Digestive Diseases and Sciences最新文献

Introduction: Endoscopic transmural drainage (ETD) using a therapeutic oblique-viewing echoendoscope is procedure of choice for symptomatic walled-off necrosis (WON). However, occasionally the procedure fails because of poor visualization, non-negotiation of proximal luminal narrowing, presence of intervening venous collaterals or difficult puncture because of oblique angle. In such situations, a forward-viewing echoendoscope (FVE) may offer technical advantages.

Objective: To evaluate safety and efficacy of EUS-guided ETD of WON using a FVE in patients in whom drainage could not be completed using oblique-viewing echoendoscope.

Methods: The endoscopic database of a tertiary-care center was retrospectively reviewed and patients who underwent ETD of WON using a FVE following failure with a conventional oblique-viewing echoendoscope were identified. Demographic data, characteristics of WON, procedural details, technical success, and procedure-related adverse events were analyzed.

Results: Twenty-one patients (18 males; age range 12-54 years) underwent ETD using a FVE. The size of the WON ranged from 9 to 18 cm. Collections were located in the head (n = 2), body (n = 5), tail (n = 2), and body and tail (n = 12) of the pancreas. ETD was performed 5-24 weeks after an episode of acute necrotizing pancreatitis. Technical success was achieved in all patients (100%). Lumen-apposing metal stents were placed in 12 patients, multiple plastic stents in 7 patients, and a nasocystic drain in 2 patients. No immediate or early procedure-related complications or stent maldeployment were observed.

Conclusions: ETD of WON using an FVE is safe and effective in patients in whom drainage using a conventional oblique-viewing echoendoscope is technically challenging or unsuccessful.

Purpose: The optimal endoscopic approach for pancreatic duct stones in chronic pancreatitis remains unclear, particularly regarding the selection between extracorporeal shock wave lithotripsy (ESWL) and peroral pancreatoscopy-guided electrohydraulic lithotripsy (POPS-EHL). This study aimed to evaluate the efficacy and limitations of POPS-EHL and to identify pre-procedural predictors of incomplete fragmentation.

Methods: We retrospectively analyzed patients who underwent POPS-assisted treatment for pancreatic duct stones at a tertiary center between 2017 and 2025. Clinical outcomes, adverse events, and factors associated with incomplete EHL were assessed, and multivariate logistic regression was used to identify independent predictors of EHL failure.

Results: POPS insertion was feasible in 47 of 52 patients (90.4%), and 34 proceeded to POPS-EHL. Complete fragmentation without the need for ESWL was achieved in 67.6% (23/34), whereas 32.4% (11/34) required ESWL because of incomplete fragmentation. Stones requiring ESWL had significantly higher CT attenuation and larger size than those successfully fragmented. Multivariate analysis identified CT attenuation > 2,050 HU (OR 8.92; 95% CI 1.78-44.6; p = 0.007) and diameter > 12.8 mm (OR 6.45; 95% CI 1.41-29.6; p = 0.016) as independent predictors of incomplete EHL. Adverse events were limited to mild or moderate pancreatitis.

Conclusion: POPS-EHL is an effective option for selected patients with chronic pancreatitis. However, stones with CT attenuation exceeding 2,050 HU or a diameter greater than 12.8 mm carry a markedly higher risk of incomplete fragmentation. Incorporating these CT-based thresholds into pre-procedural planning may help guide the choice between POPS-EHL and ESWL and ultimately improve procedural efficiency and clinical outcomes.

Background: Relative Fat Mass (RFM), a simple metric calculated from height and waist circumference, is used to estimate total body fat percentage and is often considered a more precise indicator of adiposity than Body Mass Index (BMI). While RFM is a promising metric for assessing obesity and its associated health risks, its association with diarrhea remains poorly understood. Therefore, this study aimed to examine the link between RFM and diarrhea prevalence by analyzing data from the 2005-2010 National Health and Nutrition Examination Survey (NHANES).

Results: Significant differences were observed between individuals with and without diarrhea regarding age, sex, educational attainment, poverty-income ratio (PIR), marital status, BMI, smoking status, diabetes, hypertension, physical activity, and RFM levels. Logistic regression analysis showed that each 1-unit increase in RFM was associated with a 7% higher risk of diarrhea (OR: 1.07, 95% CI: 1.03-1.11, P < 0.001). In quartile analysis, participants in the highest RFM quartile (Q4) had 2.39 times higher odds of diarrhea compared to the lowest quartile (Q1) (OR: 2.39, 95% CI: 1.24-4.61, P = 0.012). Subgroup analyses suggested that the association was more pronounced in populations with higher BMI and higher levels of physical activity. The ROC analysis yielded an AUC of 0.59 (95% CI: 0.57-0.61), indicating modest predictive value of RFM for diarrhea.

Conclusion: This study reveals that higher RFM is significantly associated with increased diarrhea prevalence, particularly among physically active individuals and those with elevated BMI. While RFM demonstrates modest predictive capability, these findings highlight its potential utility in identifying obesity-related gastrointestinal risks within diverse populations.

Background and aims: Clinically significant post-endoscopic mucosal resection bleeding (CSPEB) is one of the most common adverse events after EMR. In this meta-analysis, we evaluated the efficacy of prophylactic clipping after EMR of proximal, large (≥ 20 mm) nonpedunculated colon polyps.

Methods: We reviewed several databases from inception to September 19, 2025. Outcomes of interest were CSPEB, perforation, post-polypectomy syndrome, and abdominal pain. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random effects model. Subgroup analyses were performed based on trials conducted in specialized/high-volume tertiary referral settings vs mixed practice settings (including community and nonacademic hospitals).

Results: There was no significant difference in risk of CSPEB between the groups RR, 0.59(95% CI 0.28, 1.23), τ² = 0.43, p = 0.16, I² = 65%. Subgroup analysis showed prophylactic clipping was associated with reduced CSPEB in trials conducted in specialized, high-volume tertiary referral settings, RR, 0.34 (95% CI 0.20, 0.57). However, trials conducted in mixed or community-based settings have not demonstrated a similar benefit, RR, 1.44 (95% CI 0.75, 2.78). Clipping corresponds to an ARR of 3.6%, yielding an NNT of 28. Certainty of evidence was low based on GRADE framework (due to inconsistency and imprecision). There was no statistically significant difference in risk of perforation between the groups RR, 0.68(95% CI 0.19, 2.41), τ² = 0, p = 0.55, I² = 0. Certainty of evidence was moderate (due to imprecision). There was no statistically significant difference in risk of post-polypectomy syndrome between the groups RR, 1.67(95% CI 0.47, 5.89), τ² = 0, p = 0.43, I² = 0. Certainty of evidence was moderate (due to imprecision). There was no statistically significant difference in abdominal pain rates between the groups RR, 1.00(95% CI 0.36, 2.71), p = 0.99, τ² = 0, I² = 0. Certainty of evidence was moderate (due to imprecision).

Conclusion: In conclusion, this study demonstrates that prophylactic clip closure after EMR of proximal large nonpedunculated colorectal polyps did not present a statistically significant reduction in CSPEB. However, prophylactic clipping was associated with reduced CSPEB in trials conducted in specialized, high-volume tertiary referral settings, whereas trials conducted in mixed or community-based settings have not demonstrated a similar benefit. Additional randomized controlled trials with standardized reporting of operator experience, center volume, and closure success are needed to clarify effectiveness across broader practice settings.