Clinics and research in hepatology and gastroenterology最新文献_第3页

Comparison of repeat hepatectomy with radiofrequency ablation for the survival of hepatocellular carcinoma with solitary intrahepatic recurrence after hepatectomy 重复肝切除术与射频消融术对肝切除术后单发肝内复发肝细胞癌生存率的比较。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-20 DOI: 10.1016/j.clinre.2025.102750

Jialu Fu , Jiafeng Chen , Lei Jin , Junfeng Huang , Shengwei Mao , Xuhui Zhao , Weifeng Qu , Rui Yang , Yi Wang , Yichao Bu , Zhiqi Guan , Jun Gao , Xiaoling Wu , Qianfu Zhao , Tianhao Chu , Guiqi Zhu , Yuan Fang , Yinghong Shi , Weiren Liu

Purpose

To compare survival outcomes between repeat hepatectomy (RHT) and radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) patients with solitary intrahepatic recurrence after initial hepatic resection, and to identify associated prognostic factors.

Patients and Methods

This study included 377 HCC patients with solitary intrahepatic recurrence after initial hepatectomy (RHT=280, RFA=97). Propensity score matching (PSM) was used to balance intergroup characteristics. Survival outcomes (OS and rRFS) were analyzed using Kaplan-Meier method and compared by log-rank test. Variables that were significant in univariate analysis were further included in multivariate analysis.

Results

No significant differences were observed in either OS or rRFS between RFA and RHT groups before (P = 0.37 for OS; P = 0.30 for rRFS) or after PSM (P = 0.58 for OS; P = 0.76 for rRFS). Era-stratified analysis (earlier cohort [1996–2005]: P = 0.40 for OS, P = 0.62 for rRFS; later cohort [2006–2010]: P = 0.18 for OS, P = 0.08 for rRFS) confirmed this finding. Subgroup analyses confirmed the equivalent survival outcomes between RFA and RHT in patients with tumors ≤ 3 cm or > 3 cm but ≤ 5 cm. Multivariate analysis identified HBsAg positivity and tumor diameter > 2 cm as independent risk factors for OS, while recurrence time ≤ 24 months was an independent risk factor for both OS and rRFS.

Conclusion

RFA provides comparable OS and rRFS to RHT for HCC patients with solitary intrahepatic recurrence ≤ 5 cm after hepatic resection.

目的：比较重复肝切除术（RHT）和射频消融术（RFA）治疗原发性肝内复发肝细胞癌（HCC）患者的生存结果，并确定相关预后因素。患者和方法：本研究纳入377例肝切除术后单发肝内复发的HCC患者（RHT=280， RFA=97）。倾向得分匹配（PSM）用于平衡组间特征。生存结局（OS和rRFS）采用Kaplan-Meier法分析，log-rank检验比较。在单因素分析中显著的变量进一步纳入多因素分析。结果：RFA组和RHT组在术前（OS组P = 0.37；rRFS组P = 0.30）和术后（OS组P = 0.58；rRFS组P = 0.76）的OS或rRFS均无显著差异。时代分层分析（早期队列[1996-2005]:OS组P = 0.40，rRFS组P = 0.62；后期队列[2006-2010]:OS组P = 0.18，rRFS组P = 0.08）证实了这一发现。亚组分析证实，在肿瘤≤3cm或> 3cm但≤5cm的患者中，RFA和RHT的生存结果相当。多因素分析发现，HBsAg阳性和肿瘤直径bbb2.0 cm是OS的独立危险因素，复发时间≤24个月是OS和rRFS的独立危险因素。结论：对于肝切除术后≤5 cm单发肝内复发的HCC患者，RFA提供的OS和rRFS与RHT相当。

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引用次数: 0

Prevalence and risk factors of portopulmonary hypertension in chronic liver disease: systematic review and meta-analysis 慢性肝病中门脉肺动脉高压的患病率和危险因素：系统回顾和荟萃分析。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 10.1016/j.clinre.2025.102748

Tareq Alsaleh , Amir Harb , Parikshit Chapagain , Bassel Dakkak , Prachi Mann , Nouman Shafique , Nihal Khan , Mohamad Khaled Almujarkesh , Ayman Koteish

Background

Portopulmonary hypertension (PoPH) increases perioperative mortality in liver transplantation, underscoring the need for early detection. To better quantify its burden and improve detection, we performed a systematic review and meta-analysis of studies reporting PoPH prevalence and risk factors among adults with chronic liver disease (CLD).

Methods

We searched multiple databases through March 2025 for studies reporting the prevalence and risk factors of PoPH in CLD. The primary outcome of interest was the pooled prevalence, while the secondary outcome was risk factors. Standard meta-analysis methods were followed using the random-effects model, generating pooled effect estimates with 95% confidence intervals (CI). Heterogeneity was assessed using the I²% statistic.

Results

A total of 48 studies were included, comprising 16,351 CLD patients (mean age 55.5; 60% males). The pooled prevalence of PoPH on RHC was 2.4 % (95% CI: 1.4, 4.1; I² = 93.3%), whereas the pooled prevalence on TTE was 8.7% (95% CI: 5.9, 12.7). Significant risk factors for PoPH on TTE were female sex (OR 1.83), autoimmune hepatitis (AIH) (OR 1.92), older age (MD 2.19), and higher INR (MD 0.11). AIH was a significant risk factor for PoPH on RHC (OR 2.28). Meta-regression revealed significant decrease of RHC-based prevalence with time (-0.07% per year; p=0.007). Egger’s tests showed no publication bias.

Conclusion

PoPH confirmed by RHC is uncommon but appears overestimated by TTE. Females, patients with AIH, older age, and coagulopathy may benefit from earlier screening. Standardized echocardiographic thresholds and prospective multicenter studies are needed to refine prevalence and risk prediction.

背景：门脉肺动脉高压（PoPH）增加肝移植围手术期死亡率，强调早期发现的必要性。为了更好地量化其负担并改进检测，我们对报告慢性肝病（CLD）成人中PoPH患病率和危险因素的研究进行了系统回顾和荟萃分析。方法：我们检索了截至2025年3月的多个数据库，以报告CLD中PoPH的患病率和危险因素。研究的主要结局是总患病率，次要结局是危险因素。采用随机效应模型采用标准荟萃分析方法，产生95%置信区间（CI）的合并效应估计。采用I2%统计量评估异质性。结果：共纳入48项研究，包括16351例CLD患者（平均年龄55.5岁，60%为男性）。RHC中PoPH的总患病率为2.4% (95% CI: 1.4, 4.1; 2 = 93.3%)，而TTE的总患病率为8.7% （95% CI: 5.9, 12.7）。TTE患者PoPH的显著危险因素为女性（OR 1.83）、自身免疫性肝炎（AIH）（OR 1.92）、年龄较大（MD 2.19）和较高的INR （MD 0.11）。AIH是RHC患者发生PoPH的重要危险因素（OR 2.28）。meta回归显示，rhc患病率随时间显著下降（-0.07% /年；p=0.007）。Egger的检验没有显示发表偏倚。结论：RHC证实的PoPH不常见，但TTE对其估计过高。女性、AIH患者、老年和凝血功能障碍患者可能受益于早期筛查。需要标准化的超声心动图阈值和前瞻性多中心研究来完善患病率和风险预测。

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引用次数: 0

Evaluating the accuracy of the histological diagnosis in unexplained liver injury: A retrospective study 评价不明原因肝损伤组织学诊断的准确性：一项回顾性研究。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 10.1016/j.clinre.2025.102747

Zhikun Wang , Linqian Wu , Ke Bai , Mengru Qiu , Qing Li , Liangtao Zeng , Yipeng Wan , Hui Zhu , Lifang Chen , Zhili Wen , Lingling Yang

Backgrounds and Aims

Liver biopsy is a valuable tool for diagnosing liver diseases with unknown etiology, but it sometimes fails to provide a clear diagnosis. This study aimed to identify the cause of unexplained liver injury and evaluate the accuracy of histological diagnosis.

Methods

A retrospective analysis was conducted on the clinical and histological data of patients with chronic liver disease of unknown etiology at the Second Affiliated Hospital of Nanchang University, China, who underwent liver biopsy between September 2019 and June 2024. Diagnoses were divided into admission diagnosis, histological diagnosis, and final clinical diagnosis groups.

Results

A total of 104 patients were included, with 64 women (61.5 %) and 40 men (38.5 %), 96 (92.3 %) of whom received a definitive diagnosis through liver biopsy. The main diseases were autoimmune liver disease (AILD, 49 cases, 47.1 %), non-alcoholic fatty liver disease (NAFLD, 26 cases, 25.0 %), drug-induced liver injury (DILI, 22 cases, 21.2 %), others (11 cases, 10.6 %) and unknown etiology (8 cases, 6.9 %). AILD was most common in women (40 cases, 55.6 %), while NAFLD was most common in men (19 cases, 40.4 %). Histological diagnosis showed higher sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) compared to admission diagnosis. Venn diagram analysis revealed that 57.7 % of cases matched between admission and histological diagnosis, 60.6 % matched between admission and final clinical diagnosis, and 92.3 % matched between the histological and final clinical diagnosis.

Conclusions

Histological diagnosis is effective in determining the cause of unexplained liver injury, and liver biopsy remains a crucial tool.

背景与目的：肝活检是诊断病因不明的肝脏疾病的一种有价值的工具，但有时不能提供明确的诊断。本研究旨在确定不明原因肝损伤的原因，并评估组织学诊断的准确性。方法：回顾性分析2019年9月至2024年6月在南昌大学第二附属医院行肝活检的不明原因慢性肝病患者的临床和组织学资料。诊断分为入院诊断组、组织学诊断组和最终临床诊断组。结果：共纳入104例患者，其中女性64例（61.5%），男性40例（38.5%），其中96例（92.3%）通过肝活检得到明确诊断。主要疾病为自身免疫性肝病（AILD， 49例，47.1%）、非酒精性脂肪性肝病（NAFLD， 26例，25.0%）、药物性肝损伤（DILI， 22例，21.2%）、其他疾病（11例，10.6%）和原因不明的肝病（8例，6.9%）。AILD在女性中最常见（40例，55.6%），而NAFLD在男性中最常见（19例，40.4%）。与入院诊断相比，组织学诊断具有更高的敏感性、特异性、阳性预测值（PPVs）和阴性预测值（npv）。维恩图分析显示，入院与组织学诊断吻合率为57.7%，入院与最终临床诊断吻合率为60.6%，组织学与最终临床诊断吻合率为92.3%。结论：组织学诊断对于确定不明原因肝损伤的原因是有效的，肝活检仍然是一个重要的工具。

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引用次数: 0

Switch from cetuximab to panitumumab during encorafenib-based therapy in BRAF V600E mutated metastatic colorectal cancer: An international multicenter analysis from the AGEO group 在BRAF V600E突变的转移性结直肠癌的以恩可非尼为基础的治疗中，从西妥昔单抗切换到帕尼单抗：来自AGEO组的国际多中心分析

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 10.1016/j.clinre.2025.102746

Annalice Gandini , Victoria Probst , Matteo Landi , Maria Caterina De Grandis , Chiara Cremolini , Sara Lonardi , Paul Girot , Marie Decraecker , Alessandro Passardi , Lisa Salvatore , Alessandro Pastorino , Jeremy C Jones , Lucien Grados , Lina Sayah , Isabelle Trouilloud , David Tougeron , Julien Taieb

BRAF V600E mutation (BRAFm) is present in around 8 % of metastatic colorectal cancers (mCRC) and is associated with a poor prognosis. The encorafenib-cetuximab combination (ENCOCET) is currently the standard second-line treatment of BRAFm mCRC. However, 2–5 % of patients treated with cetuximab experience grade 3–4 infusion-related reactions (IRRs), leading to treatment discontinuation. In addition, BRAF inhibitors must be combined with an anti-EGFR to have any efficacy in BRAFm mCRC. As panitumumab (PANI) is associated with a lower risk of IRRs, this study aimed to assess the safety and efficacy of ENCO-PANI as an alternative strategy in patients experiencing an IRR to CET.

We retrospectively collected BRAFm mCRC patients that switched ENCOCET for ENCO-PANI following an IRR to CET. Twenty pts were identified across 12 centers from 4 countries. Most were male (12/20), 11/20 had right-sided primary tumor and 5/20 pts were dMMR/MSI. Median age was 66, treatment line was 2nd line in 85 % and 3rd line in 15 % of patients; 19 patients started ENCOCET and switched to ENCO-PANI (cycle 2 or 3) and 1 received ENCO-PANI upfront due to patient’s choice. Response rate was 25 % and disease control rate 85 %. Median progression-free survival was 6.2 and median overall survival 11 months. Adverse events (AEs) during ENCO-PANI occurred in 15/20, mostly G1-G2. No new IRRs nor toxic deaths were reported.

ENCO-PANI appears to be as safe and effective in pts treated for a BRAFm mCRC unable to continue CET and may represent a valid alternative therapeutic option in this setting.

BRAF V600E突变（BRAFm）存在于约8%的转移性结直肠癌（mCRC）中，并与不良预后相关。恩科非尼-西妥昔单抗联合治疗（ENCO-CET）目前是BRAFm mCRC的标准二线治疗。然而，2-5%接受西妥昔单抗治疗的患者出现3-4级输液相关反应（IRRs），导致停药。此外，BRAF抑制剂必须与抗egfr联合使用才能对BRAFm mCRC有效。由于帕尼单抗（panitumumab， PANI）与较低的IRR风险相关，本研究旨在评估ENCO-PANI作为一种替代策略在经历IRR至CET的患者中的安全性和有效性。我们回顾性收集BRAFm mCRC患者，这些患者在IRR到CET后将ENCO-CET换成ENCO-PANI。在来自4个国家的12个中心确定了20名患者。多数为男性（12/20），11/20为右侧原发肿瘤，5/20为dMMR/MSI。中位年龄66岁，85%为二线治疗，15%为三线治疗；19例患者开始使用ENCO-CET并切换到ENCO-PANI（第2或3周期），1例患者由于患者的选择而提前接受了ENCO-PANI。有效率25%，疾病控制率85%。中位无进展生存期为6.2个月，中位总生存期为11个月。ENCO-PANI期间不良事件（ae）发生在15/20，以G1-G2居多。没有新的IRRs和中毒死亡报告。ENCO-PANI在BRAFm mCRC无法继续CET治疗的患者中似乎是安全有效的，可能是这种情况下有效的替代治疗选择。

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引用次数: 0

Hematologic focal hepatic lesions in the absence of liver cirrhosis: Consider lymphoma and myeloma 没有肝硬化的血液局灶性肝脏病变：考虑淋巴瘤和骨髓瘤。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-16 DOI: 10.1016/j.clinre.2025.102749

Daniela Tirotta , Claudia Lena , Mario Torre , Paolo Muratori

Background

Solitary liver lesions in patients without underlying liver disease or elevated tumor markers (AFP, CEA, CA19-9) are uncommon and can represent hematologic malignancies, including primary hepatic lymphoma (PHL) and, more rarely, hepatic involvement by multiple myeloma. Early recognition is crucial to guide appropriate management and avoid unnecessary surgery.

Methods

A systematic literature review was conducted using PubMed, Scopus, and Google Scholar up to August 2025. Search terms included “primary hepatic lymphoma,” “hepatic plasmacytoma,” “multiple myeloma liver involvement,” and “solitary liver lesion.” Articles reporting epidemiology, clinical presentation, imaging characteristics, histopathology, and management of solitary hepatic lesions due to lymphoma or myeloma were included.

Results

Hematologic hepatic solitary lesions typically present as hypodense lesions on CT or hypointense on T1-weighted MRI with variable enhancement. Clinical manifestations are often nonspecific, including mild hepatomegaly or abdominal discomfort, while liver function tests are frequently normal. Definitive diagnosis relies on histopathology via biopsy. Management strategies differ: chemotherapy is first-line for lymphoma, whereas myeloma-related hepatic lesions may require systemic therapy or, rarely, surgical resection if diagnosis is uncertain.

Conclusions

In patients with solitary liver lesions, normal tumor markers, and no chronic liver disease, clinicians should maintain a high index of suspicion for hematologic malignancies. Accurate imaging assessment and tissue diagnosis are essential for optimal treatment planning.

背景：没有潜在肝脏疾病或肿瘤标志物（AFP， CEA, CA19-9）升高的患者的孤立性肝脏病变并不常见，可能代表血液系统恶性肿瘤，包括原发性肝淋巴瘤（PHL），更罕见的是多发性骨髓瘤累及肝脏。早期识别是指导适当治疗和避免不必要手术的关键。方法：采用截至2025年8月的PubMed、Scopus、谷歌Scholar进行系统文献综述。搜索词包括“原发性肝淋巴瘤”、“肝浆细胞瘤”、“累及肝脏的多发性骨髓瘤”和“孤立性肝脏病变”。文章报道流行病学，临床表现，影像学特征，组织病理学，和处理孤立性肝脏病变淋巴瘤或骨髓瘤纳入。结果：肝脏孤立性血液学病变在CT上表现为低密度病变，在t1加权MRI上表现为低密度病变，增强程度不一。临床表现通常是非特异性的，包括轻度肝肿大或腹部不适，而肝功能检查通常正常。最终诊断依赖于组织病理学活检。治疗策略各不相同：化疗是淋巴瘤的一线治疗，而骨髓瘤相关的肝脏病变可能需要全身治疗，如果诊断不确定，很少需要手术切除。结论：对于孤立性肝脏病变、肿瘤标志物正常、无慢性肝病的患者，临床医生应保持对血液系统恶性肿瘤的高度怀疑。准确的影像评估和组织诊断对于最佳治疗计划至关重要。

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引用次数: 0

Creating and validating an anastomotic leakage risk prediction model after laparoscopic low anterior resection for rectal cancer 腹腔镜直肠癌低位前切除术后吻合口漏风险预测模型的建立与验证。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-13 DOI: 10.1016/j.clinre.2025.102745

Wenqiang Li , Susu Zhou , Qikai Zhong , Luqiao Huang , Ning Li , Chengyu Sun , Liang Zhang , Zhengguo Zhang

Purpose

Anastomotic leakage (AL) is a serious complication after rectal cancer surgery, and there is still a lack of effective prediction tools. This study aims to provide a basis for the development of individualized AL prevention plans.

Methods

585 patients who underwent laparoscopic low anterior resection for rectal cancer in Xuzhou Central Hospital from 2019 to 2023 were retrospectively enrolled and randomly divided into a training set (410 cases) and a validation set (175 cases). Predictors were screened by LASSO regression, and a nomogram prediction model based on logistic regression was constructed. The area under the curve (AUC), calibration curve, decision curve and clinical impact curve were used to evaluate the model performance.

Results

The incidence of AL was approximately 13 % (76/585). According to LASSO regression, 8 predictors were identified: male gender, larger tumor diameter, a shorter distance between the tumor's lower margin and the anal verge, non-preservation of the left colic artery during surgery, preoperative neoadjuvant therapy, higher levels of carbohydrate antigen 19–9, no preventive stoma, and prolonged operative time. The AUC of the model in the training set and validation set was 0.745 (95 % CI: 0.675–0.814) and 0.733 (95 % CI: 0.606–0.859), respectively, and the calibration and clinical practicality were also favorable.

Conclusions

The prediction model is relatively accurate and can provide a basis for the formulation of individualized AL prevention strategies.

目的：吻合口漏（AL）是直肠癌术后的严重并发症，目前仍缺乏有效的预测工具。本研究旨在为制定个体化AL预防方案提供依据。方法：回顾性纳入2019 - 2023年在徐州市中心医院行腹腔镜直肠癌低位前切除术的585例患者，随机分为训练组（410例）和验证组（175例）。采用LASSO回归筛选预测因子，构建基于logistic回归的nomogram预测模型。采用曲线下面积（AUC）、校正曲线、决策曲线和临床影响曲线评价模型的性能。结果：AL的发生率约为13%（76/585）。通过LASSO回归，确定了8个预测因素：男性、肿瘤直径较大、肿瘤下缘与肛缘距离较短、术中未保留左结肠动脉、术前新辅助治疗、碳水化合物抗原19-9水平较高、无预防性造口、手术时间延长。该模型在训练集和验证集的AUC分别为0.745 （95% CI: 0.675-0.814）和0.733 (95% CI: 0.606-0.859)，校准和临床实用性也较好。结论：该预测模型较为准确，可为制定个体化AL预防策略提供依据。

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引用次数: 0

Low muscle density and five times sit-to-stand test predict poor outcome in liver transplant candidates 低肌肉密度和5次坐立试验预测肝移植候选人预后不良。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-10 DOI: 10.1016/j.clinre.2025.102743

Maxence Lepour , Alicia Delorme , Alexis Goffaux , Pierre Trefois , Elodie Dubois , Caroline Catoul , Frédéric Braem , David de Azevedo , Alix Collard , Nicolas Lanthier , Geraldine Dahlqvist

Background

Muscle-related parameters (myopenia, sarcopenia, myosteatosis, frailty) are linked to increased mortality in liver transplant candidates but have not been prospectively compared in the same cohort.

Aim

This study aimed to identify the most accurate muscle predictor of morbidity and mortality in patients with cirrhosis on the liver transplant waiting list.

Methods

A prospective, single-center study included all consenting adult liver transplant candidates from June 2021 to October 2023. Skeletal muscle mass index, muscle density, and myosteatosis were assessed via computed tomography at third lumbar vertebrae. Frailty was evaluated using the liver frailty index and the 6-minute walk test.

Results

Among 194 screened patients, 135 were listed for transplant, including 108 with cirrhosis. Alcohol-related liver disease was the leading etiology, 47 % were listed for hepatocellular carcinoma. Myopenia was present in 31 %, myosteatosis in 34 %, and 20 % were frail. One-year survival was 82 %. Myosteatosis was the strongest univariate predictor of mortality, but in multivariate analysis, the five times sit to stand test was the best predictor of morbi-mortality.

Conclusion

The five times sit to stand test emerged as the most robust predictor in multivariate analysis. Its simplicity and reliability make it a valuable tool for identifying high-risk patients on the liver transplant waiting list.

背景：在肝移植候选者中，肌肉相关参数（肌减少症、肌肉减少症、肌骨增生症、虚弱）与死亡率增加有关，但尚未在同一队列中进行前瞻性比较。目的：本研究旨在确定肝移植等待名单上肝硬化患者发病率和死亡率最准确的肌肉预测因子。方法：一项前瞻性单中心研究纳入了2021年6月至2023年10月期间所有同意的成人肝移植候选人。通过第三腰椎计算机断层扫描评估骨骼肌质量指数、肌肉密度和骨骼肌骨化症。使用肝衰弱指数和6分钟步行试验来评估衰弱程度。结果：194例患者中，135例被列入移植名单，其中肝硬化患者108例。酒精相关性肝病是主要病因，47%被列为肝细胞癌。31%的患者有肌肉萎缩，34%的患者有肌骨化症，20%的患者身体虚弱。一年生存率为82%。肌骨化病是死亡率最强的单因素预测因子，但在多因素分析中，5次坐位测试是发病率-死亡率的最佳预测因子。结论：在多变量分析中，5次坐站立检验是最可靠的预测因子。它的简单性和可靠性使其成为识别肝移植等待名单上高危患者的宝贵工具。

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引用次数: 0

Physiology-guided albumin therapy in decompensated cirrhosis: the expanding role of point-of-care ultrasound 生理引导的白蛋白治疗在失代偿期肝硬化：点护理超声的扩大作用。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-09 DOI: 10.1016/j.clinre.2025.102744

Froylan D Martínez-Sánchez , David Aguirre-Villarreal , Eduardo R Argaiz , Luis A Rosales-Rentería , Mario AJ Leal-Villarreal , Ignacio García-Juárez

Point-of-care ultrasound (POCUS) enables physiology-guided hemodynamic assessment in decompensated cirrhosis, moving beyond protocolized albumin use toward individualized therapy. By integrating IVC/IJV indices, lung ultrasound, and intrarenal venous Doppler, clinicians can tailor albumin and vasopressor strategies to fluid tolerance, potentially improving AKI reversal while limiting overload. We outline a pragmatic bedside framework to operationalize POCUS-guided albumin management in routine hepatology practice.

即时超声（POCUS）能够在失代偿期肝硬化中进行生理引导的血流动力学评估，使白蛋白的使用超越了方案化的使用，向个体化治疗迈进。通过整合IVC/IJV指数、肺超声和肾内静脉多普勒，临床医生可以根据液体耐受性量身定制白蛋白和血管加压策略，在限制负荷的同时潜在地改善AKI逆转。我们概述了一个实用的床边框架，在常规肝病实践中实施pocuss指导的白蛋白管理。

引用次数: 0

Five-year effectiveness of either ustekinumab or vedolizumab in 239 patients with Crohn's disease refractory to anti-tumour necrosis factor ustekinumab或vedolizumab在239例抗肿瘤坏死因子难治性克罗恩病患者中的5年疗效

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-05 DOI: 10.1016/j.clinre.2025.102741

Aurélien Amiot , Julien Kirchgesner , Hadrien Alric , Xavier Tréton , Mathieu Uzzan , Nassim Hammoudi , Matthieu Allez , Clément Bresteau , Yoram Bouhnik , Philippe Seksik , Franck Carbonnel , Antoine Meyer

Background

There are still conflicting data about superiority of ustekinumab over vedolizumab in patients with Crohn’s disease (CD) who failed anti-tumour necrosis factor (anti-TNF).

Aim

To compare the 5-year effectiveness and safety of ustekinumab and vedolizumab in patients with CD who failed anti-TNF in a multicentre retrospective observational cohort.

Methods

This is a retrospective cohort study including all consecutive patients with CD refractory or intolerant to anti-TNF who initiated either vedolizumab or ustekinumab between May 2014 and August 2018. Steroid-free clinical remission, clinical remission and treatment persistence were assessed at year 2, 3 and 5 with intention-to-treat analysis and propensity scores weighted logistic models.

Results

A total of 239 patients were included, 107 received ustekinumab and 132 vedolizumab. At year 5, ustekinumab was associated with a higher rate of steroid-free clinical remission (41.2% vs 20.5%; odds ratio 2.72 [1.43–5.18]) and treatment persistence (46.8% vs 22.5%; OR 3.03 [1.63–5.63]) than vedolizumab but not the rate of CD-related intestinal surgery. Superiority of ustekinumab was more pronounced in patients with ileal CD, stricturing or penetrating behaviour, and history of intestinal CD-related surgery. Patients treated with ustekinumab, were associated with higher treatment persistence compared to patients treated with vedolizumab with low (p < 0.001) or intermediate (p < 0.001) but not with those with high vedolizumab CDST (p = 0.95).

Conclusion

In this study, ustekinumab was associated with higher rate of steroid-free clinical remission and treatment persistence than vedolizumab after 5 years of follow-up, particularly in patients with ileal CD, stricturing or penetrating behaviour and history of CD-related intestinal surgery.

背景：对于抗肿瘤坏死因子（anti-TNF）治疗失败的克罗恩病（CD）患者，ustekinumab优于vedolizumab的数据仍然存在矛盾。目的：在多中心回顾性观察队列中比较ustekinumab和vedolizumab在抗tnf失败的CD患者中的5年有效性和安全性。方法：这是一项回顾性队列研究，包括2014年5月至2018年8月期间接受维多单抗或ustekinumab治疗的所有连续的CD难治性或抗tnf不耐受患者。使用意向治疗分析和倾向得分加权logistic模型，在第2、3和5年评估无类固醇临床缓解、临床缓解和治疗持续性。结果：共纳入239例患者，其中ustekinumab治疗107例，vedolizumab治疗132例。在第5年，与维多单抗相比，ustekinumab与更高的无类固醇临床缓解率（41.2% vs 20.5%；比值比2.72[1.43-5.18]）和治疗持久性（46.8% vs 22.5%; OR 3.03[1.63-5.63]）相关，但与cd相关肠道手术率无关。ustekinumab的优势在回肠CD、狭窄或穿透行为以及肠道CD相关手术史的患者中更为明显。结论：在这项研究中，经过5年的随访，ustekinumab与vedolizumab相比具有更高的无类固醇临床缓解率和治疗持久性，特别是在回肠CD，狭窄或穿透行为以及CD相关肠道手术史的患者中。

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引用次数: 0

Comparison of rectal indomethacin and diclofenac for post ERCP pancreatitis prophylaxis: A single center study 直肠吲哚美辛和双氯芬酸用于ERCP后胰腺炎预防的比较：单中心研究。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-12-05 DOI: 10.1016/j.clinre.2025.102742

Hüseyin Köseoğlu , Berkant Bebek , Tolga Düzenli

Background

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed invasive procedure, with post-ERCP pancreatitis (PEP) being the most frequent and clinically significant complication. Rectal non-steroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac and indomethacin, have been shown to reduce the incidence of PEP. However, real-world data comparing their efficacy remains limited. This study aimed to compare the efficacy of rectal diclofenac and indomethacin in preventing PEP among patients undergoing ERCP and to identify patient subgroups that may benefit more from one drug over the other.

Methods

A single-center, retrospective observational study was conducted, analyzing ERCP procedures. A total of 2344 procedures were evaluated, whereas 767 patients were included after exclusion of whom 322 received rectal indomethacin and 445 received rectal diclofenac. The primary outcome was the incidence of PEP, while secondary outcomes included post-ERCP bleeding, cardiorespiratory complications, and other adverse events. Subgroup analyses were performed to evaluate the effectiveness of each drug based on clinical risk factors.

Results

The overall incidence of PEP was 6.6%, with approaching but not reaching significant difference between the indomethacin (8.7%) and diclofenac (5.2%) groups (p = 0.057). Subgroup analyses revealed that diclofenac was more effective in preventing PEP in patients with a naive papilla undergoing sphincterotomy (p = 0.048).

Conclusions

This study suggests that rectal diclofenac may offer a slight advantage over indomethacin in preventing PEP, particularly in high-risk groups, such as patients undergoing sphincterotomy; which was not previously published in the existing literature.

背景：内窥镜逆行胰胆管造影（ERCP）是一种常用的侵入性手术，ERCP后胰腺炎（PEP）是最常见的临床并发症。直肠非甾体抗炎药（NSAIDs），特别是双氯芬酸和吲哚美辛，已被证明可以降低PEP的发生率。然而，比较它们疗效的真实数据仍然有限。本研究旨在比较直肠双氯芬酸和吲哚美辛在ERCP患者中预防PEP的疗效，并确定可能从一种药物中获益更多的患者亚组。方法：采用单中心回顾性观察研究，分析ERCP程序。共有2344种治疗方法被评估，而767例患者在排除后被纳入，其中322例接受直肠吲哚美辛治疗，445例接受直肠双氯芬酸治疗。主要结局是PEP的发生率，次要结局包括ercp后出血、心肺并发症和其他不良事件。根据临床危险因素进行亚组分析，评价各药物的疗效。结果：PEP总发生率为6.6%，吲哚美辛组（8.7%）与双氯芬酸组（5.2%）差异接近但未达到显著性（p = 0.057）。亚组分析显示，双氯芬酸在接受括约肌切开术的初次乳头患者中预防PEP更有效（p = 0.048）。结论：本研究表明，直肠双氯芬酸在预防PEP方面可能比吲哚美辛有轻微的优势，特别是在高危人群中，如接受括约肌切开术的患者；这是之前没有在现有文献中发表的。

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引用次数: 0