Pub Date : 2024-08-01Epub Date: 2024-06-21DOI: 10.1007/s10620-024-08527-1
Dana Ley, Sarah Lazarus, Amir Masound Forati, Francis A Farraye, Ryan Smith, Mary S Hayney, Freddy Caldera
Background: Healthy populations have high rates of sustained vaccine-induced seroprotection to hepatitis B virus, but previous studies in immunosuppressed patients with inflammatory bowel disease (IBD) have shown suboptimal seroprotection rates. A challenge dose of hepatitis B vaccine (HepB) is recommended in previously vaccinated individuals who are seronegative to elicit an anamnestic response and determine if they are seroprotected. The aim of our study was to determine sustained seroprotection rates to hepatitis B vaccine (HepB) in patients with IBD.
Methods: This was a single-center prospective study of patients with IBD previously vaccinated with a three dose HepB series. Patients had a hepatitis B surface antibody (anti-HBs) drawn; if it was below 10 mIU/mL, they received a challenge dose of the HepB vaccine to assess for anamnestic response and sustained seroprotection. The primary outcome was to determine the rate of sustained seroprotection (anti-HBs ≥ 10).
Results: A total of 168 patients met inclusion criteria, mean age 35.7 years ± 13.6 standard deviation (SD). Initially 120 (71.4%) had anti-HBs ≥ 10 mIU/mL, with median anti-HBs of 37 mIU/mL (interquartile range 0-234); 48 (28.6%) needed a challenge dose, of which 34 responded with anti-HBs ≥ 10 mIU/mL. In total, 154 (91.7%) demonstrated sustained seroprotection to HepB. Those not seroprotected were more likely to have been vaccinated on immunosuppressive therapy or after their diagnosis of IBD.
Conclusions: Most vaccinated patients with IBD maintain sustained seroprotection to HepB despite prolonged exposure to immunosuppression. This contradicts prior studies and shows that immunosuppression does not lead to loss of seroprotection.
{"title":"High Rates of Seroprotection to Hepatitis B After a Hepatitis B Challenge Dose in Previously Vaccinated Patients with Inflammatory Bowel Disease on Immunosuppressive Therapy.","authors":"Dana Ley, Sarah Lazarus, Amir Masound Forati, Francis A Farraye, Ryan Smith, Mary S Hayney, Freddy Caldera","doi":"10.1007/s10620-024-08527-1","DOIUrl":"10.1007/s10620-024-08527-1","url":null,"abstract":"<p><strong>Background: </strong>Healthy populations have high rates of sustained vaccine-induced seroprotection to hepatitis B virus, but previous studies in immunosuppressed patients with inflammatory bowel disease (IBD) have shown suboptimal seroprotection rates. A challenge dose of hepatitis B vaccine (HepB) is recommended in previously vaccinated individuals who are seronegative to elicit an anamnestic response and determine if they are seroprotected. The aim of our study was to determine sustained seroprotection rates to hepatitis B vaccine (HepB) in patients with IBD.</p><p><strong>Methods: </strong>This was a single-center prospective study of patients with IBD previously vaccinated with a three dose HepB series. Patients had a hepatitis B surface antibody (anti-HBs) drawn; if it was below 10 mIU/mL, they received a challenge dose of the HepB vaccine to assess for anamnestic response and sustained seroprotection. The primary outcome was to determine the rate of sustained seroprotection (anti-HBs ≥ 10).</p><p><strong>Results: </strong>A total of 168 patients met inclusion criteria, mean age 35.7 years ± 13.6 standard deviation (SD). Initially 120 (71.4%) had anti-HBs ≥ 10 mIU/mL, with median anti-HBs of 37 mIU/mL (interquartile range 0-234); 48 (28.6%) needed a challenge dose, of which 34 responded with anti-HBs ≥ 10 mIU/mL. In total, 154 (91.7%) demonstrated sustained seroprotection to HepB. Those not seroprotected were more likely to have been vaccinated on immunosuppressive therapy or after their diagnosis of IBD.</p><p><strong>Conclusions: </strong>Most vaccinated patients with IBD maintain sustained seroprotection to HepB despite prolonged exposure to immunosuppression. This contradicts prior studies and shows that immunosuppression does not lead to loss of seroprotection.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141436683","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 : 2024-08-01Epub Date: 2024-07-04DOI: 10.1007/s10620-024-08514-6
Alexander Abadir, Angela Troia, Hyder Said, Spurthi Tarugu, Benjamin C Billingsley, Nathan Sairam, Scott B Minchenberg, Anna H Owings, Adam M Parker, Brandon Brousse, Alexander Carlyle, Bobby R Owens, Pegah Hosseini-Carroll, Michelle Galeas-Pena, Joseph Frasca, Sarah C Glover, Konstantinos Papamichael, Adam S Cheifetz
Introduction: Expeditious initiation of biologic therapy is important in patients with inflammatory bowel disease (IBD). However, initiation of biologics in the outpatient setting may be delayed by various clinical, social, and financial variables.
Aim: To evaluate the delay in initiation of an advanced therapy in IBD and to identify factors that contributed to this delay.
Methods: This was a multi-center retrospective study. Outpatients who were initiated on a biologic therapy from 3/1/2019 to 9/30/20 were eligible for the study. Univariate and multivariate linear regression analyses were performed to identify variables associated with a delay in biologic treatment initiation. Delay was defined as the days from decision date (prescription placement) to first infusion or delivery of medication.
Results: In total 411 patients (Crohn's disease, n = 276; ulcerative colitis, n = 129) were included in the analysis. The median [interquartile range-(IQR)] delay for all drugs was 20 [12-37] days (infliximab, 19 [13-33] days; adalimumab, 10 [5-26] days; vedolizumab, 21 [14-42] days; and ustekinumab, 21 [14-42] days). Multivariate linear regression analysis identified that the most important variables associated with delays in biologic treatment initiation was self-identification as Black, longer distance from treatment site, and lack of initial insurance coverage approval.
Conclusion: There may be a significant delay in biologic treatment initiation in patients with IBD. The most important variables associated with this delay included self-identification as Black, longer distance from site, and lack of initial insurance coverage approval.
{"title":"Factors Associated with Delays in Initiating Biologic Therapy in Patients with Inflammatory Bowel Disease.","authors":"Alexander Abadir, Angela Troia, Hyder Said, Spurthi Tarugu, Benjamin C Billingsley, Nathan Sairam, Scott B Minchenberg, Anna H Owings, Adam M Parker, Brandon Brousse, Alexander Carlyle, Bobby R Owens, Pegah Hosseini-Carroll, Michelle Galeas-Pena, Joseph Frasca, Sarah C Glover, Konstantinos Papamichael, Adam S Cheifetz","doi":"10.1007/s10620-024-08514-6","DOIUrl":"10.1007/s10620-024-08514-6","url":null,"abstract":"<p><strong>Introduction: </strong>Expeditious initiation of biologic therapy is important in patients with inflammatory bowel disease (IBD). However, initiation of biologics in the outpatient setting may be delayed by various clinical, social, and financial variables.</p><p><strong>Aim: </strong>To evaluate the delay in initiation of an advanced therapy in IBD and to identify factors that contributed to this delay.</p><p><strong>Methods: </strong>This was a multi-center retrospective study. Outpatients who were initiated on a biologic therapy from 3/1/2019 to 9/30/20 were eligible for the study. Univariate and multivariate linear regression analyses were performed to identify variables associated with a delay in biologic treatment initiation. Delay was defined as the days from decision date (prescription placement) to first infusion or delivery of medication.</p><p><strong>Results: </strong>In total 411 patients (Crohn's disease, n = 276; ulcerative colitis, n = 129) were included in the analysis. The median [interquartile range-(IQR)] delay for all drugs was 20 [12-37] days (infliximab, 19 [13-33] days; adalimumab, 10 [5-26] days; vedolizumab, 21 [14-42] days; and ustekinumab, 21 [14-42] days). Multivariate linear regression analysis identified that the most important variables associated with delays in biologic treatment initiation was self-identification as Black, longer distance from treatment site, and lack of initial insurance coverage approval.</p><p><strong>Conclusion: </strong>There may be a significant delay in biologic treatment initiation in patients with IBD. The most important variables associated with this delay included self-identification as Black, longer distance from site, and lack of initial insurance coverage approval.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497436","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 : 2024-08-01Epub Date: 2024-05-29DOI: 10.1007/s10620-024-08402-z
Magnus Halland, David O Prichard, Allon Kahn, Crystal J Lavey, David A Katzka, Jeffrey A Alexander
Background: Patients with benign esophageal strictures may not maintain a response to endoscopic dilation, stenting, incisional or injectional therapies. For patients with these refractory esophageal strictures, esophageal self-dilation therapy (ESDT), performed to maintain luminal patency, may provide persistent symptomatic benefit while reducing patients' reliance on healthcare services and the risk associated with repeated endoscopic procedures.
Aims: The aim of this study was to evaluate the efficacy and safety of EDST in a randomized controlled trial and prospective observational study.
Methods: Twenty-five patients with refractory benign esophageal strictures were recruited at two esophageal clinics between November 2018 and June 2021. Twelve patients participated in the randomized trial and 13 in the prospective observational study. The number of endoscopic dilations, impact of therapy on dysphagia, adverse events, and complications were recorded.
Results: In the randomized study, 50% of patients performing ESDT and 100% of controls required endoscopic dilation during follow-up (P = 0.02). In the observational study, the median (IQR) number of endoscopic dilations fell from 7 [7-10] in the 6 months prior to commencing ESDT to 1 [0-2] in the 6 months after (P < 0.0001). Most patients (22/25) were able to learn self-dilation. Few serious adverse events were noted. Dysphagia severity remained unchanged or improved.
Conclusions: ESDT appears to be a safe effective therapy for benign esophageal strictures refractory to endoscopic treatment.
{"title":"Esophageal Self-Dilation in Benign Refractory Esophageal Strictures: Outcomes from a Randomized Controlled Trial and a Prospective Observational Study.","authors":"Magnus Halland, David O Prichard, Allon Kahn, Crystal J Lavey, David A Katzka, Jeffrey A Alexander","doi":"10.1007/s10620-024-08402-z","DOIUrl":"10.1007/s10620-024-08402-z","url":null,"abstract":"<p><strong>Background: </strong>Patients with benign esophageal strictures may not maintain a response to endoscopic dilation, stenting, incisional or injectional therapies. For patients with these refractory esophageal strictures, esophageal self-dilation therapy (ESDT), performed to maintain luminal patency, may provide persistent symptomatic benefit while reducing patients' reliance on healthcare services and the risk associated with repeated endoscopic procedures.</p><p><strong>Aims: </strong>The aim of this study was to evaluate the efficacy and safety of EDST in a randomized controlled trial and prospective observational study.</p><p><strong>Methods: </strong>Twenty-five patients with refractory benign esophageal strictures were recruited at two esophageal clinics between November 2018 and June 2021. Twelve patients participated in the randomized trial and 13 in the prospective observational study. The number of endoscopic dilations, impact of therapy on dysphagia, adverse events, and complications were recorded.</p><p><strong>Results: </strong>In the randomized study, 50% of patients performing ESDT and 100% of controls required endoscopic dilation during follow-up (P = 0.02). In the observational study, the median (IQR) number of endoscopic dilations fell from 7 [7-10] in the 6 months prior to commencing ESDT to 1 [0-2] in the 6 months after (P < 0.0001). Most patients (22/25) were able to learn self-dilation. Few serious adverse events were noted. Dysphagia severity remained unchanged or improved.</p><p><strong>Conclusions: </strong>ESDT appears to be a safe effective therapy for benign esophageal strictures refractory to endoscopic treatment.</p><p><strong>Clinical trial number: </strong>NCT03738566.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175075","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}
Pub Date : 2024-08-01Epub Date: 2024-05-29DOI: 10.1007/s10620-024-08483-w
Fouad Jaber, Saqr Alsakarneh, Tala Alsharaeh, Ahmed-Jordan Salahat, Mohammad Jaber, Islam Mohamed, Manesh Kumar Gangwani, Mohammad Aldiabat, Yassine Kilani, Mohamed Ahmed, Mahmoud Madi, Laith Numan, Ahmad Najdat Bazarbashi
Introduction: Esophageal Stents are used to maintain esophageal lumen patency in esophageal strictures caused by intrinsic and/or extrinsic malignancies and the occlusion of concomitant esophageal fistulas. While data on the efficacy and safety of esophageal stents exist, comprehensive evaluation of adverse events is limited. The aim of this study is to investigate the reported adverse events and device failures associated with esophageal self-expandable metal stents (SEMS) using the FDA's Manufacturer and User Facility Device Experience (MAUDE) database.
Methods: Post-marketing surveillance data for the esophageal SEMSs were analyzed using the FDA's MAUDE database from January 2014 to December 10, 2023. The outcomes of interest were patient-related adverse events and device failures. Statistical analysis was performed using Microsoft Excel 2010 and SPSS. Pooled numbers and percentages were calculated for each adverse event. Continuous variables underwent analysis using a two-tailed student t test, and significance was set to p ≤ 0.05.
Results: During the study period, 548 MAUDE reports revealed 873 device failures and 186 patient-related adverse events. The most common device issues were stent activation, positioning, or separation problems (4 n = 403; 46.2%), followed by device detachment or migration (n = 109, 12.5%), and material problems (n = 93, 10.7%). Patient complications included dysphagia/odynophagia (10%), perforation, pain, and bleeding (each 7.6%). The most common device failures in over-the-wire (OTW) stents and through-the-scope (TTS) stents were activation, positioning, or separation problems (TTS: n = 183, 52.6% vs OTW: n = 220, 41.9%). Compared to OTW stents, TTS stents had higher migration and breakage (13.5% vs. 11.8%, p = 0.24), and (9.2% vs. 6.7%, p = 0.08) respectively, while OTW stents had more challenges with stent advancement or removal (5.1% vs. 0.3%, p < 0.001 and 4.6% vs 3.4%, p = 0.19, respectively) and material problems (14.7% vs. 4.6%, p < 0.001). Activation, positioning, and separation problems were the most frequent device failures in fully covered (FC) and partially covered (PC) stents (FC: n = 62, 32.8%, PC: n = 168, 43.5%). FC stents had higher migration rates (20.6% vs 9.8%, p < 0.001), while PC stents exhibited more material problems (17.4% vs. 5.8%, p < 0.001) and difficulties with advancing the stents (6.7% vs. 0%, p < 0.001).
Conclusion: Our examination showed a prevalence of reported device complications associated with stent activation, positioning, and separation problems. Dysphagia or odynophagia emerged as the most frequently reported patient complication. Furthermore, our analysis, provides insights into TTS vs. OTW and FC vs. PC esophageal SEMSs, enabling endoscopists and manufacturers to better understand adverse events and potentially optimize device design for future iterations.
{"title":"A Comprehensive Analysis of Reported Adverse Events and Device Failures Associated with Esophageal Self-Expandable Metal Stents: An FDA MAUDE Database Study.","authors":"Fouad Jaber, Saqr Alsakarneh, Tala Alsharaeh, Ahmed-Jordan Salahat, Mohammad Jaber, Islam Mohamed, Manesh Kumar Gangwani, Mohammad Aldiabat, Yassine Kilani, Mohamed Ahmed, Mahmoud Madi, Laith Numan, Ahmad Najdat Bazarbashi","doi":"10.1007/s10620-024-08483-w","DOIUrl":"10.1007/s10620-024-08483-w","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal Stents are used to maintain esophageal lumen patency in esophageal strictures caused by intrinsic and/or extrinsic malignancies and the occlusion of concomitant esophageal fistulas. While data on the efficacy and safety of esophageal stents exist, comprehensive evaluation of adverse events is limited. The aim of this study is to investigate the reported adverse events and device failures associated with esophageal self-expandable metal stents (SEMS) using the FDA's Manufacturer and User Facility Device Experience (MAUDE) database.</p><p><strong>Methods: </strong>Post-marketing surveillance data for the esophageal SEMSs were analyzed using the FDA's MAUDE database from January 2014 to December 10, 2023. The outcomes of interest were patient-related adverse events and device failures. Statistical analysis was performed using Microsoft Excel 2010 and SPSS. Pooled numbers and percentages were calculated for each adverse event. Continuous variables underwent analysis using a two-tailed student t test, and significance was set to p ≤ 0.05.</p><p><strong>Results: </strong>During the study period, 548 MAUDE reports revealed 873 device failures and 186 patient-related adverse events. The most common device issues were stent activation, positioning, or separation problems (4 n = 403; 46.2%), followed by device detachment or migration (n = 109, 12.5%), and material problems (n = 93, 10.7%). Patient complications included dysphagia/odynophagia (10%), perforation, pain, and bleeding (each 7.6%). The most common device failures in over-the-wire (OTW) stents and through-the-scope (TTS) stents were activation, positioning, or separation problems (TTS: n = 183, 52.6% vs OTW: n = 220, 41.9%). Compared to OTW stents, TTS stents had higher migration and breakage (13.5% vs. 11.8%, p = 0.24), and (9.2% vs. 6.7%, p = 0.08) respectively, while OTW stents had more challenges with stent advancement or removal (5.1% vs. 0.3%, p < 0.001 and 4.6% vs 3.4%, p = 0.19, respectively) and material problems (14.7% vs. 4.6%, p < 0.001). Activation, positioning, and separation problems were the most frequent device failures in fully covered (FC) and partially covered (PC) stents (FC: n = 62, 32.8%, PC: n = 168, 43.5%). FC stents had higher migration rates (20.6% vs 9.8%, p < 0.001), while PC stents exhibited more material problems (17.4% vs. 5.8%, p < 0.001) and difficulties with advancing the stents (6.7% vs. 0%, p < 0.001).</p><p><strong>Conclusion: </strong>Our examination showed a prevalence of reported device complications associated with stent activation, positioning, and separation problems. Dysphagia or odynophagia emerged as the most frequently reported patient complication. Furthermore, our analysis, provides insights into TTS vs. OTW and FC vs. PC esophageal SEMSs, enabling endoscopists and manufacturers to better understand adverse events and potentially optimize device design for future iterations.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175070","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 : 2024-08-01Epub Date: 2024-07-04DOI: 10.1007/s10620-024-08544-0
Sandhini Lockman, Parul Tandon
{"title":"Low-Dose Aspirin Use in Pregnancy in Patients with IBD with Risk Factors for Preeclampsia: A Retrospective Cohort Study.","authors":"Sandhini Lockman, Parul Tandon","doi":"10.1007/s10620-024-08544-0","DOIUrl":"10.1007/s10620-024-08544-0","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533966","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 : 2024-08-01Epub Date: 2024-06-12DOI: 10.1007/s10620-024-08482-x
Yihuan Hu, Mei Zhou, Deliang Liu, Jian Gong
Background: Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients.
Aim: This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding.
Methods: Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included.
Results: The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I2 = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I2 = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I2 = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I2 = 91.6%], 3% [95% CI - 2 to 8, I2 = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I2 = 0%], all-cause mortality rate was 17% [95% CI 12-22, I2 = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor.
Conclusions: Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.
背景:目的:本系统综述和荟萃分析旨在评估内镜下注射氰基丙烯酸酯的效率,并总结再出血的风险因素:方法:在数据库中检索 2012 年 1 月至 2022 年 12 月间发表的文章。方法:在数据库中检索了 2012 年 1 月至 2022 年 12 月期间发表的文章,纳入了评估内镜下注射氰基丙烯酸酯胶治疗胃静脉曲张的效率和再出血风险因素的研究:结果:最终分析纳入了 24 项研究的数据。止血率从 65% 到 100% 不等。胃静脉曲张复发率为 34% [95% CI 21-46,I2 = 61.4%],早期再出血率为 16% [95% CI 11-20,I2 = 37.4%],晚期再出血率为 39% [95% CI 36-42,I2 = 90.9%],轻度和中度不良事件发生率分别为 28% [95% CI 24-31, I2 = 91.6%]、3% [95% CI - 2 to 8, I2 = 15.3%],再出血相关死亡率为 6% [95% CI 2-10, I2 = 0%],全因死亡率为 17% [95% CI 12-22, I2 = 63.6%]。胃静脉曲张再出血的独立危险因素包括门静脉血栓、腹水、氰基丙烯酸酯量、发热/全身炎症反应综合征、红色韦勒征、既往静脉曲张出血史、活动性出血和胃旁静脉。使用质子泵抑制剂可能是一个保护因素:结论:内镜下氰基丙烯酸酯胶注射是治疗胃静脉曲张有效而安全的方法。具有上述危险因素的肝硬化患者如果符合适应症,可从旨在降低门静脉高压的治疗、抗生素预防和抗凝治疗中获益。
{"title":"Risk Factors for Rebleeding After Endoscopic Injection of Cyanoacrylate Glue for Gastric Varices: A Systematic Review and Meta-Analysis.","authors":"Yihuan Hu, Mei Zhou, Deliang Liu, Jian Gong","doi":"10.1007/s10620-024-08482-x","DOIUrl":"10.1007/s10620-024-08482-x","url":null,"abstract":"<p><strong>Background: </strong>Rebleeding is a significant complication of endoscopic injection of cyanoacrylate in gastric varices in cirrhotic patients.</p><p><strong>Aim: </strong>This systematic review and meta-analysis aimed to evaluate the efficiency of endoscopic cyanoacrylate injection and summarized the risk factors for rebleeding.</p><p><strong>Methods: </strong>Databases were searched for articles published between January 2012 and December 2022. Studies evaluating the efficiency of endoscopic injection of cyanoacrylate glue for gastric varices and the risk factors for rebleeding were included.</p><p><strong>Results: </strong>The final analysis included data from 24 studies. The hemostatic rates ranged from 65 to 100%. The pooled rate of gastric varices recurrence was 34% [95% CI 21-46, I<sup>2</sup> = 61.4%], early rebleeding rate was 16% [95% CI 11-20, I<sup>2</sup> = 37.4%], late rebleeding rate was 39% [95% CI 36-42, I<sup>2</sup> = 90.9%], mild and moderate adverse events rate were 28% [95% CI 24-31, I<sup>2</sup> = 91.6%], 3% [95% CI - 2 to 8, I<sup>2</sup> = 15.3%], rebleeding-related mortality rate was 6% [95% CI 2-10, I<sup>2</sup> = 0%], all-cause mortality rate was 17% [95% CI 12-22, I<sup>2</sup> = 63.6%]. Independent risk factors for gastric variceal rebleeding included portal venous thrombosis, ascites, cyanoacrylate volume, fever/systemic inflammatory response syndrome, red Wale sign, previous history of variceal bleeding, active bleeding and paragastric veins. The use of proton pump inhibitors could be a protective factor.</p><p><strong>Conclusions: </strong>Endoscopic cyanoacrylate glue injection is an effective and safe treatment for gastric varices. Cirrhotic patients with the above risk factors may benefit from treatment aimed at reducing portal hypertension, antibiotic prophylaxis, and anticoagulation if they meet the indications.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305690","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 : 2024-08-01DOI: 10.1007/s10620-024-08578-4
Shuaiyong Wen, Yu Zhang, Guijie Zhao, Kun Zhang, Yunfeng Cui
Background
The objective of this study is to develop and validate a new nomogram-based scoring system for anticipating the recurrence of acute pancreatitis (AP) in combined hypertriglyceridemia (HTG).
Methods
A total of 292 patients diagnosed with AP combined with HTG participated in this research. Among them, 201 patients meeting the inclusion criteria were randomly divided into training and validation sets at a ratio of 7:3. Clinical data were collected for all patients. In the training set, predictive indicators were chosen through backward stepwise multivariable logistic regression analysis. Subsequently, a nomogram was developed based on the selected indicators. Finally, the model’s performance was validated in both the training and validation sets.
Results
By employing backward stepwise multivariable logistic regression analysis, we identified diabetes, gallstones, alcohol consumption, and triglyceride levels as predictive indicators. Subsequently, a clinical nomogram that incorporates these four independent risk factors was constructed. Model validation demonstrated an AUC of 0.726 (95% CI 0.644–0.809) in the training set and an AUC of 0.712 (95% CI 0.583–0.842) in the validation set, indicating a good discriminative ability. The Hosmer–Lemeshow test yielded P-values of 0.882 and 0.536 in the training and validation sets, respectively, suggesting good calibration. Calibration curves further confirmed good agreement. Ultimately, decision curve analysis (DCA) emphasized the clinical utility of our model.
Conclusion
We have developed a nomogram for predicting the recurrence of AP combined with HTG in patients, and this nomogram demonstrates good discriminative ability, calibration, and clinical utility. This tool holds the potential to assist clinicians in offering more personalized treatment strategies for AP combined with HTG.
背景本研究旨在开发和验证一种新的基于提名图的评分系统,用于预测合并高甘油三酯血症(HTG)的急性胰腺炎(AP)的复发。其中,符合纳入标准的 201 例患者按 7:3 的比例随机分为训练集和验证集。研究人员收集了所有患者的临床数据。在训练集中,通过逆向逐步多变量逻辑回归分析选出了预测指标。随后,根据所选指标建立了一个提名图。结果 通过后向逐步多变量逻辑回归分析,我们确定了糖尿病、胆结石、饮酒和甘油三酯水平作为预测指标。随后,我们构建了包含这四个独立风险因素的临床提名图。模型验证表明,训练集的AUC为0.726(95% CI 0.644-0.809),验证集的AUC为0.712(95% CI 0.583-0.842),显示出良好的判别能力。通过 Hosmer-Lemeshow 检验,训练集和验证集的 P 值分别为 0.882 和 0.536,表明校准效果良好。校准曲线进一步证实了良好的一致性。最终,决策曲线分析(DCA)强调了我们模型的临床实用性。结论我们开发了一种预测 AP 合并 HTG 患者复发的提名图,该提名图显示了良好的鉴别能力、校准性和临床实用性。该工具有望帮助临床医生为 AP 合并 HTG 患者提供更加个性化的治疗策略。
{"title":"Development and Validation of a Clinical Predictive Nomogram for Assessing the Risk of Recurrence of Acute Pancreatitis in Combined Hypertriglyceridemia","authors":"Shuaiyong Wen, Yu Zhang, Guijie Zhao, Kun Zhang, Yunfeng Cui","doi":"10.1007/s10620-024-08578-4","DOIUrl":"https://doi.org/10.1007/s10620-024-08578-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>The objective of this study is to develop and validate a new nomogram-based scoring system for anticipating the recurrence of acute pancreatitis (AP) in combined hypertriglyceridemia (HTG).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A total of 292 patients diagnosed with AP combined with HTG participated in this research. Among them, 201 patients meeting the inclusion criteria were randomly divided into training and validation sets at a ratio of 7:3. Clinical data were collected for all patients. In the training set, predictive indicators were chosen through backward stepwise multivariable logistic regression analysis. Subsequently, a nomogram was developed based on the selected indicators. Finally, the model’s performance was validated in both the training and validation sets.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>By employing backward stepwise multivariable logistic regression analysis, we identified diabetes, gallstones, alcohol consumption, and triglyceride levels as predictive indicators. Subsequently, a clinical nomogram that incorporates these four independent risk factors was constructed. Model validation demonstrated an AUC of 0.726 (95% CI 0.644–0.809) in the training set and an AUC of 0.712 (95% CI 0.583–0.842) in the validation set, indicating a good discriminative ability. The Hosmer–Lemeshow test yielded <i>P</i>-values of 0.882 and 0.536 in the training and validation sets, respectively, suggesting good calibration. Calibration curves further confirmed good agreement. Ultimately, decision curve analysis (DCA) emphasized the clinical utility of our model.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>We have developed a nomogram for predicting the recurrence of AP combined with HTG in patients, and this nomogram demonstrates good discriminative ability, calibration, and clinical utility. This tool holds the potential to assist clinicians in offering more personalized treatment strategies for AP combined with HTG.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141872275","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 : 2024-08-01Epub Date: 2024-05-30DOI: 10.1007/s10620-024-08487-6
Arjun Chatterjee, Vibhu Chittajallu, Andrew Ford, Khaled Alsabbagh Alchirazi, Rama Nanah, Emad Mansoor, Sarah DeLozier, Claire Jansson-Knodell, Alberto Rubio-Tapia
Background: Celiac Disease (CD) is associated with increased susceptibility to certain bacterial and viral infections. Herpes zoster (HZ) is a viral infection that can be prevented by immunization. In the US, the vaccine is recommended for adults ≥ 50 or ≥ 19 with certain at-risk conditions, not including CD.
Aims: We aimed to determine if adult patients aged < 50 or ≥ 50 years with CD had a higher risk of developing HZ.
Methods: We designed a retrospective cohort study. CD was defined as patients with the ICD-10 code for CD and positive Celiac serology. Patients with negative serology and lacking CD ICD-10 codes served as controls. Patients who had HZ before CD diagnosis were excluded. We formed two sub-cohorts, those aged < 50 (cohort 1) and aged ≥ 50 years (cohort 2), and evaluated HZ infection at 10-year follow-up. To account for confounding variables, we performed 1:1 propensity score matching (PSM).
Results: Following PSM, cohort 1 had 6,826 CD patients, and cohort 2 had 5,337 CD patients and respective matched controls. After ten years of follow-up, in cohort 1, 62 CD patients developed HZ versus 57 controls, RR: 1.09 (CI: 0.76-1.56, p-value = 0.64). In cohort 2, 200 CD patients developed HZ versus 159 controls, RR: 1.2 (CI: 1.02-1.54, p-value = 0.03).
Conclusion: There was no significant difference in the likelihood of getting HZ in CD patients < 50, although CD patients ≥ 50 had a modestly increased risk. Our findings do not support routine early vaccination for HZ in CD, and the vaccine should be offered at age 50.
背景:乳糜泻(CD)与对某些细菌和病毒感染的易感性增加有关。带状疱疹(HZ)是一种可通过免疫接种预防的病毒感染。在美国,建议年龄≥50 岁或年龄≥19 岁且患有某些高危疾病(不包括 CD)的成人接种该疫苗:我们设计了一项回顾性队列研究。CD是指ICD-10编码为CD且乳糜泻血清学阳性的患者。血清学阴性且无 CD ICD-10 编码的患者作为对照组。在 CD 诊断前患有 HZ 的患者被排除在外。我们组建了两个子队列,分别是年龄为 20-24 岁的患者和年龄为 20-24 岁的患者:在 PSM 之后,队列 1 有 6826 名 CD 患者,队列 2 有 5337 名 CD 患者和各自的匹配对照。经过十年的随访,在队列 1 中,62 名 CD 患者与 57 名对照组相比患上了 HZ,RR:1.09(CI:0.76-1.56,P 值 = 0.64)。在队列2中,200名CD患者与159名对照者相比,RR:1.2(CI:1.02-1.54,P值=0.03):结论:CD 患者罹患 HZ 的可能性没有明显差异。
{"title":"Increased Risk of Herpes Zoster Infection in Patients with Celiac Disease 50 Years Old and Older.","authors":"Arjun Chatterjee, Vibhu Chittajallu, Andrew Ford, Khaled Alsabbagh Alchirazi, Rama Nanah, Emad Mansoor, Sarah DeLozier, Claire Jansson-Knodell, Alberto Rubio-Tapia","doi":"10.1007/s10620-024-08487-6","DOIUrl":"10.1007/s10620-024-08487-6","url":null,"abstract":"<p><strong>Background: </strong>Celiac Disease (CD) is associated with increased susceptibility to certain bacterial and viral infections. Herpes zoster (HZ) is a viral infection that can be prevented by immunization. In the US, the vaccine is recommended for adults ≥ 50 or ≥ 19 with certain at-risk conditions, not including CD.</p><p><strong>Aims: </strong>We aimed to determine if adult patients aged < 50 or ≥ 50 years with CD had a higher risk of developing HZ.</p><p><strong>Methods: </strong>We designed a retrospective cohort study. CD was defined as patients with the ICD-10 code for CD and positive Celiac serology. Patients with negative serology and lacking CD ICD-10 codes served as controls. Patients who had HZ before CD diagnosis were excluded. We formed two sub-cohorts, those aged < 50 (cohort 1) and aged ≥ 50 years (cohort 2), and evaluated HZ infection at 10-year follow-up. To account for confounding variables, we performed 1:1 propensity score matching (PSM).</p><p><strong>Results: </strong>Following PSM, cohort 1 had 6,826 CD patients, and cohort 2 had 5,337 CD patients and respective matched controls. After ten years of follow-up, in cohort 1, 62 CD patients developed HZ versus 57 controls, RR: 1.09 (CI: 0.76-1.56, p-value = 0.64). In cohort 2, 200 CD patients developed HZ versus 159 controls, RR: 1.2 (CI: 1.02-1.54, p-value = 0.03).</p><p><strong>Conclusion: </strong>There was no significant difference in the likelihood of getting HZ in CD patients < 50, although CD patients ≥ 50 had a modestly increased risk. Our findings do not support routine early vaccination for HZ in CD, and the vaccine should be offered at age 50.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179286","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}
Pub Date : 2024-08-01Epub Date: 2024-06-18DOI: 10.1007/s10620-024-08479-6
Marcus A Healey, Geetha Ramalingam, Yiwei Hang, Ekaterina Smirnova, Amon Asgharpour, Vaishali Patel, Hannah Lee, Velimir Luketic, Scott Matherly, Mohammad Siddiqui, Joel Wedd, Arun Sanyal, Richard K Sterling
Background/aims: In alcohol-associated hepatitis (AH), the Lille score is used to assess futility of steroids. However, the ability of the Lille score to predict 30-day survival in AH is not well-defined. Our aim is to compare the utility of the Lille score in predicting 30-day survival in those with AH treated with steroids.
Methods: Retrospective chart review of 882 patients hospitalized with AH from January 1st, 2012 through December 30th, 2019 was performed. Of these, 201 patients with severe AH met the threshold to receive steroids. Those with data to calculate Lille score < 0.45 on day 4 (n = 29) or 7 (n = 89) who continued steroids were compared to 83 patients with Lille scores ≥ 0.45 on day 4 (n = 18) or 7 (n = 65) who stopped steroids. The primary outcome was 30-day survival. For comparison, a contemporaneous matched control group was also analyzed of 110 patients who were hospitalized with severe AH, but did not receive steroids.
Results: In patients with Lille score < 0.45, survival was higher at 30-day when compared to those with Lille score ≥ 0.45 (94.9% vs. 80.72%; p = 0.002). The sensitivity, specificity, positive predictive value and negative predictive value of Lille score (< 0.45) to predict 30-day survival was 95%, 19%, 63%, and 73%, respectively.
Conclusions: In severe AH, those with Lille score < 0.45 at day 4 or 7 have improved 30-day survival compared to those with Lille score ≥ 0.45. In those receiving steroids, Lille score has excellent sensitivity to predict 30-day survival but poor specificity.
{"title":"Utility of Lille Score in Predicting 30-Day Survival in Steroid-Treated Alcohol-Associated Hepatitis.","authors":"Marcus A Healey, Geetha Ramalingam, Yiwei Hang, Ekaterina Smirnova, Amon Asgharpour, Vaishali Patel, Hannah Lee, Velimir Luketic, Scott Matherly, Mohammad Siddiqui, Joel Wedd, Arun Sanyal, Richard K Sterling","doi":"10.1007/s10620-024-08479-6","DOIUrl":"10.1007/s10620-024-08479-6","url":null,"abstract":"<p><strong>Background/aims: </strong>In alcohol-associated hepatitis (AH), the Lille score is used to assess futility of steroids. However, the ability of the Lille score to predict 30-day survival in AH is not well-defined. Our aim is to compare the utility of the Lille score in predicting 30-day survival in those with AH treated with steroids.</p><p><strong>Methods: </strong>Retrospective chart review of 882 patients hospitalized with AH from January 1st, 2012 through December 30th, 2019 was performed. Of these, 201 patients with severe AH met the threshold to receive steroids. Those with data to calculate Lille score < 0.45 on day 4 (n = 29) or 7 (n = 89) who continued steroids were compared to 83 patients with Lille scores ≥ 0.45 on day 4 (n = 18) or 7 (n = 65) who stopped steroids. The primary outcome was 30-day survival. For comparison, a contemporaneous matched control group was also analyzed of 110 patients who were hospitalized with severe AH, but did not receive steroids.</p><p><strong>Results: </strong>In patients with Lille score < 0.45, survival was higher at 30-day when compared to those with Lille score ≥ 0.45 (94.9% vs. 80.72%; p = 0.002). The sensitivity, specificity, positive predictive value and negative predictive value of Lille score (< 0.45) to predict 30-day survival was 95%, 19%, 63%, and 73%, respectively.</p><p><strong>Conclusions: </strong>In severe AH, those with Lille score < 0.45 at day 4 or 7 have improved 30-day survival compared to those with Lille score ≥ 0.45. In those receiving steroids, Lille score has excellent sensitivity to predict 30-day survival but poor specificity.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418318","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}
Pub Date : 2024-08-01Epub Date: 2024-05-07DOI: 10.1007/s10620-024-08454-1
Briette Karanfilian, Amy Tyberg, Avik Sarkar, Haroon M Shahid, Alexa Simon, Karoline Reinoso, Amol Bapaye, Ashish Gandhi, Harshal P Gadhikar, Shivangi Dorwat, Hameed Raina, Jaseem Ansari, Jose Nieto, Nadim Qadir, Maria G Porfilio, Martha Arevalo-Mora, Miguel Puga-Tejada, Juan Alcivar-Vasquez, Carlos Robles-Medranda, Jose Celso Ardengh, Romy Bareket, Kelvin Liao, Roohi Patel, Sophia Pimpinelli, Monica Gaidhane, Michel Kahaleh
Background: Viral infections are known to impact the pancreato-biliary system; however, there are limited data showing that the same is true of COVID-19. Endoscopic retrograde cholangiopancreatography (ERCP) can safely be performed in patients with COVID-19 infection, but outcomes of patients with COVID-19 infections and concomitant pancreatic and biliary disease requiring endoscopic intervention are unknown.
Aims: This study aims to evaluate the severity of pancreaticobiliary diseases and post-ERCP outcomes in COVID-19 patients.
Methods: Patients with pancreato-biliary disease that required inpatient ERCP from five centers in the United States and South America between January 1, 2020, and October 31, 2020 were included. A representative cohort of patients from each month were randomly selected from each site. Disease severity and post-ERCP outcomes were compared between COVID-19 positive and COVID-19 negative patients.
Results: A total of 175 patients were included: 95 COVID positive and 80 COVID negative. Mean CTSI score for the patients who had pancreatitis was higher in COVID-positive cohort by 3.2 points (p < .00001). The COVID-positive group had more cases with severe disease (n = 41) versus the COVID-negative group (n = 2) (p < .00001). Mortality was higher in the COVID-19 positive group (19%) compared to COVID-negative group (7.5%) even though the COVID-19-negative group had higher incidence of malignancy (n = 17, 21% vs n = 7, 7.3%) (p = 0.0455).
Conclusions: This study shows that patients with COVID infection have more severe pancreato-biliary disease and worse post-ERCP outcomes, including longer length of stay and higher mortality rate. These are important considerations when planning for endoscopic intervention.
{"title":"Impact of COVID-19 Infection on Pancreato-Biliary Diseases Requiring Endoscopic Retrograde Cholangiopancreatography.","authors":"Briette Karanfilian, Amy Tyberg, Avik Sarkar, Haroon M Shahid, Alexa Simon, Karoline Reinoso, Amol Bapaye, Ashish Gandhi, Harshal P Gadhikar, Shivangi Dorwat, Hameed Raina, Jaseem Ansari, Jose Nieto, Nadim Qadir, Maria G Porfilio, Martha Arevalo-Mora, Miguel Puga-Tejada, Juan Alcivar-Vasquez, Carlos Robles-Medranda, Jose Celso Ardengh, Romy Bareket, Kelvin Liao, Roohi Patel, Sophia Pimpinelli, Monica Gaidhane, Michel Kahaleh","doi":"10.1007/s10620-024-08454-1","DOIUrl":"10.1007/s10620-024-08454-1","url":null,"abstract":"<p><strong>Background: </strong>Viral infections are known to impact the pancreato-biliary system; however, there are limited data showing that the same is true of COVID-19. Endoscopic retrograde cholangiopancreatography (ERCP) can safely be performed in patients with COVID-19 infection, but outcomes of patients with COVID-19 infections and concomitant pancreatic and biliary disease requiring endoscopic intervention are unknown.</p><p><strong>Aims: </strong>This study aims to evaluate the severity of pancreaticobiliary diseases and post-ERCP outcomes in COVID-19 patients.</p><p><strong>Methods: </strong>Patients with pancreato-biliary disease that required inpatient ERCP from five centers in the United States and South America between January 1, 2020, and October 31, 2020 were included. A representative cohort of patients from each month were randomly selected from each site. Disease severity and post-ERCP outcomes were compared between COVID-19 positive and COVID-19 negative patients.</p><p><strong>Results: </strong>A total of 175 patients were included: 95 COVID positive and 80 COVID negative. Mean CTSI score for the patients who had pancreatitis was higher in COVID-positive cohort by 3.2 points (p < .00001). The COVID-positive group had more cases with severe disease (n = 41) versus the COVID-negative group (n = 2) (p < .00001). Mortality was higher in the COVID-19 positive group (19%) compared to COVID-negative group (7.5%) even though the COVID-19-negative group had higher incidence of malignancy (n = 17, 21% vs n = 7, 7.3%) (p = 0.0455).</p><p><strong>Conclusions: </strong>This study shows that patients with COVID infection have more severe pancreato-biliary disease and worse post-ERCP outcomes, including longer length of stay and higher mortality rate. These are important considerations when planning for endoscopic intervention.</p><p><strong>Clinicaltrials: </strong>gov: (NCT05051358).</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854023","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}