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Paul R Tarnasky

Publications and source records attributed to Paul R Tarnasky.

6 recordsLinked to original sources
PubMed2005

Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial.

OBJECTIVES: We hypothesized that early intervention in patients with lower gastrointestinal bleeding (LGIB) would improve outcomes and therefore conducted a prospective randomized study comparing urgent colonoscopy to standard care. METHODS: Consecutive patients presenting with LGIB without upper or anorectal bleeding sources were randomized to urgent purge preparation followed immediately by colonoscopy or a standard care algorithm based on angiographic intervention and expectant colonoscopy. RESULTS: A total of 50 patients were randomized to each group. A definite source of bleeding was found more often in urgent colonoscopy patients (diverticula, 13; angioectasia, 4; colitis, 4) than in the standard care group (diverticula, 8; colitis, 3) (the odds ratio for the difference among the groups was 2.6; 95% CI 1.1-6.2). In the urgent colonoscopy group, 17 patients received endoscopic therapy; in the standard care group, 10 patients had angiographic hemostasis. There was no difference in outcomes among the two groups-including: mortality 2%versus 4%, hospital stay 5.8 versus 6.6 days, ICU stay 1.8 versus 2.4 days, transfusion requirements 4.2 versus 5 units, early rebleeding 22%versus 30%, surgery 14%versus 12%, or late rebleeding 16%versus 14% (mean follow-up of 62 and 58 months). CONCLUSION: Although urgent colonoscopy identified a definite source of LGIB more often than a standard care algorithm based on angiography and expectant colonoscopy, the approaches are not significantly different with regard to important outcomes. Thus, decisions concerning care for patients with acute LGIB should be based on individual experience and local expertise.

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PubMed2003

Mechanical prevention of post-ERCP pancreatitis by pancreatic stents: results, techniques, and indications.

Impaired pancreatic drainage may be most important in the pathophysiology of post-ERCP pancreatitis. When there is a mechanical problem, there is often a mechanical solution. Pancreatic stenting reduces the incidence and severity of post-ERCP pancreatitis in high-risk patients. Young patients with suspected sphincter of Oddi dysfunction or prior pancreatitis and those undergoing procedures with either a difficult cannulation, precut and/or pancreatic sphincterotomy should be strongly considered for pancreatic stenting. Stents should be removed within about one week or have the proximal flaps removed to allow early spontaneous distal migration. Pancreatic stent placement following biliary intervention can occasionally be difficult. In cases where the primary goal is pancreatic therapy, one should consider establishing pancreatic access before addressing the bile duct. A pancreatic stent can then serve as a guide for sphincterotomy, but most importantly, protect against post-ERCP pancreatitis.

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