To evaluate the effectiveness of the Lille Index (LI) on day 2 (LI2) and day 4 (LI4) in predicting short-term mortality in patients with severe alcohol-associated hepatitis (SAH) and to assess its concordance compared to the Lille Index on day 7 (LI7).
Patients and methods
This retrospective, observational, single-center study included SAH patients admitted between 2016 and 2023. SAH was defined as a Maddrey score ≥32 and/or a MELD score ≥21. The predictive ability of LI2, LI4, and LI7 for 28-, 90-, and 180-day mortality was analyzed using AUC, Cox regression (Hazar Ratio (HR)), and Kaplan-Meier curves.
Results
Among 65 SAH patients, 62 received corticosteroids. Median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (P>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (68.33% vs. 70.97%, P=.752) and LI4 vs. LI7 (73.33% vs. 70.97%, P=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7 was 93.33%.
Results
Among 65 SAH patients, 62 received corticosteroids. The median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (P>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (P=.752) and LI4 vs. LI7 (P=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7, 93.33%.
Conclusions
LI2 and LI4 were comparable to LI7 in predicting short-term mortality in SAH. Earlier calculation, particularly LI2, could anticipate clinical decisions in poor prognosis patients, such as corticosteroid discontinuation or evaluation for liver transplantation in selected cases.
{"title":"Valor pronóstico del índice de Lille precoz en los pacientes con hepatitis asociada al alcohol grave","authors":"Ana Suárez-Saro Fernández , Mónica Barreales Valbuena , Cristina Martín-Arriscado Arroba , Elena Gómez Domínguez , Álvaro Hidalgo Romero , Inmaculada Fernández Vázquez","doi":"10.1016/j.gastrohep.2025.502517","DOIUrl":"10.1016/j.gastrohep.2025.502517","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effectiveness of the Lille Index (LI) on day 2 (LI2) and day 4 (LI4) in predicting short-term mortality in patients with severe alcohol-associated hepatitis (SAH) and to assess its concordance compared to the Lille Index on day 7 (LI7).</div></div><div><h3>Patients and methods</h3><div>This retrospective, observational, single-center study included SAH patients admitted between 2016 and 2023. SAH was defined as a Maddrey score ≥32 and/or a MELD score ≥21. The predictive ability of LI2, LI4, and LI7 for 28-, 90-, and 180-day mortality was analyzed using AUC, Cox regression (Hazar Ratio (HR)), and Kaplan-Meier curves.</div></div><div><h3>Results</h3><div>Among 65 SAH patients, 62 received corticosteroids. Median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% <span>C</span>I: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (<em>P</em>>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (68.33% vs. 70.97%, <em>P</em>=.752) and LI4 vs. LI7 (73.33% vs. 70.97%, <em>P</em>=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7 was 93.33%.</div></div><div><h3>Results</h3><div>Among 65 SAH patients, 62 received corticosteroids. The median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (<em>P</em>>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (<em>P</em>=.752) and LI4 vs. LI7 (<em>P</em>=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7, 93.33%.</div></div><div><h3>Conclusions</h3><div>LI2 and LI4 were comparable to LI7 in predicting short-term mortality in SAH. Earlier calculation, particularly LI2, could anticipate clinical decisions in poor prognosis patients, such as corticosteroid discontinuation or evaluation for liver transplantation in selected cases.</div></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"48 10","pages":"Article 502517"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368789","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 : 2025-12-01DOI: 10.1016/j.gastrohep.2025.502529
Míriam Mañosa , Margalida Calafat , Esther Francia , Francesc Riba , Francisco Mesonero , Cristina Suárez , Santiago García-López , Francisco Losfablos , Xavier Calvet , Eugeni Domènech , Ana Gutiérrez Casbas , Ingrid Ordás , Luis Menchén , Francisco Rodríguez-Moranta , Yamile Zabana
Frailty is a state of vulnerability characterised by a decrease in physiological reserve and the ability to respond to stress, which increases the risk of complications, adverse effects of treatments and functional decline. Assessing frailty allows the biological age of patients to be determined, beyond their chronological age, providing a more accurate picture of their health status and care needs. The proportion of older adults with IBD is increasing in parallel with the ageing of the general population, and it is estimated that in the next decade, more than a third of IBD patients will be over 60 years of age. This population may suffer from complications arising from previously developed IBD and is particularly susceptible to developing side effects from treatment, making comprehensive assessment essential in order to identify those who are most vulnerable. Frailty is compounded by other geriatric syndromes such as comorbidity and polypharmacy, which can significantly interfere with the management and course of IBD, influencing the therapeutic strategy and prognosis.
Objective
In this context, comprehensive geriatric assessment should be systematic in elderly patients with IBD, with the aim of detecting functional deficits and implementing specific interventions for nutritional support, functional rehabilitation and psychological care to optimise their progress. This position paper aims to establish recommendations in this regard based on the available evidence.
Conclusions
The systematic incorporation of comprehensive geriatric assessment in the management of older people with IBD represents an essential strategy for improving clinical outcomes, adapting treatments to the patient's functional capacity and promoting a truly person-centred approach.
{"title":"Documento de posicionamiento de GETECCU sobre fragilidad, edad avanzada y enfermedad inflamatoria intestinal","authors":"Míriam Mañosa , Margalida Calafat , Esther Francia , Francesc Riba , Francisco Mesonero , Cristina Suárez , Santiago García-López , Francisco Losfablos , Xavier Calvet , Eugeni Domènech , Ana Gutiérrez Casbas , Ingrid Ordás , Luis Menchén , Francisco Rodríguez-Moranta , Yamile Zabana","doi":"10.1016/j.gastrohep.2025.502529","DOIUrl":"10.1016/j.gastrohep.2025.502529","url":null,"abstract":"<div><div>Frailty is a state of vulnerability characterised by a decrease in physiological reserve and the ability to respond to stress, which increases the risk of complications, adverse effects of treatments and functional decline. Assessing frailty allows the biological age of patients to be determined, beyond their chronological age, providing a more accurate picture of their health status and care needs. The proportion of older adults with IBD is increasing in parallel with the ageing of the general population, and it is estimated that in the next decade, more than a third of IBD patients will be over 60 years of age. This population may suffer from complications arising from previously developed IBD and is particularly susceptible to developing side effects from treatment, making comprehensive assessment essential in order to identify those who are most vulnerable. Frailty is compounded by other geriatric syndromes such as comorbidity and polypharmacy, which can significantly interfere with the management and course of IBD, influencing the therapeutic strategy and prognosis.</div></div><div><h3>Objective</h3><div>In this context, comprehensive geriatric assessment should be systematic in elderly patients with IBD, with the aim of detecting functional deficits and implementing specific interventions for nutritional support, functional rehabilitation and psychological care to optimise their progress. This position paper aims to establish recommendations in this regard based on the available evidence.</div></div><div><h3>Conclusions</h3><div>The systematic incorporation of comprehensive geriatric assessment in the management of older people with IBD represents an essential strategy for improving clinical outcomes, adapting treatments to the patient's functional capacity and promoting a truly person-centred approach.</div></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"48 10","pages":"Article 502529"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636866","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 : 2025-12-01DOI: 10.1016/j.gastrohep.2025.502464
Ester Navarro-Correal , Diana Muñoz-Gómez , Adriana Rivera-Sequeiros , Francisca Murciano-Gonzalo , on behalf of the MAPEA Research Group
Background and aims
This study aimed to provide a comprehensive nationwide assessment of the status of nursing management in inflammatory bowel disease (IBD).
Methods
A nationwide observational cross-sectional survey study was conducted. Nurses involved in the care of patients with IBD completed the 90-item Nursing Care Quality in IBD Assessment (NCQ-IBD) questionnaire which classifies the level of quality of care from A (highest) to D (lowest).
Results
A total of 71 f questionnaires were analyzed. In this study, category A was achieved in 2 (2.8%) cases, category B in 53 (74.6%), and category C in 16 (22.5%). Of the list of 27 professional competencies identified for a specialized IBD nurse, 23 (85.2%) were met by more than 70% of participants. Regarding the presence of specific nursing IBD care only 28 (39.4%) worked for more than 4.5 days/week. About 88.7% of nurses used clinical practice guidelines or protocols and 74.6% applied scales for assessing anxiety and depression, but just 18.8% and 25.4% evaluated IBD classification and activity indexes, respectively. Only 53.5% of participants reported to have available training plan in IBD. In the last 5 years, 25.4% of professionals had participated in more than five research projects, 9.9% had presented more than five communications in meetings, and 14.1% had published more than three articles.
Conclusions
Nursing care was highly satisfactory. Signage on nursing consultation doors, administrative support, holiday coverage, encouraging research, and primarily increasing the ratio of nurses working full-time, are areas for improvement.
{"title":"Insights into the status of the quality of nursing care in patients with inflammatory bowel disease: A nationwide survey (The MAPEA Project)","authors":"Ester Navarro-Correal , Diana Muñoz-Gómez , Adriana Rivera-Sequeiros , Francisca Murciano-Gonzalo , on behalf of the MAPEA Research Group","doi":"10.1016/j.gastrohep.2025.502464","DOIUrl":"10.1016/j.gastrohep.2025.502464","url":null,"abstract":"<div><h3>Background and aims</h3><div>This study aimed to provide a comprehensive nationwide assessment of the status of nursing management in inflammatory bowel disease (IBD).</div></div><div><h3>Methods</h3><div>A nationwide observational cross-sectional survey study was conducted. Nurses involved in the care of patients with IBD completed the 90-item Nursing Care Quality in IBD Assessment (NCQ-IBD) questionnaire which classifies the level of quality of care from A (highest) to D (lowest).</div></div><div><h3>Results</h3><div>A total of 71 f questionnaires were analyzed. In this study, category A was achieved in 2 (2.8%) cases, category B in 53 (74.6%), and category C in 16 (22.5%). Of the list of 27 professional competencies identified for a specialized IBD nurse, 23 (85.2%) were met by more than 70% of participants. Regarding the presence of specific nursing IBD care only 28 (39.4%) worked for more than 4.5<!--> <!-->days/week. About 88.7% of nurses used clinical practice guidelines or protocols and 74.6% applied scales for assessing anxiety and depression, but just 18.8% and 25.4% evaluated IBD classification and activity indexes, respectively. Only 53.5% of participants reported to have available training plan in IBD. In the last 5 years, 25.4% of professionals had participated in more than five research projects, 9.9% had presented more than five communications in meetings, and 14.1% had published more than three articles.</div></div><div><h3>Conclusions</h3><div>Nursing care was highly satisfactory. Signage on nursing consultation doors, administrative support, holiday coverage, encouraging research, and primarily increasing the ratio of nurses working full-time, are areas for improvement.</div></div>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":"48 10","pages":"Article 502464"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086026","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}
{"title":"Striking image of sigmoid megaesophagus in rapidly progressing type I achalasia.","authors":"Orlando Morera Alvarez, Oriol Llargues Pou, Pere Borràs Garriga, Yamile Zabana","doi":"10.1016/j.gastrohep.2025.502631","DOIUrl":"10.1016/j.gastrohep.2025.502631","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502631"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145632492","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 : 2025-11-13DOI: 10.1016/j.gastrohep.2025.502630
Ana Plaza Fernández, Marta Fernández Carrasco, María Del Mar Calvo Bernal
{"title":"Hiatal hernia with cardiac impact: When syncope is not what it seems.","authors":"Ana Plaza Fernández, Marta Fernández Carrasco, María Del Mar Calvo Bernal","doi":"10.1016/j.gastrohep.2025.502630","DOIUrl":"10.1016/j.gastrohep.2025.502630","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502630"},"PeriodicalIF":1.9,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530607","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 : 2025-11-11DOI: 10.1016/j.gastrohep.2025.502629
Álvaro Díaz-González, Cristina Molera, Elena Gómez-Domínguez, Gema Muñoz-Bartolo, Javier Ampuero, Conrado Fernández-Rodríguez, Jesus Quintero, Esther Molina, Magdalena Salcedo, Antonio Olveira, Rosa Morillas, María Alós Díez, Marta Casado, Luisa García-Buey, Sergio Rodríguez-Tajes, Francisco Jorquera, Marina Berenguer, Jose Luis Montero, Maria Carlota Londoño
Cholestatic liver diseases comprise a heterogeneous group of disorders affecting both adult and pediatric population, characterized by alterations in bile formation, secretion, or flow, leading to the accumulation of bile acids and other toxic substances in the liver. In recent years, advances in new pharmacological therapies, the availability of next-generation genetic sequencing techniques, and the development of specific treatments for genetic cholestasis have transformed the diagnostic and therapeutic approach to these conditions. This document, jointly prepared by the "Asociación Española para el Estudio del Hígado" (AEEH) and the "Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica" (SEGHNP), presents a national evidence-based guideline for the diagnosis and management of hepatic cholestasis in Spain. It addresses recommendations for differential diagnosis, diagnostic algorithms, indications for genetic studies, treatment and follow-up criteria in diseases such as primary biliary cholangitis, primary sclerosing cholangitis, genetic cholestasis, intrahepatic cholestasis of pregnancy, and vanishing bile duct syndrome. In addition, recommendations are included for the management of extrahepatic complications, indications for liver transplantation, and special considerations in pregnancy and childhood. The guideline emphasizes the importance of a multidisciplinary approach, the use of non-invasive tools for risk stratification, and the incorporation of new targeted therapies, with the aim of improving the prognosis and quality of life of patients affected by cholestatic liver diseases.
胆汁淤积性肝病包括影响成人和儿童人群的异质性疾病，其特征是胆汁形成、分泌或流动的改变，导致胆汁酸和其他有毒物质在肝脏中的积累。近年来，新药物治疗的进展，下一代基因测序技术的可用性，以及遗传性胆汁淤积症特异性治疗方法的发展，已经改变了对这些疾病的诊断和治疗方法。该文件由“Asociación Española para el Estudio del Hígado”（AEEH）和“Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica”（SEGHNP）联合编写，提出了西班牙肝脏胆汁淤滞症诊断和管理的国家循证指南。它提出了鉴别诊断、诊断算法、遗传研究的适应症、治疗和随访标准等疾病的建议，如原发性胆管炎、原发性硬化性胆管炎、遗传性胆汁淤积、妊娠肝内胆汁淤积和胆管消失综合征。此外，建议包括肝外并发症的处理，肝移植的适应症，以及孕期和儿童期的特殊注意事项。该指南强调多学科方法的重要性，使用非侵入性工具进行风险分层，并结合新的靶向治疗，以改善胆汁淤积性肝病患者的预后和生活质量。
{"title":"Spanish clinical practice guidelines for the diagnosis and management of cholestatic liver diseases in adult and pediatric population: Joint report from AEEH and SEGHNP.","authors":"Álvaro Díaz-González, Cristina Molera, Elena Gómez-Domínguez, Gema Muñoz-Bartolo, Javier Ampuero, Conrado Fernández-Rodríguez, Jesus Quintero, Esther Molina, Magdalena Salcedo, Antonio Olveira, Rosa Morillas, María Alós Díez, Marta Casado, Luisa García-Buey, Sergio Rodríguez-Tajes, Francisco Jorquera, Marina Berenguer, Jose Luis Montero, Maria Carlota Londoño","doi":"10.1016/j.gastrohep.2025.502629","DOIUrl":"10.1016/j.gastrohep.2025.502629","url":null,"abstract":"<p><p>Cholestatic liver diseases comprise a heterogeneous group of disorders affecting both adult and pediatric population, characterized by alterations in bile formation, secretion, or flow, leading to the accumulation of bile acids and other toxic substances in the liver. In recent years, advances in new pharmacological therapies, the availability of next-generation genetic sequencing techniques, and the development of specific treatments for genetic cholestasis have transformed the diagnostic and therapeutic approach to these conditions. This document, jointly prepared by the \"Asociación Española para el Estudio del Hígado\" (AEEH) and the \"Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica\" (SEGHNP), presents a national evidence-based guideline for the diagnosis and management of hepatic cholestasis in Spain. It addresses recommendations for differential diagnosis, diagnostic algorithms, indications for genetic studies, treatment and follow-up criteria in diseases such as primary biliary cholangitis, primary sclerosing cholangitis, genetic cholestasis, intrahepatic cholestasis of pregnancy, and vanishing bile duct syndrome. In addition, recommendations are included for the management of extrahepatic complications, indications for liver transplantation, and special considerations in pregnancy and childhood. The guideline emphasizes the importance of a multidisciplinary approach, the use of non-invasive tools for risk stratification, and the incorporation of new targeted therapies, with the aim of improving the prognosis and quality of life of patients affected by cholestatic liver diseases.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502629"},"PeriodicalIF":1.9,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512736","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 : 2025-11-08DOI: 10.1016/j.gastrohep.2025.502627
Ana García-Rodríguez, Beatriz García Zafra, Natacha Llopart, Carla Santos
{"title":"Impact of GLP-1 receptor agonists on capsule endoscopy: Proposal for adaptation of preparation protocols.","authors":"Ana García-Rodríguez, Beatriz García Zafra, Natacha Llopart, Carla Santos","doi":"10.1016/j.gastrohep.2025.502627","DOIUrl":"10.1016/j.gastrohep.2025.502627","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502627"},"PeriodicalIF":1.9,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488179","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 : 2025-11-06DOI: 10.1016/j.gastrohep.2025.502610
Romario Ruiz, Milagros Dávalos, Edson Guzmán, Ramiro Díaz, Edgar Alva, Javier Contreras, Felipe De La Torre, Luis Cervera
Objective: To evaluate the diagnostic performance of the 2019 American Society for Gastrointestinal Endoscopy (ASGE) criteria for choledocholithiasis in patients with acute biliary pancreatitis (ABP).
Patients and methods: We retrospectively analyzed patients diagnosed with ABP and suspected choledocholithiasis at a tertiary hospital between January and December 2024. Common bile duct (CBD) stones were confirmed by magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT) followed by endoscopic retrograde cholangiopancreatography (ERCP). Patients were stratified according to ASGE 2019 criteria. Diagnostic accuracy was assessed, and cut-off values for alkaline phosphatase (ALP), total bilirubin (TB), and CBD diameter were determined using receiver operating characteristic (ROC) analysis and logistic regression. Biochemical follow-up was analyzed in intermediate-risk patients without confirmed stones.
Results: A total of 197 patients were included; 52 (26.4%) had confirmed choledocholithiasis. Prevalence was 46.9% in the high-risk group and 22.4% in the intermediate group. High-risk classification showed low sensitivity (28.8%) but high specificity (88.3%). Alkaline phosphatase (ALP) was the only independent predictor (cut-off 518IU/L). In intermediate-risk patients without stones, 95% achieved biochemical normalization within 2 weeks.
Conclusions: ASGE 2019 criteria overestimate the risk of choledocholithiasis in ABP, particularly in intermediate-risk patients. Early biochemical follow-up may avoid unnecessary imaging and procedures in this group, while ALP remains the most consistent independent predictor. These results support more conservative and cost-effective management strategies in ABP.
{"title":"Diagnostic performance of ASGE criteria for choledocholithiasis in acute biliary pancreatitis: A retrospective cohort study.","authors":"Romario Ruiz, Milagros Dávalos, Edson Guzmán, Ramiro Díaz, Edgar Alva, Javier Contreras, Felipe De La Torre, Luis Cervera","doi":"10.1016/j.gastrohep.2025.502610","DOIUrl":"10.1016/j.gastrohep.2025.502610","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic performance of the 2019 American Society for Gastrointestinal Endoscopy (ASGE) criteria for choledocholithiasis in patients with acute biliary pancreatitis (ABP).</p><p><strong>Patients and methods: </strong>We retrospectively analyzed patients diagnosed with ABP and suspected choledocholithiasis at a tertiary hospital between January and December 2024. Common bile duct (CBD) stones were confirmed by magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT) followed by endoscopic retrograde cholangiopancreatography (ERCP). Patients were stratified according to ASGE 2019 criteria. Diagnostic accuracy was assessed, and cut-off values for alkaline phosphatase (ALP), total bilirubin (TB), and CBD diameter were determined using receiver operating characteristic (ROC) analysis and logistic regression. Biochemical follow-up was analyzed in intermediate-risk patients without confirmed stones.</p><p><strong>Results: </strong>A total of 197 patients were included; 52 (26.4%) had confirmed choledocholithiasis. Prevalence was 46.9% in the high-risk group and 22.4% in the intermediate group. High-risk classification showed low sensitivity (28.8%) but high specificity (88.3%). Alkaline phosphatase (ALP) was the only independent predictor (cut-off 518IU/L). In intermediate-risk patients without stones, 95% achieved biochemical normalization within 2 weeks.</p><p><strong>Conclusions: </strong>ASGE 2019 criteria overestimate the risk of choledocholithiasis in ABP, particularly in intermediate-risk patients. Early biochemical follow-up may avoid unnecessary imaging and procedures in this group, while ALP remains the most consistent independent predictor. These results support more conservative and cost-effective management strategies in ABP.</p>","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502610"},"PeriodicalIF":1.9,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476903","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 : 2025-11-05DOI: 10.1016/j.gastrohep.2025.502626
Guillén Bernal-Bandrés, María Escuín-Sanmartín, Sergio García-Mateo, Reynaldo Alfonso Vilorio-Guzmán, Enrique Ceamanos-Ibarra, Marta Latre-Santos, Gonzalo Hijos-Mallada
{"title":"Gastrointestinal bleeding from gastric metastases of renal carcinoma: An uncommon cause.","authors":"Guillén Bernal-Bandrés, María Escuín-Sanmartín, Sergio García-Mateo, Reynaldo Alfonso Vilorio-Guzmán, Enrique Ceamanos-Ibarra, Marta Latre-Santos, Gonzalo Hijos-Mallada","doi":"10.1016/j.gastrohep.2025.502626","DOIUrl":"10.1016/j.gastrohep.2025.502626","url":null,"abstract":"","PeriodicalId":12802,"journal":{"name":"Gastroenterologia y hepatologia","volume":" ","pages":"502626"},"PeriodicalIF":1.9,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470869","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}
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