Upper GI Bleeding By Jiwon Kim, Pharm.D., BCPS, FCSHP Reviewed by Clarence Chant, Pharm.D., FCSHP, FCCP, BCPS; and Steven E. Pass, Pharm.D., FCCP, FCCM, BCPS Learning Objectives
Evolution of Barrett s esophagus
Endoscopic Treatment and Surveillance of Esophageal Cancer: GI Perspective Charles J. Lightdale, MD Columbia University New York, NY Evolution of Barrett s esophagus Squamous esophagus Chronic inflammation
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT
THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological
New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis
New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET Departments of Gastroenterology and Hepatology,
OFFICE OF THE STATE CORONER FINDINGS OF INVESTIGATION
OFFICE OF THE STATE CORONER FINDINGS OF INVESTIGATION CITATION: TITLE OF COURT: JURISDICTION: Non-inquest findings into the death of Mr B Coroner s Court Brisbane DATE: 29 February 2016 FILE NO(s): 2015/1036
Clinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results
Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and
Gloucestershire Hospitals
TRUST GUIDELINE In the case of hard copies of this policy the content can only be assured to be accurate on the date of issue marked on the document. The Policy framework requires that the policy is fully
Colonoscopy Data Collection Form
Identifier: Sociodemographic Information Type: Zip Code: Gender: Height: (inches) Race: Ethnicity Inpatient Outpatient Male Female Birth Date: Weight: (pounds) American Indian (Native American) or Alaska
Is H. pylori infection...
Is H. pylori infection... the culprit behind your stomach symptoms? What s really going on in your stomach? You may often have stomach symptoms that you blame on certain foods or stress. You may take over-the-counter
Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment
Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Donna Zazworsky, RN, MS, CCM, FAAN Vice President: Community Health and Continuum Care Carondelet Health
Service Specification Template Department of Health, updated June 2015
Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st
Guidelines for diagnosis and management of acute pulmonary embolism
Guidelines for diagnosis and management of acute pulmonary embolism By Dr. Ahmed Zaghloul M.D. Anesthesia & Critical Care 2014 Predisposing factors for VTE Predisposing factor Strong predisposing factors
The Official Guidelines for coding and reporting using ICD-9-CM
Reporting Accurate Codes In the Era of Recovery Audit Contractor Reviews Sue Roehl, RHIT, CCS The Official Guidelines for coding and reporting using ICD-9-CM A set of rules that have been developed to
National Digestive Diseases Information Clearinghouse
Gastritis National Digestive Diseases Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What is gastritis? Gastritis is a condition in which the stomach
The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery
Program Overview The University of Hong Kong Department of Surgery Division of Esophageal and Upper Gastrointestinal Surgery Weight Control and Metabolic Surgery Program The Weight Control and Metabolic
Inhibit terminal acid secretion from parietal cells by blocking H + /K + - ATPase pump
Chris J. Taylor, Pharm.D., BCPS Clinical Pharmacist Phoenix VA Health Care System Review pharmacology of PPIs Discuss possible association between PPI use and development of the following: Pneumonia (community-acquired
Gastrointestinal (GI) bleeding
Gastrointestinal (GI) bleeding Somchai Leelakusolvong, M.D. Div of Gastroenterology, Dept of Medicine, Siriraj Endoscopy Center e-mail address: srsll@mahidol.ac.th 07-07-2010 RCPT อ ตรด ตถ GI Bleeding
National Patient Safety Goals Effective January 1, 2015
National Patient Safety Goals Goal 1 Nursing are enter ccreditation Program Improve the accuracy of patient and resident identification. NPSG.01.01.01 Use at least two patient or resident identifiers when
Rebleeding and survival after acute lower gastrointestinal bleeding
The American Journal of Surgery 188 (2004) 485 490 Scientific paper Rebleeding and survival after acute lower gastrointestinal bleeding Thomas Anthony, M.D.*, Pradeep Penta, B.S., Robert D. Todd, B.S.,
DVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D.
Early Colonoscopy in Patients with Acute Diverticulitis Simon Bar-Meir, M.D. Professor of Medicine Germanis Kaufman Chair of Gastroenterology Director, Dept. of Gastroenterology Chaim Sheba Medical Center,
STROKE April 2011 Dr Amer Jafar A delay in recognizing early warning signs (WS) and risk factors (RF) of ischemic stroke causes a delay in treatment Evaluated: knowledge of RF and WS and the impact of
CREDENTIALING FOR GASTROINTESTINAL ENDOSCOPY
CREDENTIALING FOR GASTROINTESTINAL ENDOSCOPY A reference document for credentialing committees and physicians seeking hospital privileges to perform gastrointestinal endoscopy Produced in collaboration
You have been advised by your GP or hospital doctor to have an investigation known as a Gastroscopy.
Gastroscopy (OGD) The Procedure Explained You have been advised by your GP or hospital doctor to have an investigation known as a Gastroscopy. This procedure requires your formal consent. If you are unable
A. Ketorolac*** B. Naproxen C. Ibuprofen D. Celecoxib
1. A man, 66 years of age, with a history of knee osteoarthritis (OA) is experiencing increasing pain at rest and with physical activity. He also has a history of depression and coronary artery disease.
Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines)
Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Authors: Dr. M. Love, Kathy Harrigan Reviewers:
Gruppo di lavoro: Malattie Tromboemboliche
Gruppo di lavoro: Malattie Tromboemboliche 2381 Soluble Recombinant Thrombomodulin Ameliorates Hematological Malignancy-Induced Disseminated Intravascular Coagulation More Promptly Than Conventional Anticoagulant
The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass
ORIGINAL ARTICLE Annals of Gastroenterology (2015) 28, 1-6 The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass Katherine Arndtz a, Helen Steed b, James Hodson
STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE
STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,
The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS)
RESEARCH Original article... Q The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS) Lathy Prabhakaran*, Wai Yan Chee*, Kia Chong Chua,
National Patient Safety Goals Effective January 1, 2015
National Patient Safety Goals Effective January 1, 2015 Goal 1 Improve the accuracy of resident identification. NPSG.01.01.01 Long Term are ccreditation Program Medicare/Medicaid ertification-based Option
PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators
Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf
Post-DDW OAG Course - Therapeutic Endoscopy
Post-DDW OAG Course - Therapeutic Endoscopy June 13, 2015 Jeffrey Mosko Division of Gastroenterology St. Michael's Hospital University of Toronto moskoj@smh.ca Program Name: Post-DDW OAG course CanMEDS
Endoscopy is an important diagnostic and therapeutic
ORIGINAL ARTICLE Appropriateness and Diagnostic Yield of Colonoscopy in the Management of Patients with Ulcerative Colitis: A Prospective Study in an Open Access Endoscopy Service Gianpiero Manes, MD,
Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital
Mahidol University Journal of Pharmaceutical Sciences 008; 35(14): 81. Original Article Outcome of Drug Counseling of Outpatients in Chronic Obstructive Pulmonary Disease Clinic at Thawangpha Hospital
Summary and general discussion
Chapter 7 Summary and general discussion Summary and general discussion In this thesis, treatment of vitamin K antagonist-associated bleed with prothrombin complex concentrate was addressed. In this we
This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the clinical
DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
Gastrointestinal bleeding
Gastrointestinal bleeding..is the reason in 2 % of all admissions to hospital 85.000 cases/year in the US. The incidence of urgent upper GI bleeding: 145/100.000 inhabitant/year in Hungary ( Nagy Gy. MBA
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
(ASGE 617b) Is There a Subgroup of Patients With Forrest Ib (Oozing) Peptic Ulcer Bleeding at Increased Risk of Rebleeding?
(ASGE 617b) Is There a Subgroup of Patients With Forrest Ib (Oozing) Peptic Ulcer Bleeding at Increased Risk of Rebleeding? Dennis M. Jensen 1, Robert Stuart 2, Henrik Ahlbom 3, Stefan Eklund 3, Alan Barkun
Guide to Biostatistics
MedPage Tools Guide to Biostatistics Study Designs Here is a compilation of important epidemiologic and common biostatistical terms used in medical research. You can use it as a reference guide when reading
East Midlands Cancer Clinical Network Improving Lung Cancer Outcomes. Dr Paul Beckett Royal Derby Hospital
East Midlands Cancer Clinical Network Improving Lung Cancer Outcomes Dr Paul Beckett Royal Derby Hospital Number of resections Five year net survival Background to the Workshop Survival for lung cancer
Learning Luncheon 7: Endoscopic Mucosal Resection: When, Where and How?
Endoscopic Mucosal Resection (EMR): When, Where, and Charles J. Lightdale, MD Columbia University New York, NY Endoscopic Mucosal Resection (EMR) EMR developed for removal of sessile or flat neoplasms
American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection
American Journal of Gastroenterology ISSN 0002-9270 C 2007 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2007.01393.x Published by Blackwell Publishing American College of Gastroenterology
Why and how to have end-of-life discussions with your patients:
Why and how to have end-of-life discussions with your patients: A guide with a suggested script and some basic questions to use The medical literature consistently shows that physicians can enhance end-of-life
Aktuelle Literatur aus der Notfallmedizin
05.02.2014 Aktuelle Literatur aus der Notfallmedizin prä- und innerklinisch Aktuelle Publikationen aus 2012 / 2013 PubMed hits zu emergency medicine 12,599 Abstract OBJECTIVES: Current American Heart
XIV ANNUAL MEETING OF NURSING
Archive of Oncology 2000;8(Suppl 1):69. SESSION 5 XIV ANNUAL MEETING OF NURSING 69 Archive of Oncology 2000;8(Suppl 1):70. 70 UDC: 616.34-007.272:616-089.8:614.39 I. GAJI M. ULAFI Æ. MIHAJLOVI R. NE I
Management of the new antiplatelets and anticoagulants
Management of the new antiplatelets and anticoagulants Session No.: 1 Name: C. Boustiere, T Ponchon Guidelines : Anti-thrombotic agents and digestive endoscopy 2006 : French guideline (SFED) 2007 : Japanese
St Lucia Diabetes and Hypertension Screening and Disease Management Programs
St Lucia Diabetes and Hypertension Screening and Disease Management Programs Michael Graven, MD, MSc,, MPH, FAAP Health Informatics and Neonatal Pediatrics Dalhousie University Halifax, Nova Scotia CANADA
Treating delayed endoscopic sphincterotomy-induced bleeding: Epinephrine injection with or without thermotherapy
Online Submissions: wjg.wjgnet.com World J Gastroenterol 2009 October 14; 15(38): 4823-4828 wjg@wjgnet.com World Journal of Gastroenterology ISSN 1007-9327 doi:10.3748/wjg.15.4823 2009 The WJG Press and
Gastrointestinal Bleeding
Gastrointestinal Bleeding Introduction Gastrointestinal bleeding is a symptom of many diseases rather than a disease itself. A number of different conditions can cause gastrointestinal bleeding. Some causes
Peptic ulcers are a common cause of nonvariceal upper
original article ractices in peptic ulcer bleeding controversies among university- versus nonuniversity-affiliated gastroenterologists Justin Cheung MD FRCC 1, Grant Sawisky MD 2, Robert Enns MD FRCC 3,
HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below
Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications
ACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014
ACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014 Thromboembolism epidemiology 5 million DVT s 900,000 PE s 290,000 fatalities Heit J. Blood. 2005;106:910. 10 VTE events Since this talk began DVT
4/24/2015. Urgent, STAT, Super STAT, ASAP! Achieving timely lab testing for the Emergency Department. Learning Objectives.
Urgent, STAT, Super STAT, ASAP! Achieving timely lab testing for the Emergency Department Nichole Korpi-Steiner, PhD, DABCC, FACB University of North Carolina Chapel Hill, NC Learning Objectives Describe
Appendix G - Identification and Selection of Studies
FINAL Emergency framework for rationing of blood for massively bleeding patients during a red phase of a Appendix G - Identification and Selection of Studies Inclusion/Exclusion Criteria We included studies
Gastroscopy the procedure explained
Gastroscopy the procedure explained Exceptional healthcare, personally delivered Introduction You have been advised by your GP or hospital doctor to have an investigation known as a gastroscopy (OGD).
HemoClip: Guidelines & Atlas
HemoClip: Guidelines & Atlas Cases presented by: Dennis M. Jensen, MD, CURE DDRC, UCLA & VA Medical Centers, and David Geffen School of Medicine at UCLA 1 Epi Injection and Hemoclipping of Chronic Gastric
Improving Appropriate Use of Proton Pump Inhibitors as Gastrointestinal Prophylaxis in the Hospital Setting
Improving Appropriate Use of Proton Pump Inhibitors as Gastrointestinal Prophylaxis in the Hospital Setting DATE Educating for Quality Improvement & Patient Safety 1 The Team Division CS&E Participants
How to treat early gastric cancer. Surgery
How to treat early gastric cancer Surgery Mark I. van Berge Henegouwen Department of Surgery, AMC, Amsterdam Director upper GI surgical unit Academic Medical Center Upper GI surgery at AMC 100 oesophagectomies