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Purpose: To explore the effects of the clinical pathway on the outcomes of patients with non-variceal upper gastrointestinal bleeding.Materials and Methods: Randomized controlled trial. The study was conducted in two medical centers in China from 1 June 2022 to 31 December 2022. Patients with a diagnosis of non-variceal upper gastrointestinal bleeding who provided written informed consent were consecutively assigned to the intervention group. The patients in the intervention group were treated using the clinical pathway, while the control group received routine care and follow-up. Time, cost, complications, and prognostic indicators were analyzed. Intentional-to-treat analysis and per-protocol analysis were used for data analysis.Results: A total of 114 eligible patients with non-variceal upper gastrointestinal bleeding were randomly divided into two groups and included in the intention-to-treat analysis. In addition, 106 patients were included in the per-protocol analysis. The median age of the 106 patients was 57 years (range, 18– 92 years) and 83.0% were male. There were no significant differences between groups regarding the baseline characteristics. The intervention group demonstrated a statistically significantly shorter length of stay, lower hospital cost (ie, cost during hospitalization, cost in the emergency room, and cost in the ward), significantly fewer cases of complications, and a higher level of patient satisfaction when compared with the control group. There was no significant difference between the two groups in the rates of transfusion, repeat endoscopy, rebleeding readmission, and mortality.Conclusion: The implementation of the clinical pathway for patients with non-variceal upper gastrointestinal bleeding may help improve patient outcomes and satisfaction.Trial Registration Number: ChiCTR2200060316.Registration Link: https://www.chictr.org.cn/. [ABSTRACT FROM AUTHOR]

Keywords: endoscopy; gastrostomy; enteral nutrition; indications; complications EN endoscopy gastrostomy enteral nutrition indications complications 733 741 9 05/11/22 20220401 NES 220401 Introduction Compared to parenteral nutrition, enteral nutrition helps to maintain mucosal barrier protection,[1] as well as improve the immunology and nutritional status of patients.[2] Tube feeding can be considered for patients with poor oral intake due to various reasons such as neurological disorders, dysphagia, etc. For patients with advanced tumors or patients who can not receive sufficient oral intake for other reasons, if their nutritional status can be improved by gastrostomy, their quality of life will be greatly improved. A nasogastric tube is mainly used for temporary enteral feeding (< 4 weeks), while various gastrostomy and enterostomy techniques are used for long-term enteral feeding (> 4 weeks).[3] Currently, percutaneous endoscopic gastrostomy (PEG) is the most widely used technique for the establishment of long-term tube feeding access. After stratifying patients with malignant tumors according to their tumor location, it was found that the complication rates of the two groups were similar in patients with head, neck and esophageal cancer (P = 0.648 and P = 0.052). [Extracted from the article]

Purpose: COVID-19 is a new infectious disease with global spread. The aim of the present study was to explore possible risk factors and evaluate prognosis in COVID-19 with liver injury. Methods: A retrospective study was conducted on 356 COVID-19 patients in the Third People's Hospital of Yichang, Hubei, China. Clinical characteristics and laboratory tests between patients with and without liver injury were compared, while risk factors of COVID-19–related liver injury were analyzed. Univariate and multivariate Cox regression analyses were conducted to identify risk factors of in-hospital death. Results: Of the patients with liver injury, severe and critical types of COVID-19 comprised 12.43% and 14.69%, respectively, higher than in patients without liver injury (both P< 0.05). CRP and male sex were independent risk factors for for patients with liver injury, while decreased lymphocyte count (HR 0.024, 95% CI 0.001– 0.821) and elevated monocytes (HR 1.951, 95% CI 1.040– 3.662) and CRP (HR 1.028, 95% CI 1.010– 1.045) were independent risk factors of prognosis of death in COVID-19 patients with liver injury. Conclusion: Liver injury is a common complication in severe COVID-19 patients. Male sex and elevated CRP were independent risk factors in COVID-19 complicated by liver damage. Liver damage with increased CRP and monocyte count and decreased lymphocyte count may imply a poor prognosis. [ABSTRACT FROM AUTHOR]