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Neoplastic Progression Risk in Females With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data. 女性巴雷特食管癌患者的肿瘤进展风险:对患者个体数据的系统回顾和荟萃分析。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-05 DOI: 10.1016/j.cgh.2024.06.053
Pauline A Zellenrath, Laurelle van Tilburg, Roos E Pouw, Rena Yadlapati, Yonne Peters, Michael B Ujiki, Prashanthi N Thota, Norihisa Ishimura, Stephen J Meltzer, Noam Peleg, Won-Tak Choi, John V Reynolds, Alexandros D Polydorides, Arjun D Koch, Judith Honing, Manon C W Spaander

Background and aims: Females with Barrett's esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.

Methods: We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.

Results: IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13-1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1-7.7 years) in females and 4.2 years (interquartile range, 2.0-8.1 years) in males.

Conclusion: Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.

背景和目的:女性巴雷特食管(Barrett's esophagus,BE)患者的肿瘤进展风险低于男性,但目前缺乏足够的风险分析。本研究对患者个体数据(IPD)进行系统回顾和荟萃分析,旨在为女性肿瘤进展风险提供更有力的证据:对三个电子数据库(Medline、Embase、Google Scholar)进行系统文献检索,检索时间从开始到 2023 年 8 月。符合条件的研究(1)报告了从非增生异常BE(NDBE)、增生异常不定期(IND)或低度增生异常(LGD)到高级别增生异常(HGD)或食管腺癌(EAC)进展的原始数据,(2)纳入了女性和男性患者。IPD由两名独立审稿人进行质量控制。主要结果是性别与肿瘤进展风险之间的关系,使用多变量考克斯回归分析对风险因素进行调整。次要结果是进展时间和年进展率的性别差异:从11/66项符合条件的研究中获得了IPD,其中包括2 196名女性(31%)。在对年龄、吸烟、用药、食道裂孔疝、BE长度和基线病理学进行调整后,女性的肿瘤进展风险较低(男性与女性的HR为1.44,95%CI为1.13-1.82)。女性的年进展率为 0.88%,男性为 1.29%。男女肿瘤进展时间相似:女性为3.7年(IQR 2.1-7.7),男性为4.2年(IQR 2.0-8.1):结论:虽然女性肿瘤恶化的风险较低,但性别差异小于之前的报道,而且男女肿瘤恶化的时间相似。未来的研究应关注性别以外的其他因素,以识别低风险和高风险的 BE 患者。
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引用次数: 0
Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis. 胆囊癌的环境风险因素:全领域系统回顾和荟萃分析。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-05 DOI: 10.1016/j.cgh.2024.07.046
Daniele Piovani, Georgios K Nikolopoulos, Alessio Aghemo, Ana Lleo, Saleh A Alqahtani, Cesare Hassan, Alessandro Repici, Stefanos Bonovas

Background & aims: Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.

Methods: We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.

Results: We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] per 5-unit increase, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR per 5-cm increase, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.

Conclusions: This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).

背景和目的:胆石症是胆囊癌(GBC)--主要的胆道恶性肿瘤--最公认的风险因素;然而,其他可改变的暴露因素的可信度仍不确定。我们对与胆囊癌相关的环境因素进行了全领域的系统回顾和荟萃分析:我们系统地检索了 Medline/PubMed 和 Embase(截至 2023 年 5 月 8 日),以确定研究 GBC 环境因素的随机和非随机研究。我们对纵向研究进行了随机效应荟萃分析。病例对照研究的证据被视为补充。证据可信度按照预先规定的标准进行分级,包括随机效应估计值、95% 置信区间、P 值、统计异质性、小型研究效应以及对未测量混杂因素的稳健性:我们确定了 215 项符合条件的主要研究,并在生活方式、生殖、代谢、饮食、感染、干预、污染物和职业暴露等七个领域进行了 350 项元分析。根据纵向证据,体重指数(RR 每增加 5 个单位为 1.27;95% CI,1.21-1.33)、臀围(RR 每增加 5 厘米为 1.16;1.11-1.22)、胆管感染(RR 31.7;24.8-40.6)、高妊娠率(RR 1.48;1.30-1.68)、肥胖(RR 1.70;1.44-2.01)、超重(RR 1.28;1.14-1.43)、腰围(每增加 5 厘米,RR 为 1.14;1.10-1.18)和腰围身高比(每增加 0.1 厘米,RR 为 1.49;1.36-1.64)与 GBC 风险增加密切相关,而高学历(RR 为 0.63;0.49-0.82)则与风险降低相关(可信度为中高水平)。另外 39 项重要关联的可信度较低,包括吸烟、饮酒和体育锻炼不足的不同暴露情景:本研究详细评估并绘制了有关可改变 GBC 的因素的证据图谱。进一步开展高质量的前瞻性研究对于验证新出现的关联并为高发地区的预防策略提供信息至关重要。
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引用次数: 0
Preparing the Next Generation of Gastroenterologists to Tackle Climate Change. 培养下一代消化内科医生应对气候变化。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-04 DOI: 10.1016/j.cgh.2024.07.043
Amisha Ahuja, Nitin K Ahuja
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引用次数: 0
The Impact of Immigration Status on Gastric Cancer Risk in a Community Hospital in New York City. 移民身份对纽约市一家社区医院胃癌风险的影响。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-04 DOI: 10.1016/j.cgh.2024.08.038
Meredith E Pittman, Avleen Kaur, Thin Phyu Phyu Aung, Linda A Lee, Yasutoshi Shiratori
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引用次数: 0
Oral Antibiotic Use in Adulthood and Risk of Early-Onset Colorectal Cancer: A Case-Control Study. 成年后口服抗生素与早发结直肠癌的风险:病例对照研究
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-03 DOI: 10.1016/j.cgh.2024.09.002
Kevin J Kane, Christopher D Jensen, Jingrong Yang, Huyun Dong, Sophie A Merchant, Pradeep Koripella, Xiaoran Li, Jeffrey M Hendel, Douglas A Corley, Jeffrey K Lee

Background and aims: Prior antibiotic use may be a factor in the rising incidence of colorectal cancer seen in those under 50 years of age (early-onset colorectal cancer [EOCRC]); however, the few studies to examine this link have reported conflicting results. Therefore, we evaluated the association between oral antibiotic use in adulthood and EOCRC in a large integrated healthcare system in the United States.

Methods: A population-based nested case-control study was conducted among Kaiser Permanente Northern California patients 18-49 years of age diagnosed with EOCRC (adenocarcinoma of the colon or rectum) in 1998-2020 who had ≥2 years of continuous pharmacy benefit prior to diagnosis. Cases were matched 4:1 to healthy controls on birth year, sex, race and ethnicity, medical facility, and duration of pharmacy benefit. Antibiotic exposure >1 year before the diagnosis/index date was assessed using prescribing records. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A sensitivity analysis was performed among those with ≥10 years of continuous prescribing records.

Results: A total of 1359 EOCRC cases were matched to 4711 healthy controls. Antibiotic use in adulthood was not significantly associated with EOCRC in unadjusted or adjusted analyses (adjusted odds ratio, 1.04; 95% confidence interval, 0.94-1.26). No associations were seen for cumulative number of oral antibiotic dispensations or for any prior period of antibiotic exposure.

Conclusions: In a large U.S. healthcare setting, there was no conclusive evidence of an association between oral antibiotic use in adulthood and risk of EOCRC.

背景与目的:50 岁以下人群的结直肠癌(早发结直肠癌 [EOCRC])发病率不断上升,之前使用抗生素可能是其中的一个因素;然而,对这一联系进行研究的少数几项研究报告了相互矛盾的结果。因此,我们在美国的一个大型综合医疗系统中评估了成年后口服抗生素与 EOCRC 之间的关联:方法:我们对 1998-2020 年间被诊断为 EOCRC(结肠或直肠腺癌)的 18-49 岁北加州凯泽医疗集团患者进行了一项基于人群的巢式病例对照研究,这些患者在确诊前有≥2 年的连续药房福利。病例与健康对照组在出生年份、性别、种族和民族、医疗机构和药房福利持续时间方面的匹配比例为 4:1。根据处方记录对诊断/指标日期前一年以上的抗生素接触情况进行评估。条件逻辑回归用于估计几率比(OR)和 95% 置信区间(CI)。对连续处方记录≥10年的患者进行了敏感性分析:1359 例 EOCRC 病例与 4711 例健康对照组进行了配对。在未调整或调整后的分析中,成年期使用抗生素与 EOCRC 的关系不大(调整后 OR:1.04;95% CI:0.94-1.26)。口服抗生素的累计配药次数或之前接触抗生素的任何时期均与此无关联:在美国的大型医疗机构中,没有确凿证据表明成年后口服抗生素与罹患 EOCRC 的风险有关。
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引用次数: 0
Response to A Lin, A Jiang, P Luo. 答复 A Lin、A Jiang、P Luo。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-02 DOI: 10.1016/j.cgh.2024.08.037
Ka Shing Cheung, Wai K Leung
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引用次数: 0
Editorial: Getting to the Real Skinny on GLP-1RAs and the Risk of Aspiration During Endoscopy. 社论:了解 GLP-1RA 与内窥镜检查期间吸入风险的真实情况。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-02 DOI: 10.1016/j.cgh.2024.08.035
Jennifer Christie
{"title":"Editorial: Getting to the Real Skinny on GLP-1RAs and the Risk of Aspiration During Endoscopy.","authors":"Jennifer Christie","doi":"10.1016/j.cgh.2024.08.035","DOIUrl":"10.1016/j.cgh.2024.08.035","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
acFibroMASH Index for the Diagnosis of Fibrotic MASH and Prediction of Liver-related Events: An International Multicenter Study. 用于诊断纤维化 MASH 和预测肝脏相关事件的 acFibroMASH 指数:一项国际多中心研究。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-02 DOI: 10.1016/j.cgh.2024.07.045
Gong Feng, Ferenc E Mózes, Dong Ji, Sombat Treeprasertsuk, Takeshi Okanoue, Toshihide Shima, Huiqing Liang, Emmanuel Tsochatzis, Jinjun Chen, Jörn M Schattenberg, Christian Labenz, Sanjiv Mahadeva, Wah Kheong Chan, Xiaoling Chi, Adèle Delamarre, Victor de Lédinghen, Salvatore Petta, Elisabetta Bugianesi, Hannes Hagström, Jérôme Boursier, José Luis Calleja, George Boon-Bee Goh, Rocio Gallego-Durán, Arun J Sanyal, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Stephen A Harrison, Manuel Romero-Gomez, Seung Up Kim, Yongfen Zhu, Geraldine Ooi, Junping Shi, Masato Yoneda, Atsushi Nakajima, Jing Zhang, Monica Lupsor-Platon, Bihui Zhong, Jeremy F L Cobbold, Chun-Yan Ye, Peter J Eddowes, Philip Newsome, Jie Li, Jacob George, Fangping He, Myeong Jun Song, Hong Tang, Yuchen Fan, Jidong Jia, Liang Xu, Su Lin, Yiling Li, Zhonghua Lu, Yuemin Nan, Junqi Niu, Xuebing Yan, Yongjian Zhou, Chenghai Liu, Hong Deng, Qing Ye, Qing-Lei Zeng, Lei Li, Jing Wang, Song Yang, Huapeng Lin, Hye Won Lee, Terry Cheuk-Fung Yip, Céline Fournier-Poizat, Grace Lai-Hung Wong, Grazia Pennisi, Angelo Armandi, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara-Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Clemence M Canivet, Fanpu Ji, Yongning Xin, Jin Chai, Zhiyong Dong, Giovanni Targher, Christopher D Byrne, Na He, Man Mi, Feng Ye, Vincent Wai-Sun Wong, Michael Pavlides, Ming-Hua Zheng

Background & aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).

Methods: We analyzed data from 3004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and 9 international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs.

Results: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).

Conclusions: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.

背景与目的:代谢功能障碍相关性脂肪性肝炎(MASH)和纤维化MASH是重大的健康挑战。这项跨国研究旨在验证用于MASH诊断的acMASH指数(包括血清肌酐和天冬氨酸氨基转移酶浓度),并开发一种新的指数(acFibroMASH),用于无创识别纤维化MASH,并探索其对肝脏相关事件(LREs)的预测价值:我们分析了29个中国队列和9个国际队列中3004名经活检证实患有代谢功能障碍相关性脂肪肝(MAFLD)的患者的数据,以验证acMASH指数并开发acFibroMASH指数。此外,我们还利用来自9034名MAFLD患者的多国队列的独立外部数据,研究了acFibroMASH指数与LREs风险之间的关联:在汇总的全球队列中,acMASH 指数识别 MASH 的 AUROC 为 0.802(95%CI 0.786-0.818)。acFibroMASH指数(包括acMASH指数和肝脏硬度测量)能准确识别纤维化MASH,在衍生队列中的AUROC为0.808,在验证队列中的AUROC为0.800。值得注意的是,acFibroMASH 指数的 AUROC 为 0.835(95% CI 0.786-0.882),优于 FAST 评分的 0.750(95% CI 0.693-0.800,P0.39):这项多种族研究验证了 acMASH 指数是识别 MASH 的可靠、无创检测方法。新提出的 acFibroMASH 指数是识别纤维化 MASH 和预测 LRE 风险的可靠检测方法。
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引用次数: 0
Global Progression Rates of Precursor Lesions for Gastric Cancer: A Systematic Review and Meta-Analysis. 胃癌前驱病变的全球进展率:系统回顾与元分析》。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-10-01 DOI: 10.1016/j.cgh.2024.09.003
Anne I Hahn, Duco T Mülder, Robert J Huang, Margaret J Zhou, Benjamin Blake, Omonefe Omofuma, John D Murphy, Daniela S Gutiérrez-Torres, Ann G Zauber, James F O'Mahony, M Constanza Camargo, Uri Ladabaum, Jennifer M Yeh, Chin Hur, Iris Lansdorp-Vogelaar, Reinier Meester, Monika Laszkowska

Background & aims: Whether gastric cancer (GC) precursor lesions progress to invasive cancer at similar rates globally remains unknown. We conducted a systematic review and meta-analysis to determine the progression of precursor lesions to GC in countries with low versus medium/high incidence.

Methods: We searched relevant databases for studies reporting the progression of endoscopically confirmed precursor lesions to GC. Studies were stratified by low (<6 per 100,000) or medium/high (≥6 per 100,000) GC incidence countries. Random-effects models were used to estimate the progression rates of atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia to GC per 1000 person-years.

Results: Among the 5829 studies identified, 44 met our inclusion criteria. The global pooled estimates of the progression rate per 1000 person-years were 2.09 (95% confidence interval, 1.46-2.99), 2.89 (2.03-4.11), and 10.09 (5.23-19.49) for AG, IM, and dysplasia, respectively. The estimated progression rates per 1000 person-years for low versus medium/high GC incidence countries, respectively, were 0.97 (0.86-1.10) versus 2.47 (1.70-2.99) for AG (P < .01), 2.37 (1.43-3.92) versus 3.47 (2.13-5.65) for IM (P = .29), and 5.51 (2.92-10.39) versus 14.80 (5.87-37.28) for dysplasia (P = .08). There were no differences for progression of AG between groups when high-quality studies were compared.

Conclusions: Similar progression rates of IM and dysplasia were observed among low and medium/high GC incidence countries. This suggests that the potential benefits of surveillance for these lesions in low-risk regions may be comparable with those of population-wide interventions in high-risk regions. Further prospective studies are needed to confirm these findings and inform global screening and surveillance guidelines.

背景和目的:全球胃癌(GC)前驱病变进展为浸润性癌症的比例是否相似仍是未知数。我们进行了一项系统性回顾和荟萃分析,以确定低发病率国家与中/高发病率国家的胃癌前病变进展情况:我们在相关数据库中检索了报告内镜确诊前驱病变发展为 GC 的研究。研究按照低发病率和中/高发病率进行了分层:在确定的 5829 项研究中,有 44 项符合我们的纳入标准。每千人年AG、IM和发育不良的进展率全球汇总估计值分别为2.09(95% CI 1.46-2.99)、2.89(2.03-4.11)和10.09(5.23-19.49)。低 GC 发病率国家与中/高 GC 发病率国家的每千人年估计进展率分别为 0.97(0.86-1.10) vs. AG 2.47(1.70-2.99)(p 结论:低GC发病率国家和中/高GC发病率国家的IM和发育不良进展率相似。这表明,在低风险地区监测这些病变的潜在益处可能与在高风险地区采取全民干预措施的益处相当。需要进一步的前瞻性研究来证实这些发现,并为全球筛查和监测指南提供信息。
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引用次数: 0
Endoscopic Submucosal Dissection Provides Hemostasis by Curative Resection for a Large Bleeding and Obstructive Duodenal Lipoma. 内镜粘膜下剥离术通过治愈性切除大出血和阻塞性十二指肠脂肪瘤实现止血。
IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-09-27 DOI: 10.1016/j.cgh.2024.08.034
Mark Tawfik, Chloe Lahoud, Sherif Andrawes
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引用次数: 0
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Clinical Gastroenterology and Hepatology
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