Jun Takada, Yukari Uno, Koji Yamashita, Masamichi Arao, Masaya Kubota, Takashi Ibuka, Hiroshi Araki, Masahito Shimizu
Background: Cecal intubation during colonoscopy is difficult to achieve in patients with severe sigmoid adhesions. This retrospective observational study assessed the efficacy of using a gastroscope for colonoscopy in patients with severe sigmoid adhesions. Furthermore, the ability of computed tomography (CT) to predict the possibility of cecal intubation using a gastroscope was examined.
Methods: A total of 1,626 patients who underwent colonoscopy for total colon observation by one endoscopist were enrolled. Cecal intubation rate and other procedure-related outcomes were evaluated. We also investigated whether identification of the sigmoid colon pathway by CT was involved in cecal intubation rate using a gastroscope.
Results: Of the enrolled patients, cecal intubation by colonoscope was not feasible in 19 patients (1.2%) because of severe sigmoid adhesions. Cecal intubation was possible in 13 patients (68.4%) using a gastroscope, and the cecal intubation rate of peritoneal carcinomatosis (0%, p < 0.01) was significantly lower than that of other causes such as a diverticulum (100%) and history of gynecologic surgery (80%). The identifiable case of the sigmoid colon pathway by horizontal section on CT showed significantly higher cecal intubation rate compared to those of unidentifiable cases (92.3% vs. 16.7%, p < 0.01).
Conclusion: Using a gastroscope is effective in performing cecal intubation during colonoscopy in patients with severe sigmoid adhesions. However, in patients with sigmoid adhesions caused by peritoneal carcinomatosis, cecal intubation may be difficult, even when a gastroscope is used. The ability of CT to identify the sigmoid colon pathway may predict success of cecal intubation.
背景:严重乙状结肠粘连患者在结肠镜检查时难以实现盲肠插管。这项回顾性观察性研究评估了在严重乙状结肠粘连患者中使用胃镜进行结肠镜检查的疗效。此外,计算机断层扫描(CT)的能力,以预测盲肠插管的可能性使用胃镜进行了检查。方法:共纳入1626例由一名内镜医师行结肠镜检查观察全结肠的患者。评估盲肠插管率和其他手术相关结果。我们还研究了CT对乙状结肠路径的识别是否与胃镜下盲肠插管率有关。结果:在纳入的患者中,由于严重的乙状结肠粘连,19例(1.2%)患者无法通过结肠镜进行盲肠插管。13例(68.4%)患者在胃镜下可行盲肠插管,其中腹膜癌的盲肠插管率(0%,p < 0.01)明显低于憩室(100%)和有妇科手术史(80%)等其他原因的盲肠插管率。在CT水平切片上发现乙状结肠通道的病例,盲肠插管率明显高于未发现病例(92.3% vs. 16.7%, p < 0.01)。结论:在严重乙状结肠粘连的结肠镜下行盲肠插管是有效的。然而,在腹膜癌引起乙状结肠粘连的患者中,即使使用胃镜,盲肠插管也可能很困难。CT识别乙状结肠通路的能力可以预测盲肠插管的成功。
{"title":"Efficacy of a Gastroscope for Cecal Intubation during Colonoscopy in Patients with Severe Sigmoid Adhesion.","authors":"Jun Takada, Yukari Uno, Koji Yamashita, Masamichi Arao, Masaya Kubota, Takashi Ibuka, Hiroshi Araki, Masahito Shimizu","doi":"10.1159/000528449","DOIUrl":"https://doi.org/10.1159/000528449","url":null,"abstract":"<p><strong>Background: </strong>Cecal intubation during colonoscopy is difficult to achieve in patients with severe sigmoid adhesions. This retrospective observational study assessed the efficacy of using a gastroscope for colonoscopy in patients with severe sigmoid adhesions. Furthermore, the ability of computed tomography (CT) to predict the possibility of cecal intubation using a gastroscope was examined.</p><p><strong>Methods: </strong>A total of 1,626 patients who underwent colonoscopy for total colon observation by one endoscopist were enrolled. Cecal intubation rate and other procedure-related outcomes were evaluated. We also investigated whether identification of the sigmoid colon pathway by CT was involved in cecal intubation rate using a gastroscope.</p><p><strong>Results: </strong>Of the enrolled patients, cecal intubation by colonoscope was not feasible in 19 patients (1.2%) because of severe sigmoid adhesions. Cecal intubation was possible in 13 patients (68.4%) using a gastroscope, and the cecal intubation rate of peritoneal carcinomatosis (0%, p < 0.01) was significantly lower than that of other causes such as a diverticulum (100%) and history of gynecologic surgery (80%). The identifiable case of the sigmoid colon pathway by horizontal section on CT showed significantly higher cecal intubation rate compared to those of unidentifiable cases (92.3% vs. 16.7%, p < 0.01).</p><p><strong>Conclusion: </strong>Using a gastroscope is effective in performing cecal intubation during colonoscopy in patients with severe sigmoid adhesions. However, in patients with sigmoid adhesions caused by peritoneal carcinomatosis, cecal intubation may be difficult, even when a gastroscope is used. The ability of CT to identify the sigmoid colon pathway may predict success of cecal intubation.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9542040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Although the involvement of circular RNA Circ_0071662 in bladder cancer and esophageal cancer has been reported, its role in hepatocellular carcinoma (HCC) is unclear. The presented research aimed to study its role in HCC.
Methods: This study enrolled 60 HCC patients (advanced stage), 60 hepatic angiomyolipoma patients, 60 liver abscess patients, 60 hypertrophic cardiomyopathy patients, 60 focal nodular hyperplasia patients, and 60 healthy controls (HCs). Plasma samples were obtained from all participants prior to treatment. HCC and paired nontumor samples were collected from HCC patients. HCC patients received radiotherapy and plasma samples were also collected after treatment. Gene expression was analyzed by RT-qPCR. The role of Circ_0071662 in the diagnosis of HCC was evaluated by ROC curve analysis.
Results: Compared to HCs, decreased plasma expression levels of Circ_0071662 were only observed in HCC patients, but not in other patient groups. HCC tissues also exhibited decreased expression levels of Circ_0071662 compared to that in nontumor samples. Decreased plasma expression levels of Circ_0071662 separated HCC patients from HCs and other patient groups. After radiotherapy, 28 patients developed radioresistance (RR) and the rest showed no RR. Decreased plasma expression levels of Circ_0071662 were closely associated with patients' poor survival. Compared to pretreatment level, decreased plasma expression levels of Circ_0071662 were only observed in RR group. The expression levels of Circ_0071662 in plasma and tissues were closely associated with patients' tumor metastasis and tumor size.
Conclusion: Circ_0071662 was downregulated in HCC and may serve as a potential biomarker to improve the diagnosis of HCC. Moreover, downregulation of Circ_0071662 is likely correlated to the development of radioresistance.
{"title":"Application of Circular RNA Circ_0071662 in the Diagnosis and Prognosis of Hepatocellular Carcinoma and Its Response to Radiotherapy.","authors":"Xingwei Wang, Jing Zhang, Fang Luo, Yaolin Shen","doi":"10.1159/000527696","DOIUrl":"https://doi.org/10.1159/000527696","url":null,"abstract":"<p><strong>Background: </strong>Although the involvement of circular RNA Circ_0071662 in bladder cancer and esophageal cancer has been reported, its role in hepatocellular carcinoma (HCC) is unclear. The presented research aimed to study its role in HCC.</p><p><strong>Methods: </strong>This study enrolled 60 HCC patients (advanced stage), 60 hepatic angiomyolipoma patients, 60 liver abscess patients, 60 hypertrophic cardiomyopathy patients, 60 focal nodular hyperplasia patients, and 60 healthy controls (HCs). Plasma samples were obtained from all participants prior to treatment. HCC and paired nontumor samples were collected from HCC patients. HCC patients received radiotherapy and plasma samples were also collected after treatment. Gene expression was analyzed by RT-qPCR. The role of Circ_0071662 in the diagnosis of HCC was evaluated by ROC curve analysis.</p><p><strong>Results: </strong>Compared to HCs, decreased plasma expression levels of Circ_0071662 were only observed in HCC patients, but not in other patient groups. HCC tissues also exhibited decreased expression levels of Circ_0071662 compared to that in nontumor samples. Decreased plasma expression levels of Circ_0071662 separated HCC patients from HCs and other patient groups. After radiotherapy, 28 patients developed radioresistance (RR) and the rest showed no RR. Decreased plasma expression levels of Circ_0071662 were closely associated with patients' poor survival. Compared to pretreatment level, decreased plasma expression levels of Circ_0071662 were only observed in RR group. The expression levels of Circ_0071662 in plasma and tissues were closely associated with patients' tumor metastasis and tumor size.</p><p><strong>Conclusion: </strong>Circ_0071662 was downregulated in HCC and may serve as a potential biomarker to improve the diagnosis of HCC. Moreover, downregulation of Circ_0071662 is likely correlated to the development of radioresistance.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9552984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haitao Shi, Hong Zeng, Mei Wang, Jiong Jiang, Sumei Sha, Fenrong Chen, Yan Wang, Yan Cheng, Shiyang Ma, Xin Liu
Background: Studies have found that water-assisted colonoscopy (WAC) including water immersion colonoscopy (WIC) and water exchange colonoscopy (WEC) is superior to air insufflation colonoscopy (AIC) in terms of the cecal intubation rate. However, the application of WAC in ulcerative colitis (UC) has rarely been reported. This study aimed to explore the effectiveness of WAC without sedation in patients with UC.
Methods: One hundred and seventy-two UC patients were randomly divided into the AIC group (n = 56), WIC group (n = 58), and WEC group (n = 58). The cecal intubation rate, abdominal pain score, operator difficulty, bowel cleanliness, insertion, and total time were compared.
Results: The cecal intubation rate was higher in the WIC (91.4% vs. 75.0%; mean difference = 16.4%; 95% CI: 3.0-29.8%) and WEC (93.1% vs. 75.0%; mean difference = 18.1%; 95% CI: 5.0-31.2%) compared to the AIC group, while there was no difference between the WIC and WEC groups. The abdominal pain score and operator difficulty were lower in the WIC and WEC groups than in the AIC group, while there was no difference between the WIC and WEC groups. The bowel cleanliness during withdrawal was higher in the WIC and WEC groups than in the AIC group, while the WEC was superior to WIC. Compared with the AIC and WIC groups, the insertion time and total time were longer in the WEC group, and there was no difference in the AIC group and WIC group.
Conclusion: In comparison with AIC, WAC can increase the cecal intubation rate, reduce abdominal pain scores and improve bowel cleanliness in patients with UC.
背景:研究发现水辅助结肠镜(WAC)包括水浸结肠镜(WIC)和水交换结肠镜(WEC)在盲肠插管率方面优于空气充气结肠镜(AIC)。然而,WAC在溃疡性结肠炎(UC)中的应用鲜有报道。本研究旨在探讨不加镇静的WAC在UC患者中的有效性。方法:将172例UC患者随机分为AIC组(n = 56)、WIC组(n = 58)和WEC组(n = 58)。比较盲肠插管率、腹痛评分、操作难度、肠道清洁度、插管时间和总时间。结果:WIC组盲肠插管率较高(91.4% vs. 75.0%;平均差值= 16.4%;95% CI: 3.0-29.8%)和WEC (93.1% vs. 75.0%;平均差值= 18.1%;95% CI: 5.0-31.2%)与AIC组相比,而WIC组与WEC组之间无差异。WIC组和WEC组腹痛评分和操作难度均低于AIC组,而WIC组和WEC组之间无差异。WIC组和WEC组停药期间肠道清洁度高于AIC组,而WEC组优于WIC组。与AIC和WIC组相比,WEC组的插入时间和总时间更长,AIC组与WIC组无差异。结论:与AIC相比,WAC可提高UC患者盲肠插管率,降低腹痛评分,改善肠道清洁度。
{"title":"Effectiveness of Water-Assisted Colonoscopy without Sedation in Patients with Ulcerative Colitis.","authors":"Haitao Shi, Hong Zeng, Mei Wang, Jiong Jiang, Sumei Sha, Fenrong Chen, Yan Wang, Yan Cheng, Shiyang Ma, Xin Liu","doi":"10.1159/000531652","DOIUrl":"https://doi.org/10.1159/000531652","url":null,"abstract":"<p><strong>Background: </strong>Studies have found that water-assisted colonoscopy (WAC) including water immersion colonoscopy (WIC) and water exchange colonoscopy (WEC) is superior to air insufflation colonoscopy (AIC) in terms of the cecal intubation rate. However, the application of WAC in ulcerative colitis (UC) has rarely been reported. This study aimed to explore the effectiveness of WAC without sedation in patients with UC.</p><p><strong>Methods: </strong>One hundred and seventy-two UC patients were randomly divided into the AIC group (n = 56), WIC group (n = 58), and WEC group (n = 58). The cecal intubation rate, abdominal pain score, operator difficulty, bowel cleanliness, insertion, and total time were compared.</p><p><strong>Results: </strong>The cecal intubation rate was higher in the WIC (91.4% vs. 75.0%; mean difference = 16.4%; 95% CI: 3.0-29.8%) and WEC (93.1% vs. 75.0%; mean difference = 18.1%; 95% CI: 5.0-31.2%) compared to the AIC group, while there was no difference between the WIC and WEC groups. The abdominal pain score and operator difficulty were lower in the WIC and WEC groups than in the AIC group, while there was no difference between the WIC and WEC groups. The bowel cleanliness during withdrawal was higher in the WIC and WEC groups than in the AIC group, while the WEC was superior to WIC. Compared with the AIC and WIC groups, the insertion time and total time were longer in the WEC group, and there was no difference in the AIC group and WIC group.</p><p><strong>Conclusion: </strong>In comparison with AIC, WAC can increase the cecal intubation rate, reduce abdominal pain scores and improve bowel cleanliness in patients with UC.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10214018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Johannes Heymer, Florian Dengler, Alexander Krohn, Christina Jaki, Tobias Schilling, Martina Mueller-Schilling, Arne Kandulski, Matthias Ott
Background and aims: Aerosols and droplets are the main vectors in transmission of highly contagious SARS-CoV-2. Invasive diagnostic procedures like upper airway and gastrointestinal endoscopy have been declared as aerosol-generating procedures. Protection of healthcare workers is crucial in times of the COVID-19 pandemic.
Methods: We simulated aerosol and droplet spread during upper airway and gastrointestinal endoscopy with and without physico-mechanical barriers using a simulation model.
Results: A clear plastic drape as used for central venous access markedly reduced visualized aerosol and droplet spread during endoscopy.
Conclusion: A simple and cheap drape has the potential to reduce aerosol and droplet spread during endoscopy. In terms of healthcare worker protection, this may be important particularly in low- or moderate-income countries.
{"title":"Simulation of Aerosol and Droplet Spread during Upper Airway and Gastrointestinal Endoscopy.","authors":"Johannes Heymer, Florian Dengler, Alexander Krohn, Christina Jaki, Tobias Schilling, Martina Mueller-Schilling, Arne Kandulski, Matthias Ott","doi":"10.1159/000525482","DOIUrl":"https://doi.org/10.1159/000525482","url":null,"abstract":"<p><strong>Background and aims: </strong>Aerosols and droplets are the main vectors in transmission of highly contagious SARS-CoV-2. Invasive diagnostic procedures like upper airway and gastrointestinal endoscopy have been declared as aerosol-generating procedures. Protection of healthcare workers is crucial in times of the COVID-19 pandemic.</p><p><strong>Methods: </strong>We simulated aerosol and droplet spread during upper airway and gastrointestinal endoscopy with and without physico-mechanical barriers using a simulation model.</p><p><strong>Results: </strong>A clear plastic drape as used for central venous access markedly reduced visualized aerosol and droplet spread during endoscopy.</p><p><strong>Conclusion: </strong>A simple and cheap drape has the potential to reduce aerosol and droplet spread during endoscopy. In terms of healthcare worker protection, this may be important particularly in low- or moderate-income countries.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10608267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ulf Helwig, Thomas Helmut Krause, Christian Maaser, Jürgen Büning, Attyla Drabik, Margit Blömacher, Sandra Plachta-Danielzik, Niels Teich, Annette Krummenerl, Andreas Sturm, Matthias Schwab, Stefan Schreiber
Background: The therapeutic goal of clinical remission in patients with moderate to severe ulcerative colitis (UC) is achieved after biological therapy only in 16-39%. Individualization of therapeutic intervention would benefit from prediction of early response.
Study objective: The primary objective of our study was to assess golimumab (GLM) trough serum level of ≥2.5 μg/mL in combination with a reduction of faecal calprotectin (FC) of ≥50% at week 6 compared to baseline to predict clinical response at week 26 after regular GLM intake.
Methods: Patients with moderate to severe active UC and planned GLM treatment were recruited for a prospective, multicentre, observational study in Germany. Prediction of clinical response was assessed by FC and GLM trough level. Missing data were imputed as therapy failure according to the last observation carried forward method.
Results: Fifty nine patients have been enrolled. 54% of patients were anti-TNF naïve. Clinical response at week 6 was a significant predictor for achieving clinical response at week 26 (odds ratio [OR] 10.97, confidence interval [CI], 2.96-40.68; p < 0.001). Moreover, patients with a GLM trough level of ≥2.5 μg/mL and a ≥50% reduction of FC at week 6 had an OR of 5.33 (95% CI, 0.59-47.84) to achieve clinical response at week 26.
Conclusion: Clinical response at week 6 is the best predictive marker for achieving clinical response at week 26. Consideration of significant reduction of FC and trough GLM serum levels could improve prediction of response.
{"title":"Early MOnitoring of REsponse (MORE) to Golimumab Therapy: Results of a Multicentre, Prospective Observational Trial.","authors":"Ulf Helwig, Thomas Helmut Krause, Christian Maaser, Jürgen Büning, Attyla Drabik, Margit Blömacher, Sandra Plachta-Danielzik, Niels Teich, Annette Krummenerl, Andreas Sturm, Matthias Schwab, Stefan Schreiber","doi":"10.1159/000527460","DOIUrl":"https://doi.org/10.1159/000527460","url":null,"abstract":"<p><strong>Background: </strong>The therapeutic goal of clinical remission in patients with moderate to severe ulcerative colitis (UC) is achieved after biological therapy only in 16-39%. Individualization of therapeutic intervention would benefit from prediction of early response.</p><p><strong>Study objective: </strong>The primary objective of our study was to assess golimumab (GLM) trough serum level of ≥2.5 μg/mL in combination with a reduction of faecal calprotectin (FC) of ≥50% at week 6 compared to baseline to predict clinical response at week 26 after regular GLM intake.</p><p><strong>Methods: </strong>Patients with moderate to severe active UC and planned GLM treatment were recruited for a prospective, multicentre, observational study in Germany. Prediction of clinical response was assessed by FC and GLM trough level. Missing data were imputed as therapy failure according to the last observation carried forward method.</p><p><strong>Results: </strong>Fifty nine patients have been enrolled. 54% of patients were anti-TNF naïve. Clinical response at week 6 was a significant predictor for achieving clinical response at week 26 (odds ratio [OR] 10.97, confidence interval [CI], 2.96-40.68; p < 0.001). Moreover, patients with a GLM trough level of ≥2.5 μg/mL and a ≥50% reduction of FC at week 6 had an OR of 5.33 (95% CI, 0.59-47.84) to achieve clinical response at week 26.</p><p><strong>Conclusion: </strong>Clinical response at week 6 is the best predictive marker for achieving clinical response at week 26. Consideration of significant reduction of FC and trough GLM serum levels could improve prediction of response.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10835317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Saleh, Shyon Parsa, Manuel Garza, Eamonn M M Quigley, Bincy P Abraham
Background: Considerable research supports an important role for the microbiome and/or microbiome-host immune system interactions in the pathogenesis of inflammatory bowel disease (IBD). Consequently, microbiota-modulating interventions, such as fecal microbiota transplantation (FMT), have attracted interest in the management of IBD, including ulcerative colitis (UC).
Summary: While the clinical response to FMT in UC has varied between different studies, results to date may offer guidance toward optimal use of FMT. Thus, increased microbiome biodiversity, the presence of short-chain fatty acid-producing bacteria, Clostridium clusters IV and XIVa, Odoribacter splanchnicus, and reduced levels of Caudovirales bacteriophages have been identified as characteristics of the donor microbiome that predict a positive response. However, inconsistency in FMT protocol between studies confounds their interpretation, so it is currently difficult to predict response and premature to recommend FMT, in general, as a treatment for UC. Additional randomized controlled trials designed based on previous findings and employing a standardized protocol are needed to define the role of FMT in the management of UC.
Key messages: There is a well-developed rationale for the use of microbiome-modulating interventions in UC. Despite variations in study protocol and limitations in study design that confound their interpretation, FMT seems to benefit patients with UC, overall. Available data identify factors predicting FMT response and should lead to the development of optimal FMT study protocols.
{"title":"The Role of Fecal Microbiota Transplantation in the Induction of Remission in Ulcerative Colitis.","authors":"Adam Saleh, Shyon Parsa, Manuel Garza, Eamonn M M Quigley, Bincy P Abraham","doi":"10.1159/000529591","DOIUrl":"https://doi.org/10.1159/000529591","url":null,"abstract":"<p><strong>Background: </strong>Considerable research supports an important role for the microbiome and/or microbiome-host immune system interactions in the pathogenesis of inflammatory bowel disease (IBD). Consequently, microbiota-modulating interventions, such as fecal microbiota transplantation (FMT), have attracted interest in the management of IBD, including ulcerative colitis (UC).</p><p><strong>Summary: </strong>While the clinical response to FMT in UC has varied between different studies, results to date may offer guidance toward optimal use of FMT. Thus, increased microbiome biodiversity, the presence of short-chain fatty acid-producing bacteria, Clostridium clusters IV and XIVa, Odoribacter splanchnicus, and reduced levels of Caudovirales bacteriophages have been identified as characteristics of the donor microbiome that predict a positive response. However, inconsistency in FMT protocol between studies confounds their interpretation, so it is currently difficult to predict response and premature to recommend FMT, in general, as a treatment for UC. Additional randomized controlled trials designed based on previous findings and employing a standardized protocol are needed to define the role of FMT in the management of UC.</p><p><strong>Key messages: </strong>There is a well-developed rationale for the use of microbiome-modulating interventions in UC. Despite variations in study protocol and limitations in study design that confound their interpretation, FMT seems to benefit patients with UC, overall. Available data identify factors predicting FMT response and should lead to the development of optimal FMT study protocols.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9809427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rino Richter, Johannes Bruns, Wilfried Obst, Verena Keitel-Anselmino, Jochen Weigt
Background: Artificial intelligence systems recently demonstrated an increase in polyp and adenoma detection rate. Over the daytime, the adenoma detection rate decreases as tiredness leads to a lack of attention. It is not clear if a polyp detection system with artificial intelligence leads to constant adenoma detection over the day.
Methods: We performed a database analysis of screening and surveillance colonoscopies with and without the use of AI. In both groups, patients were investigated with the same endoscopy equipment and by the same endoscopists. Only patients with good bowel preparation (BBPS >6) were included. We correlated the daytime, the investigational time, day of the week, and the adenoma and polyp detection.
Results: A total of 303 colonoscopies were analyzed. 163 endoscopies in the AI+ group and 140 procedures in the AI- group were included. In both groups, the total adenoma detection rate was equal (AI+ 0.39 vs. AI- 0.43). The adenoma detection rate throughout the day had a significant decreasing trend in the group without the use of AI (p = 0.015), whereas this trend was not present in the investigations that have been performed with AI (p = 0.65). The duration of investigation did not show a significant difference between the groups (8.9 min in both groups). No relevant effect was noticed in adenoma detection between single days of the working week with or without the use of AI.
Conclusion: AI helps overcome the decay in adenoma detection over the daytime. This may be attributed to a constant awareness caused by the use of the AI system.
{"title":"Influence of Artificial Intelligence on the Adenoma Detection Rate throughout the Day.","authors":"Rino Richter, Johannes Bruns, Wilfried Obst, Verena Keitel-Anselmino, Jochen Weigt","doi":"10.1159/000528163","DOIUrl":"https://doi.org/10.1159/000528163","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence systems recently demonstrated an increase in polyp and adenoma detection rate. Over the daytime, the adenoma detection rate decreases as tiredness leads to a lack of attention. It is not clear if a polyp detection system with artificial intelligence leads to constant adenoma detection over the day.</p><p><strong>Methods: </strong>We performed a database analysis of screening and surveillance colonoscopies with and without the use of AI. In both groups, patients were investigated with the same endoscopy equipment and by the same endoscopists. Only patients with good bowel preparation (BBPS >6) were included. We correlated the daytime, the investigational time, day of the week, and the adenoma and polyp detection.</p><p><strong>Results: </strong>A total of 303 colonoscopies were analyzed. 163 endoscopies in the AI+ group and 140 procedures in the AI- group were included. In both groups, the total adenoma detection rate was equal (AI+ 0.39 vs. AI- 0.43). The adenoma detection rate throughout the day had a significant decreasing trend in the group without the use of AI (p = 0.015), whereas this trend was not present in the investigations that have been performed with AI (p = 0.65). The duration of investigation did not show a significant difference between the groups (8.9 min in both groups). No relevant effect was noticed in adenoma detection between single days of the working week with or without the use of AI.</p><p><strong>Conclusion: </strong>AI helps overcome the decay in adenoma detection over the daytime. This may be attributed to a constant awareness caused by the use of the AI system.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The objective of this study was to clarify characteristics of metachronous endoscopic curability C2 (eCura C2) cancer during post-endoscopic submucosal dissection (ESD) follow-up.
Methods: Of 4,355 gastric lesions treated by ESD at our hospital during 2005-2021, 657 were metachronous. After excluding lesions found ≥2 years since the prior examination or in the gastric remnant, the remaining 515 were analyzed. Study 1: We compared 35 eCura C2 cancers and 480 eCura A-C1 cancers. Study 2: Endoscopic findings of the 35 lesions were examined to determine why they had been missed.
Results: Mean tumor size was larger (34.0 mm vs. 12.1 mm, p < 0.01) and the proportions of mixed-type and poorly differentiated cancers were higher (highly:mixed:poorly, 34.3:57.1:8.6 vs. 94.2:5.0:0.8, p < 0.01) in the eCura C2 group. Study 2: At the prior examination, 4 lesions were noticed but considered benign, 2 lacked sufficient imaging, 19 were detectable on imaging but missed, and 10 were not detectable on imaging. Over half the lesions that were detectable but missed at the prior examination were in the lesser curvature, many being type IIa-IIb lesions with color similar to the background mucosa. All lesions not detectable on imaging at the prior examination were mixed-type or poorly differentiated type.
Discussion: Metachronous cancer detected as eCura C2 cancers was significantly larger, and a significantly higher proportion was mixed-type or poorly differentiated cancers, compared with eCura A-C1 cancers. Possible reasons why these lesions were missed include rapid progression of mixed-type and poorly differentiated cancers, and poor recognition that lesions showing only slight color changes may be present at the lesser curvature.
简介:本研究的目的是在内镜下粘膜下剥离(ESD)随访期间阐明异时性内镜下可治愈性C2 (eCura C2)癌的特征。方法:我院2005-2021年行ESD治疗的4355例胃病变中,异时性病变657例。在排除前一次检查≥2年或残胃中发现的病变后,对剩余的515例进行分析。研究1:我们比较了35例eCura C2癌和480例eCura A-C1癌。研究2:对35个病变的内镜检查结果进行检查,以确定它们被遗漏的原因。结果:平均肿瘤大小较大(34.0 mm比12.1 mm, p <0.01),混合型和低分化癌的比例更高(高度:混合:低分化,34.3:57.1:8.6比94.2:5.0:0.8,p <0.01)。研究2:在术前检查中,4个病灶被发现但认为是良性的,2个缺乏足够的影像学检查,19个影像学检查可发现但未发现,10个影像学检查未发现。半数以上在先前检查中未被发现的病变位于小弯,许多为IIa-IIb型病变,颜色与背景粘膜相似。所有影像学检查未发现的病变均为混合型或低分化型。讨论:与eCura a - c1癌相比,eCura C2癌检出的异时性癌明显更多,混合型或低分化癌的比例明显更高。这些病变被遗漏的可能原因包括混合型和低分化癌的快速进展,以及对仅显示轻微颜色变化的病变可能存在于小曲率的认识不足。
{"title":"Metachronous Multiple Gastric Cancer Discovered as Endoscopic Curability C2 during Regular Follow-Up after Gastric Endoscopic Submucosal Dissection.","authors":"Kosuke Nomura, Shu Hoteya, Daisuke Kikuchi, Yusuke Kawai, Yorinari Ochiai, Takayuki Okamura, Yugo Suzuki, Junnosuke Hayasaka, Yutaka Mitsunaga, Masami Tanaka, Kazuhiro Fuchinoue, Hiroyuki Odagiri, Satoshi Yamashita, Akira Matsui","doi":"10.1159/000531002","DOIUrl":"https://doi.org/10.1159/000531002","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to clarify characteristics of metachronous endoscopic curability C2 (eCura C2) cancer during post-endoscopic submucosal dissection (ESD) follow-up.</p><p><strong>Methods: </strong>Of 4,355 gastric lesions treated by ESD at our hospital during 2005-2021, 657 were metachronous. After excluding lesions found ≥2 years since the prior examination or in the gastric remnant, the remaining 515 were analyzed. Study 1: We compared 35 eCura C2 cancers and 480 eCura A-C1 cancers. Study 2: Endoscopic findings of the 35 lesions were examined to determine why they had been missed.</p><p><strong>Results: </strong>Mean tumor size was larger (34.0 mm vs. 12.1 mm, p < 0.01) and the proportions of mixed-type and poorly differentiated cancers were higher (highly:mixed:poorly, 34.3:57.1:8.6 vs. 94.2:5.0:0.8, p < 0.01) in the eCura C2 group. Study 2: At the prior examination, 4 lesions were noticed but considered benign, 2 lacked sufficient imaging, 19 were detectable on imaging but missed, and 10 were not detectable on imaging. Over half the lesions that were detectable but missed at the prior examination were in the lesser curvature, many being type IIa-IIb lesions with color similar to the background mucosa. All lesions not detectable on imaging at the prior examination were mixed-type or poorly differentiated type.</p><p><strong>Discussion: </strong>Metachronous cancer detected as eCura C2 cancers was significantly larger, and a significantly higher proportion was mixed-type or poorly differentiated cancers, compared with eCura A-C1 cancers. Possible reasons why these lesions were missed include rapid progression of mixed-type and poorly differentiated cancers, and poor recognition that lesions showing only slight color changes may be present at the lesser curvature.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10160338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-09-13DOI: 10.1159/000533946
Darren Tan, Kai En Chan, Zhen Yu Wong, Cheng Han Ng, Jieling Xiao, Wen Hui Lim, Phoebe Tay, Ansel Tang, Clarissa Elysia Fu, Mark Muthiah, Benjamin Nah, Eunice X Tan, Margaret L P Teng, Mohammad Shadab Siddiqui, Yock Young Dan, Seng Gee Lim, Rohit Loomba, Daniel Q Huang
Introduction: The etiology of liver diseases has changed significantly, but its impact on the comparative burden of cirrhosis between males and females is unclear. We estimated sex differences in the burden of cirrhosis across 204 countries and territories from 2010 to 2019.
Methods: We analyzed temporal trends in the burden of cirrhosis using the methodology framework of the 2019 Global Burden of Disease study. We estimated annual frequencies and age-standardized rates (ASRs) of cirrhosis incidence, death, and disability-adjusted life-years (DALYs) by sex, region, country, and etiology.
Results: In 2019, the frequency of incident cases, deaths, and DALYs due to cirrhosis was 1,206,125, 969,068, and 31,781,079 in males versus 845,429, 502,944, and 14,408,336 in females, respectively. From 2010 to 2019, the frequency of cirrhosis deaths increased by 9% in males and 12% in females. Incidence ASRs remained stable in males but increased in females, while death ASRs declined in both. Death ASRs for both sexes declined in all regions, except in the Americas where they remained stable. In 2019, alcohol was the leading cause of cirrhosis deaths in males, and hepatitis C in females. Death ASRs declined for all etiologies in both sexes, except in nonalcoholic steatohepatitis (NASH). The ratio of female-to-male incidence ASRs in 2019 was lowest in alcohol(0.5), and highest in NASH(1.3), while the ratio of female-to-male death ASRs was lowest in alcohol(0.3) and highest in NASH(0.8).
Conclusion: The global burden of cirrhosis is higher in males. However, incidence and death ASRs from NASH cirrhosis in females are comparable to that of males.
导言:肝病的病因发生了显著变化,但其对男性和女性肝硬化负担比较的影响尚不清楚。我们估算了 2010 年至 2019 年 204 个国家和地区肝硬化负担的性别差异:我们使用 2019 年全球疾病负担研究的方法框架分析了肝硬化负担的时间趋势。我们按性别、地区、国家和病因估算了肝硬化发病、死亡和残疾调整生命年(DALYs)的年度频率和年龄标准化率(ASRs):2019年,男性肝硬化发病、死亡和残疾调整寿命年数分别为1,206,125例、969,068例和31,781,079年,女性分别为845,429例、502,944例和14,408,336年。从 2010 年到 2019 年,男性肝硬化死亡人数增加了 9%,女性增加了 12%。男性的发病率 ASR 保持稳定,但女性的发病率 ASR 有所上升,而两者的死亡 ASR 均有所下降。除美洲地区保持稳定外,其他所有地区的男女死亡率均有所下降。2019年,酒精是男性肝硬化死亡的主要原因,而丙型肝炎是女性肝硬化死亡的主要原因。除非酒精性脂肪性肝炎(NASH)外,所有病因的男女死亡率均有所下降。2019年女性与男性的发病ASR之比,酒精最低(0.5),非酒精性脂肪性肝炎最高(1.3),而女性与男性的死亡ASR之比,酒精最低(0.3),非酒精性脂肪性肝炎最高(0.8):结论:全球肝硬化患者中男性较多。然而,女性NASH肝硬化的发病率和死亡ASR与男性相当。
{"title":"Global Epidemiology of Cirrhosis: Changing Etiological Basis and Comparable Burden of Nonalcoholic Steatohepatitis between Males and Females.","authors":"Darren Tan, Kai En Chan, Zhen Yu Wong, Cheng Han Ng, Jieling Xiao, Wen Hui Lim, Phoebe Tay, Ansel Tang, Clarissa Elysia Fu, Mark Muthiah, Benjamin Nah, Eunice X Tan, Margaret L P Teng, Mohammad Shadab Siddiqui, Yock Young Dan, Seng Gee Lim, Rohit Loomba, Daniel Q Huang","doi":"10.1159/000533946","DOIUrl":"10.1159/000533946","url":null,"abstract":"<p><strong>Introduction: </strong>The etiology of liver diseases has changed significantly, but its impact on the comparative burden of cirrhosis between males and females is unclear. We estimated sex differences in the burden of cirrhosis across 204 countries and territories from 2010 to 2019.</p><p><strong>Methods: </strong>We analyzed temporal trends in the burden of cirrhosis using the methodology framework of the 2019 Global Burden of Disease study. We estimated annual frequencies and age-standardized rates (ASRs) of cirrhosis incidence, death, and disability-adjusted life-years (DALYs) by sex, region, country, and etiology.</p><p><strong>Results: </strong>In 2019, the frequency of incident cases, deaths, and DALYs due to cirrhosis was 1,206,125, 969,068, and 31,781,079 in males versus 845,429, 502,944, and 14,408,336 in females, respectively. From 2010 to 2019, the frequency of cirrhosis deaths increased by 9% in males and 12% in females. Incidence ASRs remained stable in males but increased in females, while death ASRs declined in both. Death ASRs for both sexes declined in all regions, except in the Americas where they remained stable. In 2019, alcohol was the leading cause of cirrhosis deaths in males, and hepatitis C in females. Death ASRs declined for all etiologies in both sexes, except in nonalcoholic steatohepatitis (NASH). The ratio of female-to-male incidence ASRs in 2019 was lowest in alcohol(0.5), and highest in NASH(1.3), while the ratio of female-to-male death ASRs was lowest in alcohol(0.3) and highest in NASH(0.8).</p><p><strong>Conclusion: </strong>The global burden of cirrhosis is higher in males. However, incidence and death ASRs from NASH cirrhosis in females are comparable to that of males.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10716870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10234385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesco Auriemma, Alessandro De Marco, Alessandro Repici, Benedetto Mangiavillano
Gastric outlet obstruction is a condition characterized by inadequate gastric emptying due to benign or malignant conditions inducing an inadequate oral intake. In recent years, a novel therapeutic treatment for this condition is given by the use of electrocautery lumen-apposing metal stents. In this case report, we want to present an example of a benign condition treated by endoscopic ultrasound-guided gastroenterostomy with the bi-flanged SpaxusTM stent (Taewoong Medical Co.) mounted on electrocautery catheter.
胃出口梗阻是一种以胃排空不足为特征的疾病,这是由于良性或恶性疾病引起的口服摄入不足。近年来,对这种情况的一种新的治疗方法是使用电灼腔金属支架。在这个病例报告中,我们想提出一个病例,通过内镜超声引导下的双翼SpaxusTM支架(Taewoong Medical Co.)安装在电切导管上的胃肠道造口术治疗良性疾病。
{"title":"Endoscopic Ultrasound Gastro-Enteroanastomosis for Benign Gastric Outlet Obstruction due to Large Duodenal Diverticula.","authors":"Francesco Auriemma, Alessandro De Marco, Alessandro Repici, Benedetto Mangiavillano","doi":"10.1159/000528885","DOIUrl":"https://doi.org/10.1159/000528885","url":null,"abstract":"<p><p>Gastric outlet obstruction is a condition characterized by inadequate gastric emptying due to benign or malignant conditions inducing an inadequate oral intake. In recent years, a novel therapeutic treatment for this condition is given by the use of electrocautery lumen-apposing metal stents. In this case report, we want to present an example of a benign condition treated by endoscopic ultrasound-guided gastroenterostomy with the bi-flanged SpaxusTM stent (Taewoong Medical Co.) mounted on electrocautery catheter.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10159274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}