Digestive Diseases and Sciences最新文献

Purpose: Crohn's disease is a chronic inflammatory bowel disease of unknown etiology. Mesentery dysfunction and aberrant adipokine levels participate in the pathogenesis of Crohn's disease. Macrophage polarization plays important roles in mesenteric inflammation. This study aimed to explore the expression of adipokine CTRP12 in Crohn's disease patients and possible roles using IL-10 deficient (Il-10^-/-) mice.

Methods: Expression of CTRP12 in mesentery adipose tissue specimens from Crohn's patients (n = 20) and control patients (n = 10) was detected. Il-10^-/- mice with established colitis were administered with CTRP12, and untreated mice served as controls (n = 8 for each group). Disease activity, and colonic and mesenteric inflammation was evaluated. Modulation of macrophage polarization and related signaling pathway was also analyzed.

Results: Our findings indicate CTRP12 is highly expressed in the mesentery of Crohn's patients. CTRP12 treatment can reduce intestinal and mesenteric inflammation in chronic colitis model with CD-like features and can promote the polarization of mesenteric macrophages to M2 type, possibly related to the activation of TGFβRII/Smad signaling pathway.

Conclusion: These findings suggest adipokine CTRP12 could ameliorate Crohn's colitis by modulating polarization of mesenteric macrophages to M2 type, providing new target for Crohn's disease therapy.

Background: Because of the nature of colonoscopy, missed colon adenoma occurs, of which flat adenoma is closely related to the interval cancer. Thus, methods to reduce missed adenoma have been studied but are still lacking.

Aims: To investigate the relationship between the withdrawal time of the proximal colon and the missed flat adenoma, and to find the appropriate withdrawal time.

Methods: We retrospectively studied the medical records of patients who underwent screening colonoscopy. According to the proximal colon withdrawal time, the patients were classified into two groups and compared with the clinical characteristics, adenoma detection rate (ADR), and flat adenoma detection rate (FADR). The correlation between adenoma miss rate (AMR), flat adenoma miss rate (FAMR), and withdrawal time of proximal colon was analyzed.

Results: A total of 10,253 patients were enrolled, of whom 1273 received colonoscopy more than twice. Based on proximal colon withdrawal time, 40.6% (n = 4162) were less than 3 min and 59.4% (n = 6091) were more than 3 min. Compared to a group with a withdrawal time of less than 3 min, the group with a withdrawal time of more than 3 min had a significantly high proximal colon ADR (17.8% vs. 21.1%, P = 0.000) and FADR (4.2% vs. 5.4%, P = 0.006), and statistically low AMR (17.9% vs. 12.8%, P = 0.016) and FAMR (8.2% vs. 4.0%, P = 0.003). Multivariate analysis also showed that the group with a withdrawal time longer than 3 min had a significantly low AMR (OR 1.381; 95% CI 1.025-2.012, P = 0.043) and FAMR (OR 2.053; 95% CI 1.198-3.417, P = 0.018).

Conclusions: Flat adenoma detection and miss rate of the proximal colon were significantly different according to the withdrawal time of 3 min. Proximal colon withdrawal time of more than 3 min is required for colonoscopy, and it is expected to reduce interval cancer.

Background: Propofol is the most commonly used intravenous anesthetic for endoscopic surgery, although it comes with various adverse effects. Research indicates that Remimazolam, which is considered a safe general anesthetic, is being increasingly adopted as an alternative to propofol in clinical settings. Our meta-analysis sought to evaluate whether the rate of adverse reactions associated with Remimazolam in gastrointestinal endoscopic procedures is acceptable, and whether its surgical success rate is at least comparable to that of propofol.

Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, Scopus, Cochrane Library, Embase, and Web of Science) to identify eligible studies published up to January 2025. Using R version R.4.4, we reported outcomes as risk ratios (RRs) or mean differences (MDs) and confidence intervals (CIs). A P-value of ≤ 0.05 is considered statistically significant.

Results: Our meta-analysis included 37 studies encompassing 8533 patients. The results, analyzed using a random effects model, demonstrated no statistically significant difference in induction time between the two sedative groups, with an overall MD of 0.11 min (95% [- 0.10; 0.31], p = 0.2977). Patients in the Remimazolam group experienced longer total sedation times than those receiving Propofol, with an MD of 1.84 min (95% CI [0.61; 3.07], p = 0.0033). The pooled analysis indicated low heterogeneity (I² = 4.2%). There was no statistically significant difference between the two sedatives in procedure time, with an MD of 0.16 (95% CI: [-0.13; 0.45], p = 0.2689). The pooled analysis displayed moderate heterogeneity (I² = 43.5%, p = 0.0052).

Conclusion: Remimazolam has demonstrated safety, showing a reduced incidence of hypotension, bradycardia, respiratory depression, and hypoxemia compared to propofol. However, efficacy outcomes including the induction time and total procedure time were comparable between the two groups. However, the results were heterogeneous, which could be due to variability in the perfumed procedures, co-analgesics or dosing.