Over-the-Scope Clip to the Rescue! A Novel Tool for Refractory Acute Nonvariceal Upper Gastrointestinal Hemorrhage

© 2020 © 2020 The Author(s). Published by S. Karger AG, Basel. Nonvariceal upper gastrointestinal hemorrhage (NVUGIH) is more prevalent than lower gastrointestinal hemorrhage and carries a high risk of mortality in the elderly, especially those with significant cardiovascular comorbidities. Traditional endoscopic methods, such as through-the-scope clips, electrocautery, and epinephrine injection, are frequently used to control these bleeds; however, they carry a 10% risk of rebleeding, and this itself carries a mortality risk of 36%. The larger over-the-scope clips (OTSC) that were initially used for the closure of fistulas and perforations are now gradually being implemented to manage NVUGIH. To our knowledge, we present the first cases to be reported in the literature where OTSC was successfully used as salvage therapy for refractory acute upper gastrointestinal bleeders who failed traditional endoscopic management and interventional radiology-guided embolization of the bleeding artery. We also provide an up-to-date literature review on the use of OTSC and its superiority to traditional endoscopic interventions in the management of complicated NVUGIH

Acute Liver Failure in a COVID-19 Patient Without any Preexisting Liver Disease.

In December 2019, an outbreak of novel coronavirus started in Wuhan, China, which gradually spread to the entire world. The World Health Organization (WHO) on February 11, 2020, officially announced the name for the disease as coronavirus disease 2019, abbreviated as COVID-19. It is caused by severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2). The WHO declared SARS-CoV-2 as a pandemic on March 11, 2020. SARS-CoV-2 mainly causes fever as well as respiratory symptoms such as cough and shortness of breath. Gastrointestinal/hepatic sequelae such as diarrhea, nausea, vomiting, and elevated liver enzymes have been reported as well. Studies and data so far on coronavirus infections from China, Singapore, and other countries showed that liver enzymes elevation could be seen in 20-50% of cases. More severe disease can correlate with the worsening of liver enzymes. However, acute liver failure in patients with COVID-19 has not been described. Herein we report a case of acute liver failure in an elderly patient with COVID-19 infection who did not have a history of preexisting liver disease

A Case of Wernicke\u27s Encephalopathy in a Pregnant Woman With a History of Sleeve Gastrectomy.

Wernicke\u27s encephalopathy (WE) is a neurological complication of thiamine deficiency characterized by a triad of acute confusion, ataxia, and ophthalmoplegia. Even though it is most common in chronic alcoholism, an increase in prevalence has been reported recently due to the increased popularity of bariatric surgeries. WE is a known neurological complication after gastric bypass surgery but rarely reported after sleeve gastrectomy. We present a unique case of WE in pregnant women four months after sleeve gastrectomy

Roth Net-Assisted Endoscopic-Guided Manometry Catheter Placement.

High-resolution esophageal manometry (HRM) has become the gold standard to diagnose esophageal motility disorders. Usually, this procedure is performed by introducing the catheter, which has pressure sensors, into the esophagus and proximal stomach via the nares. Repeated coiling of the catheter and inability to pass through the gastroesophageal junction (GEJ) are common challenges encountered. Endoscopy-guided placement of the catheter can overcome these difficulties. However, sometimes even with the use of endoscopy, it is difficult to advance catheter due to anatomical variants. The extreme fragility of the catheter and sensors and the high cost of this reusable device precludes the use of biopsy forceps or snare to advance the catheter. There is no literature on using accessories during endoscopy in case of difficult placement under direct visualization. We report a unique case of using Roth Net via the suction channel to advance esophageal manometry catheter into the stomach by using endoscopy

Some observations on light fishing off Thiruvananthapuram coast

The artisanal fisheries of the Thiruvananthapuram coast axe of considerable importance in the fisheries of Kerala State due to their significant contributions to the catch of resources like tunas, anchovies, ribbonfish, caranglds, perches and cephalopods

On five whale sharks landed along the Trivandrum-Kanyakumari coast

Five whale sharks Rhiniodon typus Smith, weie landed during April, 1988 at three centres on the southwest coast between St. Andrews in the Trivandrum district of Kerala and Colachel in the Kanyakumari district of Tamil Nadu. The five specimens were landed within 14 days within a coastal stretch of about 70 km caught from less than 15 m depth