Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis

Abstract Background and study aims Hemodialysis (HD) is considered one of the risk factors for post-endoscopic sphincterotomy (ES) bleeding. Therefore, we conducted a retrospective study to evaluate HD as a risk factor for post-ES bleeding in patients with choledocholithiasis. Patients and methods We used the post-ES bleeding rate as the main outcome measure. To evaluate the influence of HD on the risk of post-ES bleeding, logistic regression and propensity score analyses were conducted. In addition, univariate analysis-based comparisons of various clinical parameters (as secondary outcome measures) were performed between the patients in the HD and non-HD groups that experienced post-ES bleeding. Results A total of 1518 patients were enrolled. In the multivariate analysis, a platelet count of < 50,000, anticoagulant therapy, bleeding during ES, and HD were found to be significantly associated with post-ES bleeding (odds ratio [OR]: 35.30, 95 % confidence interval [CI]: 3.81 – 328.00; OR: 4.39, 95 % CI: 1.53 – 12.60; OR: 4.28, 95 % CI: 2.30 – 7.97; and OR: 13.30, 95 % CI: 5.78 – 30.80, respectively). Propensity score matching created 28 matched pairs. Propensity score analysis showed that the risk difference between the groups was 0.214 (95 % CI: 0.022 – 0.407). In a comparison between the patients in the HD and non-HD groups that suffered post-ES bleeding, it was found that the post-ES bleeding was significantly more severe in the HD group (p = 0.033), and massive blood transfusions and long periods of hospitalization were more frequently required in the HD group (p = 0.008 and p < 0.001, respectively). Conclusion HD is an independent risk factor for post-ES bleeding and makes post-ES bleeding more serious.

Download Full-text

1045. A Multicenter Propensity Score-Adjusted Retrospective Study for Comparison of the Outcome of Treatment With Third-Generation Cephalosporin vs. Broad-Spectrum Antibiotics for Enterobacter Bacteremia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.882 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S312-S312

Author(s):

Satoshi Hayano ◽

Shungo Yamamoto ◽

Ryota Hase ◽

Akihiro Toguchi ◽

Yoshihito Otsuka ◽

...

Keyword(s):

Propensity Score ◽

Broad Spectrum ◽

Antimicrobial Therapy ◽

Resistant Strain ◽

Propensity Score Analysis ◽

Risk Difference ◽

Third Generation ◽

Broad Spectrum Antibiotics ◽

Score Analysis ◽

Definitive Therapy

Abstract Background Enterobacter spp. can develop resistance during prolonged therapy with third-generation cephalosporins (3GC: ceftriaxone, cefotaxime, or ceftazidime) because of derepression of AmpC β-lactamase. However, the clinical significance of this phenomena remains undetermined. This study aims to assess the outcome of patients with 3GC-susceptible Enterobacter bacteremia (EB) who received definite therapy with 3GC or broad-spectrum antibiotics (BSA) using propensity score analysis. Methods In this retrospective, cohort study conducted at two tertiary care hospitals in Japan, we determined consecutive patients with EB identified from the laboratory databases between January 2010 and December 2017. We enrolled patients with 3GC-susceptible EB treated with 3GC or BSA (defined as fourth-generation cephalosporins, carbapenems, and piperacillin/tazobactam) as definitive therapy. The primary outcome was 28-day mortality. The secondary outcome was the emergence of antimicrobial-resistant strain during antimicrobial therapy. We compared outcomes using the propensity scores and inverse-probability-weighting (IPW) adjustment to decrease the confounding by indication. Results We identified 320 patients with EB; of these, 191 cases were eligible (86 treated with 3GC and 105 treated with BSA). All the measured covariates were well balanced after the IPW adjustment. We observed no significant differences in the unadjusted mortality [5.8% in the 3GC group vs. 13.3% in the BSA group; risk difference, −7.5%; 95% confidence interval (CI): −15.7–0.6; P = 0.09], and the IPW-adjusted mortality (5.1% vs. 9.4%; risk difference −4.3%; 95% CI: −12.2–3.5; P = 0.3) between the groups. The results of the propensity score-matched analysis and sensitivity analysis were similar. Furthermore, we did not observe the emergence of antimicrobial resistance during antimicrobial therapy in both groups. Conclusion Definitive therapy with 3GC for susceptible EB was not associated with an increased risk of the 28-day mortality after adjustment for potential confounders with the propensity score analysis or with the emergence of antimicrobial-resistant strain. Disclosures All authors: No reported disclosures.

Download Full-text

Endoscopic sphincterotomy to prevent post-ERCP pancreatitis in patients with biliary neoplasms: a multicenter retrospective cohort study

Endoscopy International Open ◽

10.1055/a-1107-2629 ◽

2020 ◽

Vol 08 (04) ◽

pp. E513-E522

Author(s):

Takashi Tamura ◽

Takeshi Ogura ◽

Mamoru Takenaka ◽

Kensuke Tanioka ◽

Masahiro Itonaga ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Propensity Score ◽

Endoscopic Sphincterotomy ◽

Independent Risk Factor ◽

Propensity Score Analysis ◽

Plastic Stents ◽

Metal Stents ◽

Biliary Duct ◽

Multicenter Cohort Study

Abstract Background and aims Treatment of biliary neoplasms often involves multiple endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Endoscopic sphincterotomy (ES) may prevent post-ERCP pancreatitis (PEP). This retrospective, multicenter cohort study aimed to investigate the effectiveness of ES for prevention of PEP in patients with biliary neoplasm. Methods Patients with biliary duct neoplasm who underwent ERCP between January 2006 and December 2016 were enrolled. The frequency of PEP was compared between the ES and non-ES groups using propensity score analysis. The effectiveness of ES in subgroups of patients who underwent biliary duct stent placement, intraductal ultrasound (IDUS), and transpapillary biliary duct biopsy was analyzed by logistic regression. Results Of the 362 patients enrolled, 84 (23.2 %) developed PEP. Propensity score matching for PEP risk factors in 172 ERCP procedures showed that the frequency of PEP in the ES group was lower than that in the non-ES group (19.7 % vs. 33.7 %). Non-ES was also an independent risk factor for PEP in patients who underwent intraductal ultrasound and transpapillary biliary duct biopsy (RR = 4.54 and 5.26), but was not an independent risk factor for PEP in patients with biliary duct stents. In addition, there was no evidence that the frequency of PEP was statistically different between patients with plastic stents and metal stents in the ES and non-ES groups (P = 0.14 and 0.10). Conclusions ES is an effective technique to prevent PEP in patients with biliary neoplasms. In particular, ES is a safe technique to prevent PEP when performing IDUS and transpapillary biliary duct biopsy.

Download Full-text

Impact of history of myomectomy on preterm birth risk in women with a leiomyomatous uterus: a propensity score analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03413-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Emmanuel Rault ◽

Pierre Delorme ◽

François Goffinet ◽

Aude Girault

Keyword(s):

Preterm Birth ◽

Propensity Score ◽

Propensity Score Analysis ◽

Sensitivity Analyses ◽

Secondary Outcome ◽

Spontaneous Preterm Birth ◽

Multivariable Logistic Regression Model ◽

Score Analysis ◽

Tertiary Center ◽

History Of

Abstract Background To evaluate if women with a history of myomectomy have a modified preterm birth risk compared to women with myomas during pregnancy. Methods Retrospective cohort study including all women with a history of myomectomy (operated group) or uterine myomas during pregnancy (unoperated group) who delivered in a tertiary center between January, 2011 and December, 2017. The operated group included women who had a myomectomy history with or without myomas during the ongoing pregnancy. The unoperated group included women with uterine myoma(s) seen on at least one ultrasound during pregnancy without history of myomectomy. The primary outcome was preterm birth < 37 weeks, and the secondary outcome spontaneous preterm birth < 37 weeks. To control for confounding factors, a propensity score approach was used. Two sensitivity analysis were performed, one repeating the analysis using the propensity score after excluding operated women with persistent myomas and one using a classical multivariable logistic regression model. Results The cohort included 576 women: 283 operated women and 293 unoperated women. The rate of preterm birth was similar in the two groups: 12.6% in the unoperated group and 12.0% in the operated group (p = 0.82). No difference in preterm birth risk was shown between unoperated and operated women in the cohort matched on the propensity score: OR 0.86; 95%CI [0.47–1.59]. These results were consistent for spontaneous preterm birth (OR 1.61; 95%CI [0.61–4.23]) and for the sensitivity analyses. Conclusion In women with a leiomyomatous uterus, a history of myomectomy is not associated with a reduced preterm birth risk.

Download Full-text