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Background/aims: Endoscopic variceal ligation (EVL) is an established treatment for esophageal variceal bleeding. Midazolam (MDZ) is most commonly used for sedation during endoscopic procedures. However, adverse events (AEs) may occur more frequently in patients with cirrhosis due to altered MDZ metabolism., Materials and Methods: We retrospectively reviewed the records of 325 patients with cirrhosis who received EVL., Results: No significant differences were found in treatment outcome and procedure time among 151 patients in the MDZ group and 169 patients in the non-MDZ group. Desaturation (23.2% vs. 7.7%, p<0.01), bradycardia (22.5% vs. 17.2%, p=0.03), and hepatic encephalopathy (HE) (6.6% vs. 0.6%, p<0.01) were more common in the MDZ group than in the non-MDZ group. Logistic regression analyses revealed that an Eastern Cooperative Oncology Group (ECOG) score of ≥2 (p<0.01) and the use of MDZ (p<0.01) were associated with the development of overall AEs. An ECOG score of ≥2 (p=0.01), high serum creatinine level (p=0.02), and the use of MDZ (p<0.01) were significant risk factors for HE., Conclusion: Extreme caution should be taken when sedating patients with cirrhosis receiving EVL due to the AEs associated with the use of MDZ.

Background/aims: While gastric variceal bleeding (GVB) is not as prevalent as esophageal variceal bleeding, it is reportedly more serious, with high failure rates of the initial hemostasis (>30%), and has a worse prognosis than esophageal variceal bleeding. However, there is limited information regarding hemostasis and the prognosis for GVB. The aim of this study was to determine retrospectively the clinical outcomes of GVB in a multicenter study in Korea., Methods: The data of 1,308 episodes of GVB (males:females=1062:246, age=55.0±11.0 years, mean±SD) were collected from 24 referral hospital centers in South Korea between March 2003 and December 2008. The rates of initial hemostasis failure, rebleeding, and mortality within 5 days and 6 weeks of the index bleed were evaluated., Results: The initial hemostasis failed in 6.1% of the patients, and this was associated with the Child-Pugh score [odds ratio (OR)=1.619; P<0.001] and the treatment modality: endoscopic variceal ligation, endoscopic variceal obturation, and balloon-occluded retrograde transvenous obliteration vs. endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and balloon tamponade (OR=0.221, P<0.001). Rebleeding developed in 11.5% of the patients, and was significantly associated with Child-Pugh score (OR=1.159, P<0.001) and treatment modality (OR=0.619, P=0.026). The GVB-associated mortality was 10.3%; mortality in these cases was associated with Child-Pugh score (OR=1.795, P<0.001) and the treatment modality for the initial hemostasis (OR=0.467, P=0.001)., Conclusions: The clinical outcome for GVB was better for the present cohort than in previous reports. Initial hemostasis failure, rebleeding, and mortality due to GVB were universally associated with the severity of liver cirrhosis.

Aim Percutaneous endoscopic gastrostomy ( PEG) is carried out commonly for patients with dysphagia. Clinicians, however, are often reluctant to carry out PEG in the elderly because of concerns about complications and short life expectancy. The present study aimed to assess the safety of PEG in elderly patients. Methods The medical records of 116 patients who received PEG from October 2005 to May 2012 were reviewed retrospectively. Among them, 63 patients were aged 65 years and older (the elderly group), and 53 were aged less than 65 years (the younger group). Results Baseline characteristics showed no significant difference in both groups, except that pulmonary comorbidities was more common in the elderly group ( P = 0.003). Overall, PEG-related complications occurred in 23 (19.8%) patients. Wound infections were the most common (15 patients), and followed by gastrointestinal bleeding, esophageal injury, pneumomediastinum and buried bumper syndrome. Although there was no difference in the overall complications, wound infections were less frequent in the elderly group than in the younger group (4 [6.3%] out of 63 vs 11 [20.8%] out of 53, P = 0.027). There were 17 (14.7%) cases of mortality, with three patients (2.5%) dying within 30 days after the procedure and the causes of deaths were unrelated to PEG. No significant difference in mortality rate was observed between the two groups (13 [20.6%] vs 4 [7.5%], P = 0.065). Conclusions PEG can be carried out safely in elderly patients, as procedure-related complications and mortality did not increase compared with those of younger patients. Geriatr Gerontol Int 2016; 16: 481-485. [ABSTRACT FROM AUTHOR]