Clinical and Translational Gastroenterology最新文献

Introduction: Few studies have examined outcomes of laparoscopic cholecystectomy for acute cholecystitis in patients with heart failure (HF). This study was to assess the impact of HF on cholecystectomy outcomes.

Methods: Data from the United States Nationwide Inpatient Sample (NIS) from 2016 to 2020 were examined. Adults 20 years and older diagnosed with acute cholecystitis who underwent laparoscopic cholecystectomy were included. Patients were categorized into groups with and without pre-existing HF.

Results: Outcomes assessed included inhospital mortality, nonroutine discharge, length of hospital stay, total hospital cost, and complications. Propensity score matching at a 1:1 ratio was conducted to balance between-group characteristics. Associations between HF and the outcomes were determined using univariate and multivariable regression analyses. After propensity score matching, 11,646 patients were included in the analysis: 5,823 with HF and 5,823 without. Patients with HF had significantly elevated risks of inhospital mortality (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [CI]: 1.44-3.17), nonroutine discharge (aOR = 1.80, 95% CI: 1.61-2.01), and complications (aOR = 1.51, 95% CI: 1.40-1.63). Patients with HF also had longer length of hospital stay (1.52 days, 95% CI: 1.45-1.60) and higher total hospital costs (16.64 thousand USD, 95% CI: 15.58-17.70). The outcomes of patients with HF were seen in those with HF reduced ejection fraction and HF with preserved ejection fraction.

Discussion: Patients with HF, either HF reduced ejection fraction or HF with preserved ejection fraction, have increased risk of adverse inpatient outcomes after laparoscopic cholecystectomy for acute cholecystitis. This emphasizes the importance of tailored perioperative care to optimize patient outcomes.

Introduction: The magnitude and modifiers of the association between acute pancreatitis (AP) and pancreatic cancer (PC) are unclear. This systematic review and meta-analysis aimed to quantify the occurrence of PC in AP, the association of PC after AP, and the impact of specific risk factors on PC diagnosis.

Methods: The systematic search was conducted in PubMed, EMBASE, and Central Register of Controlled Trial from inception until July 14, 2025 (PROSPERO: CRD42023470350). Eligible studies included adult populations reporting on the association between AP and PC. Primary outcomes included prevalence, incidence, and diagnosis of PC in individuals with AP, including subset analyses of specific clinical and demographic factors. Meta-analyses were performed using random-effects models to calculate pooled outcome measures and corresponding 95% confidence intervals (CI).

Results: A total of 61 studies were included. The prevalence of PC among AP patients was 2% (CI: 2%-4%). The time-dependent analysis revealed an increased hazard of PC in AP vs no AP: <24 months (HR: 31.94, CI: 9.35-109.09), 24-60 months (HR: 2.68, CI: 1.65-4.37), and >60 months (HR: 1.71, CI: 1.22-2.40). AP patients with subsequently diagnosed chronic pancreatitis (OR: 3.71, CI: 2.00-6.90), new-onset diabetes mellitus (OR: 2.22, CI: 1.02-4.84), idiopathic AP (OR: 2.97, CI: 1.44-6.13), and older than 50 years (OR: 4.04, CI: 2.73-5.97) showed significantly increased odds of having PC. We found no evidence for increased odds for PC with AP severity, smoking, and alcoholic and gallstone etiologies.

Discussion: Patients with AP have a higher likelihood of PC diagnosis, especially within the first 2 years. Although the association decreases with time, it remains significant long term. Newly diagnosed chronic pancreatitis, new-onset diabetes mellitus, idiopathic AP may further elevate the likelihood of PC diagnosis. PC diagnosed after AP tends to occur at a younger age, more often at an earlier stage, typically in the pancreatic head.

Introduction: Biliary strictures present diagnostic challenges, necessitating early differentiation between benign and malignant cases. This study evaluates the diagnostic value of biliary and serum carcinoembryonic antigen (SCEA, BCEA) and carbohydrate antigen 19-9 (BCA19-9, SCA19-9) to enhance diagnostic accuracy.

Methods: A single-center retrospective cohort study enrolled 268 endoscopic retrograde cholangiopancreatography-treated patients, divided into training (n = 160) and validation (n = 108) sets. Levels of SCEA/SCA19-9 and BCEA/BCA19-9 were measured, and a combined diagnostic model was developed using receiver operating characteristic analysis and logistic regression. A meta-analysis of 7 studies assessed pooled odds ratios and heterogeneity in marker detection.

Results: BCEA and BCA19-9 levels significantly exceeded serum levels, with the combined model achieving an area under the curve of 0.921 (training) and 0.911 (validation), sensitivity 85.0%-83.3%, and specificity 83.7%-87.0%. Meta-analysis demonstrated a pooled odds ratio of 25.65, sensitivity of 95.0%, and specificity of 83.7%. CA19-9 cutoff variations had an insignificant impact, and the model improved pre-endoscopic retrograde cholangiopancreatography diagnostic accuracy by 20.7%.

Discussion: BCEA and BCA19-9 exhibit superior expression levels and diagnostic efficacy in distinguishing benign and malignant biliary strictures. The multimarker model enhances diagnostic performance, suggesting the relevance of integrating serum and biliary markers for accurate differentiation. Future studies should focus on optimizing cutoff values for enhanced diagnostic precision.

Introduction: Indomethacin is often used experimentally to induce intestinal hyperpermeability, enabling evaluation of interventions targeting barrier function.

Methods: We conducted a randomized, double-blind, placebo-controlled study (NCT05538247) in healthy volunteers to assess whether a supplement could mitigate indomethacin-induced hyperpermeability. Participants received 150 mg/d of indomethacin for 6 days, either before or during placebo/supplement administration. Permeability was measured using 13 C-mannitol and lactulose urinary excretion.

Results: Contrary to expectations, indomethacin failed to increase 13 C-mannitol excretion in either group. No meaningful elevations in serum (zonulin, claudins) or fecal (calprotectin) biomarkers were observed.

Discussion: Our findings suggest that the expected increase in intestinal permeability after indomethacin administration may not be consistently observed in healthy volunteers. These results highlight the need to carefully consider the reproducibility and sensitivity of this model in future clinical studies aiming to investigate gut barrier function.

Introduction: Endoscopic removal of a bony foreign body is accompanied by risks, such as perforation. The use of a transparent cap attached to the tip of the endoscope has become an increasingly recommended technique for removing esophageal foreign bodies. However, its effectiveness specifically for bony foreign bodies remains uncertain, as does the optimal timing for cap application. This study aimed to investigate the effectiveness and the optimal timing of a transparent cap.

Methods: From January 1, 2010-May 30, 2025, patients with reported bony esophageal foreign body for endoscopic removal were retrospectively analyzed. The primary outcome was the technical failure rate of endoscopic removal of a bony foreign body.

Results: A total of 595 patients with bony esophageal foreign bodies underwent endoscopic removal during the study period: 216 underwent the transparent cap-assisted method and 379 underwent the conventional method. Among these foreign bodies, fish bones accounted for the majority (91.4%). The endoscopic failure rate of bony foreign body removal was lower in the cap-assisted group than in the conventional group (3.2% vs 7.9%, P = 0.022). Subgroup analysis demonstrated the incidence of esophageal erosions and ulcerations was higher in patients who underwent endoscopy withdrawal for capping than in those who received capping before the examination (58.5% vs 32.8%, P < 0.001).

Discussion: The use of a transparent cap is an effective method to reduce the technical failure rate for endoscopic removal of an esophageal bony foreign body. Applying the transparent cap before the start of the endoscopic examination reduced the complication rates.

Introduction: The risk of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has been extensively studied; however, nonpancreatic adverse events, such as cholangitis, bleeding, and cardiopulmonary complications, are under characterized. We aimed to characterize the 30-day incidence and financial burden of nonpancreatic post-ERCP adverse events.

Methods: We performed a cross-sectional analysis using the Merative MarketScan commercial claims database from January 1, 2019 to December 31, 2021. The study included 27,482 patients who underwent 42,318 inpatient and outpatient ERCPs. Primary outcomes were post-ERCP cholangitis, bleeding, and cardiopulmonary complications within 30 days. Financial burden was measured using total direct healthcare costs and out-of-pocket costs during the 30-day period after ERCP. Multivariable logistic regression was used to identify associated risk factors and to estimate adjusted costs.

Results: Among 27,482 patients who underwent a total of 42,318 ERCPs, nonpancreatic adverse events occurred in 5.3% of cases: cholangitis in 3.6% (95% confidence interval [CI] 3.5%-3.8%), bleeding in 1.3% (95% CI 1.2%-1.4%), and cardiopulmonary complications in 1.1% (95% CI 1.0-1.3). In multivariable analysis, adverse events were more common among men and those with higher comorbidity burden. Patients with complications had significantly higher adjusted 30-day costs: cholangitis ($38,512 vs $30,881, difference $7,631), bleeding ($43,702 vs $30,918; difference $12,748), and cardiopulmonary complications ($53,649 vs $30,918; difference $22,930). Out-of-pocket costs varied by region and insurance type but exceeded $1,000 for many patients.

Discussion: Nonpancreatic ERCP adverse events occur in over 5% of cases and can impose a substantial financial burden on both healthcare systems and patients.

Introduction: Esophagogastric varices (EGV) are known to correlate with a poorer prognosis in patients with liver cirrhosis or hepatocellular carcinoma. However, their clinical significance in patients with cholangiocarcinoma (CCA) remains unknown. The aim of this study was to investigate the impact of EGV on the outcomes of patients with CCA.

Methods: This retrospective study enrolled 923 consecutive treatment-naive patients diagnosed with CCA between January 2013 and December 2023. Among these, 321 patients received esophagogastroduodenoscopy at the time of CCA diagnosis. The primary end point was to assess the impact of EGV on overall survival (OS) in patients with CCA, whereas the secondary end point was to identify the predictive factors for the occurrence of EGV.

Results: Of the patients analyzed, 47 (14.6%) were diagnosed with EGV by esophagogastroduodenoscopy. Among these, 39 patients did not receive primary prophylaxis for EGV bleeding and were classified as the EGV group, whereas the remaining 274 patients (85.4%) formed the non-EGV group. The median OS was shorter in the EGV group than that in the non-EGV group (182 vs 357 days, P = 0.009). Multivariate analyses identified the presence of EGV as an independent risk factor of poorer OS (hazard ratio 1.823, confidence interval 1.248-2.663, P = 0.002). Besides, fibrosis-4 scores >2.67 and albumin-bilirubin grades >1 were predictive factors for EGV occurrence.

Discussion: While the prevalence of concurrent EGV in patients with CCA was relatively low, its presence was associated with a poorer prognosis. The fibrosis-4 scores and albumin-bilirubin grades predicted the occurrence of EGV.

Introduction: Esophageal motility disorders (EMDs) are common in clinical practice, with a high symptomatic burden and significant impact on the patients' quality of life. High-resolution esophageal manometry (HREM) is the gold standard for the evaluation of functional esophageal disorders. The Chicago Classification offers a standardized approach to HREM. However, HREM remains a complex procedure, both in data analysis and in accessibility. This study aimed to develop and validate machine learning (ML) models to detect EMDs according to the Chicago Classification.

Methods: We retrospectively analyzed 618 HREM examinations from 3 centers (Spain and the United States) using 2 recording systems. Labels were assigned by expert consensus as either disorder present or absent for 2 categories: esophagogastric junction outflow disorders and peristalsis disorders. Several ML models were trained and evaluated. ML classifiers were developed using an 80/20 patient-level stratified split for training/validation and testing. Model selection was guided by internal evaluation through repeated 10-fold cross-validation. Model performance was assessed by accuracy and area under the receiver-operating characteristic curve (AUC-ROC).

Results: The GradientBoostingClassifier model outperformed the remaining ML models with an accuracy of 0.942 ± 0.015 and an AUC-ROC of 0.921 ± 0.041 for identifying disorders of esophagogastric junction outflow. The xGBClassifier model detected disorders of peristalsis with an accuracy of 0.809 ± 0.029 and an AUC-ROC of 0.871 ± 0.027. Performance was consistent across repeated validations, demonstrating model robustness and generalization.

Discussion: This multicenter, multidevice study demonstrates that ML models can accurately detect EMDs in HREM. Artificial intelligence-driven HREM may improve diagnosis by standardizing interpretation and reducing interobserver variability.

Introduction: Esophageal adenocarcinoma (EAC) is an aggressive cancer with poor prognosis. Barrett's esophagus (BE) is a critical precursor of EAC. Patients with BE undergo endoscopic surveillance to monitor disease progression although only a small fraction develop EAC. These procedures are invasive and have limited accuracy in predicting BE progression. We evaluated the utility of an 8-protein mass spectrometry panel in predicting progression in patients with BE.

Methods: Eighty untreated controls and 20 cases were selected from our institutional tissue registry. Quantitative mass-spectrometry was performed on microdissected tissue sections. Data were split into 80% training and 20% test sets. We used Least Absolute Shrinkage and Selection Operator-regularized regression to train a logistic classifier on training data. Classifier performance was evaluated in test data.

Results: Ninety-two samples had sufficient tissue for mass spectrometry analysis (18 progressors, 74 nonprogressors). The multivariable regression model produced a sensitivity of 100% and a specificity of 39% in the overall cohort, with AUCs of 0.75 and 0.89 in the overall and test cohorts, respectively. Cox proportional hazards time-to-progression (TTP) showed a hazard ratio of 66.1 (95% CI 7.79-561, P = 0.00012) for the model prediction.

Discussion: The promising performance of the model generated here suggests that the test may aid in selecting patients most likely to benefit from active BE surveillance. Moreover, the association of this model's prediction with time-to-progression may offer decision support for management of patients likely to progress quickly. These results support continued development of this proteomic panel as a risk stratification tool for patients with BE.