Journal of Digestive Diseases最新文献_第9页

Concordance of phenotypic characteristics among patients with familial Crohn's disease in China 中国家族性克罗恩病患者表型特征的一致性。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-08-21 DOI: 10.1111/1751-2980.13304

Xiao Xia Deng, Min Zhi Lin, Xiang Gao, Xin Yu Liu, Yan Hui Wu, Kang Chao, Jian Tang

Objectives

Familial Crohn's disease (CD) accounts for approximately 1.5%–22.5% of all CD cases worldwide. We aimed to assess the concordance in disease subtype and phenotypic features among patients with CD and their relatives based on data from a large, well-characterized, referral center-based cohort in China.

Methods

A retrospective study was conducted on patients with familial CD who were admitted to the Sixth Affiliated Hospital of Sun Yat-sen University between January 2012 and June 2022. We analyzed the disease characteristics and performed a concordance analysis within the same family among patients with familial CD.

Results

Among 5150 patients, 70 (1.4%) had a family history of Crohn's disease. The median age of the patients at initial diagnosis did not differ significantly between the probands and successors of family members with CD (p = 0.25). At the initial diagnosis, 54 first-degree relatives showed moderate concordance in age (κ = 0.50) and disease location (κ = 0.44). At the last follow-up visit, all family members and first-degree relatives showed good concordance in upper gastrointestinal involvement (κ = 0.67 and 0.62) and stricturing or penetrating behavior (κ = 0.69 and 0.77), respectively. Patients with familial CD within the same family showed moderate agreement regarding anti-tumor necrosis factor α monoclonal antibody use and treatment efficacy (κ = 0.44 and 0.42) and mild agreement regarding the efficacy and adverse reactions of thiopurine (κ = 0.26 and 0.35).

Conclusions

The proportion of patients with familial CD in China may be relatively low. The consistency of certain disease features in familial CD may be associated with the degree of kinship and convergence with longer follow-up duration.

目的：家族性克罗恩病（CD）约占全球所有 CD 病例的 1.5%-22.5%。我们的目的是基于中国一个大型、特征明确、以转诊中心为基础的队列数据，评估克罗恩病患者及其亲属在疾病亚型和表型特征方面的一致性：我们对中山大学附属第六医院2012年1月至2022年6月期间收治的家族性CD患者进行了回顾性研究。我们分析了家族性 CD 患者的疾病特征，并对同一家族内的患者进行了一致性分析：在5150名患者中，70人（1.4%）有克罗恩病家族史。初次确诊时患者的中位年龄在克罗恩病家族成员的原发者和继发者之间没有显著差异（P = 0.25）。在初次诊断时，54 名一级亲属在年龄（κ = 0.50）和发病部位（κ = 0.44）方面表现出中等程度的一致性。在最后一次随访时，所有家庭成员和一级亲属在上消化道受累（κ = 0.67和0.62）和严格或穿透行为（κ = 0.69和0.77）方面分别显示出良好的一致性。同一家族中的家族性 CD 患者在抗肿瘤坏死因子 α 单克隆抗体的使用和疗效方面表现出中等程度的一致性（κ = 0.44 和 0.42），在硫嘌呤的疗效和不良反应方面表现出轻度的一致性（κ = 0.26 和 0.35）：结论：中国家族性 CD 患者的比例可能相对较低。结论：中国家族性 CD 患者的比例可能相对较低，家族性 CD 患者某些疾病特征的一致性可能与亲缘关系程度有关，随访时间越长越趋同。

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引用次数: 0

Clinical and endoscopic characteristics of colorectal sessile serrated lesions with or without dysplasia/carcinoma: A systematic review and meta-analysis 有或无发育不良/癌的结直肠无柄锯齿状病变的临床和内镜特征：系统综述和荟萃分析。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-08-05 DOI: 10.1111/1751-2980.13302

Qing Qing Zhang, Jian Di Wu, Xue Yan Li, Fei Fei Fang, Gang Ping Li, Tao Bai, Jun Song

Objective

We aimed to compare the clinical and endoscopic characteristics of sessile serrated lesions (SSLs) with dysplasia/carcinoma (SSLD/Cs) and SSLs without dysplasia in this systematic review and meta-analysis.

Methods

MEDLINE, EMBASE, and Cochrane Library databases and Clinicaltrials.gov were searched for relevant studies published up to August 28, 2023. The primary outcome was lesion size in SSLD/Cs and SSLs without dysplasia. The secondary outcomes included risk of dysplasia/carcinoma, morphology (classified based on the Paris classification), and lesion features such as mucus cap and nodules/protrusions in the two groups.

Results

Thirteen studies with 14 381 patients were included. The proportion of SSLD/Cs ≥10 mm was significantly higher than that of SSLs without dysplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.21–12.02, p = 0.02). There was no significant difference in the risk of dysplasia/carcinoma between the proximal (OR 0.80, 95% CI 0.57–1.14) and distal colon (OR 1.25, 95% CI 0.88–1.77, p = 0.21). The 0-Ip (OR 2.47, 95% CI 1.50–4.09) and 0-IIa + Is (OR 10.38, 95% CI 3.08–34.98) morphologies were more prevalent among SSLD/Cs, whereas the 0-IIa morphology (OR 0.38, 95% CI 0.22–0.65) was more prevalent among SSLs without dysplasia (all p < 0.001). Furthermore, mucus cap (OR 0.61, 95% CI 0.42–0.89, p = 0.01) was more common among SSLs without dysplasia, whereas nodules/protrusions (OR 7.80, 95% CI 3.07–19.85, p < 0.001) were more common in SSLD/Cs.

Conclusion

SSLs >10 mm, 0-Ip or 0-IIa + Is morphologies, and those with nodules/protrusions are significantly associated with dysplasia/carcinoma.

目的：我们旨在通过本系统综述和荟萃分析比较伴有发育不良/癌（SSLD/Cs）的无柄锯齿状病变（SSLs）和不伴有发育不良的无柄锯齿状病变（SSLs）的临床和内窥镜特征：检索了 MEDLINE、EMBASE 和 Cochrane Library 数据库以及 Clinicaltrials.gov 中截至 2023 年 8 月 28 日发表的相关研究。主要研究结果为 SSLD/Cs 和 SSLs 中病变的大小，无发育不良。次要结果包括两组患者发生发育不良/癌变的风险、形态（根据巴黎分类法分类）以及病变特征，如粘液帽和结节/突起：结果：共纳入 13 项研究，14 381 名患者。SSLD/Cs≥10毫米的比例明显高于无发育不良的SSL（几率比[OR]3.82，95%置信区间[CI]1.21-12.02，P = 0.02）。近端结肠（OR 0.80，95% CI 0.57-1.14）和远端结肠（OR 1.25，95% CI 0.88-1.77，P = 0.21）发生发育不良/癌变的风险无明显差异。0-Ip（OR 2.47，95% CI 1.50-4.09）和 0-IIa + Is（OR 10.38，95% CI 3.08-34.98）形态在 SSLD/Cs 中更为常见，而 0-IIa 形态（OR 0.38，95% CI 0.22-0.65）在无发育不良的 SSL 中更为常见（所有 p 均为结论）：大于 10 毫米的 SSL、0-Ip 或 0-IIa + Is 形态以及伴有结节/突起的 SSL 与发育不良/癌明显相关。

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引用次数: 0

Are biologics beneficial alternatives for cryptogenic multifocal ulcerous stenosing enteritis? A case report and literature review 生物制剂是治疗隐源性多灶性溃疡性狭窄肠炎的有益替代品吗？病例报告和文献综述。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-08-01 DOI: 10.1111/1751-2980.13305

Shao Heng Zhang, Qing Qing, Huo Wang Ye, Xin Ying Wang

引用次数: 0

Development of a risk scoring system for predicting advanced colorectal neoplasia within subcentimetric polyps: A population-based study 开发风险评分系统，用于预测亚厘米息肉中的晚期结直肠肿瘤：一项基于人群的研究。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-30 DOI: 10.1111/1751-2980.13303

Junjie Huang, Eman Y. M. Leung, Sam C. C. Chun, Zhaojun Li, Xianjing Liu, Chao Ying Zhong, Jian Li Lin, Jun Jie Hang, Claire C. W. Zhong, Jin Qiu Yuan, Martin C. S. Wong

Objective

To determine a risk scoring system for predicting advanced colorectal neoplasia (ACN) within subcentimetric polyps in a large Asian population.

Methods

A retrospective study was conducted in Hong Kong SAR, China involving participants who underwent colonoscopy between 2008 and 2015. A random sample of 20 072 subjects were included as the derivation cohort to assess ACN-associated independent factors using logistic regression modeling. Another 8603 subjects formed a validation cohort. A risk scoring system was developed and its performance was assessed using the area under the receiver operating characteristic curve (AUROC).

Results

The risk scores were assigned based on the following criteria: (a) patients who were admitted from inpatient colonoscopy (2.2) or not (1); (b) with three or more chronic diseases (hypertension, diabetes mellitus, hyperlipidemia, heart disease, or cancer) (1.7) or not (1); (c) anemia (1.3) or without anemia (1); (d) receiving aspirin (0.5) or not (1); (e) receiving other nonsteroidal anti-inflammatory drugs (0.3) or not (1); (f) male (1.2) or female gender (1); (g) age <55 (1), 55–64 (1.4), 65–69 (2), 70 years or above (2.2). ACN was more common in those with scores of 2.192 or higher, and they were classified as high risk (HR). The prevalence of ACN in the validation cohort was 13.28% and 3.56% in the HR and low-risk groups, respectively. In both the derivation and validation cohorts, AUROC of the risk-scoring model was 0.7138.

Conclusion

Physicians are recommended to utilize this validated score for risk-stratification of patients having subcentimetric polyps.

目的确定一个风险评分系统，用于预测大量亚洲人群中的亚厘米息肉内的晚期结直肠肿瘤（ACN）：在中国香港特别行政区开展了一项回顾性研究，研究对象包括在 2008 年至 2015 年期间接受过结肠镜检查的人。随机抽取 20 072 名受试者作为衍生队列，使用逻辑回归模型评估与 ACN 相关的独立因素。另外 8603 名受试者组成验证队列。研究人员开发了一套风险评分系统，并利用接收者操作特征曲线下面积（AUROC）对其性能进行了评估：风险评分标准如下(结果：根据以下标准进行风险评分：(a) 住院患者接受结肠镜检查（2.2）或未接受结肠镜检查（1）；(b) 患有三种或三种以上慢性疾病（高血压、糖尿病、高脂血症、心脏病或癌症）（1.7）或未患慢性疾病（1）；(c) 贫血（1.3）或无贫血（1）；（d）服用阿司匹林（0.5）或未服用（1）；（e）服用其他非甾体抗炎药（0.3）或未服用（1）；（f）男性（1.2）或女性（1）；（g）年龄结论：建议医生使用该有效评分法对亚高危息肉患者进行风险分级。

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引用次数: 0

Interaction of Th17 differentiations-related gene polymorphisms and environmental factors contributing to the disease classification, complications, and surgical risks of Crohn's disease in the Chinese Han population Th17分化相关基因多态性与环境因素对中国汉族克罗恩病的疾病分类、并发症和手术风险的交互作用。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-29 DOI: 10.1111/1751-2980.13301

Ru Ning Zhou, Ge Chong Ruan, Mei Xu Wu, Ming Yue Guo, Hao Zheng Liang, Xiao Yin Bai, Hong Yang

Objectives

Few studies have been conducted on gene–environment interactions in the Chinese population with Crohn's disease (CD). We aimed to investigate the association between single nucleotide polymorphisms (SNPs) on the T helper 17 (Th17) cell and CD susceptibility/performance in Chinese individuals.

Methods

We conducted a case–control and case-only study at the Peking Union Medical College Hospital. Four SNPs related to the Th17 cell pathway genes were prioritized, including rs2284553 (interferon gamma receptor 2), rs7517847 (interleukin 23 receptor), rs7773324 (interferon regulatory factor 4), and rs4263839 (tumor necrosis factor superfamily 15). SNP frequency was calculated, and gene–environment interaction was assessed by multifactor dimensionality reduction analysis.

Results

Altogether 159 CD patients and 316 healthy controls were included. All analyzed SNPs were found in Hardy–Weinberg equilibrium (P > 0.05). The frequency of rs2284553-A allele and rs4263839-A allele were lower in CD patients compared with controls (P < 0.05). While the rs4263839-A allele was more prevalent in ileocolonic CD patients than in those with isolated small intestinal or colonic disease (P = 0.035). Gene–environment interactions revealed associations between rs2284553 and breastfeeding, sunshine exposure, and fridge-stored food, affecting age at diagnosis, intestinal involvement, and intestinal stricture. Interaction of rs4263839 and breastfeeding influenced small intestinal lesions and intestinal stricture in CD.

Conclusions

This study provided information on the genetic background in Chinese CD patients. Incorporating these SNPs into predictive models may improve risk assessment and outcome prediction. Gene–environment interaction contributes to the understanding of CD pathogenesis.

研究目的有关中国克罗恩病（CD）患者基因与环境相互作用的研究很少。我们的目的是研究中国人T辅助细胞17（Th17）的单核苷酸多态性（SNPs）与克罗恩病易感性/表现之间的关系：方法：我们在北京协和医院进行了一项病例对照和纯病例研究。方法：我们在中国协和医科大学附属北京协和医院进行了一项病例对照和病例纯合研究，优先选择了 4 个与 Th17 细胞通路基因相关的 SNP，包括 rs2284553（γ 干扰素受体 2）、rs7517847（白细胞介素 23 受体）、rs7773324（干扰素调节因子 4）和 rs4263839（肿瘤坏死因子超家族 15）。计算了SNP频率，并通过多因素降维分析评估了基因与环境的相互作用：结果：共纳入了 159 名 CD 患者和 316 名健康对照者。所有分析的SNP均处于哈代-温伯格平衡状态（P>0.05）。与对照组相比，rs2284553-A等位基因和rs4263839-A等位基因在CD患者中的频率较低（P 结论：该研究为CD患者的遗传背景提供了信息：本研究提供了中国 CD 患者的遗传背景信息。将这些 SNPs 纳入预测模型可改善风险评估和预后预测。基因与环境的相互作用有助于了解 CD 的发病机制。

{"title":"Interaction of Th17 differentiations-related gene polymorphisms and environmental factors contributing to the disease classification, complications, and surgical risks of Crohn's disease in the Chinese Han population","authors":"Ru Ning Zhou, Ge Chong Ruan, Mei Xu Wu, Ming Yue Guo, Hao Zheng Liang, Xiao Yin Bai, Hong Yang","doi":"10.1111/1751-2980.13301","DOIUrl":"10.1111/1751-2980.13301","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Few studies have been conducted on gene–environment interactions in the Chinese population with Crohn's disease (CD). We aimed to investigate the association between single nucleotide polymorphisms (SNPs) on the T helper 17 (Th17) cell and CD susceptibility/performance in Chinese individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a case–control and case-only study at the Peking Union Medical College Hospital. Four SNPs related to the Th17 cell pathway genes were prioritized, including rs2284553 (interferon gamma receptor 2), rs7517847 (interleukin 23 receptor), rs7773324 (interferon regulatory factor 4), and rs4263839 (tumor necrosis factor superfamily 15). SNP frequency was calculated, and gene–environment interaction was assessed by multifactor dimensionality reduction analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 159 CD patients and 316 healthy controls were included. All analyzed SNPs were found in Hardy–Weinberg equilibrium (<i>P</i> > 0.05). The frequency of rs2284553-A allele and rs4263839-A allele were lower in CD patients compared with controls (<i>P</i> < 0.05). While the rs4263839-A allele was more prevalent in ileocolonic CD patients than in those with isolated small intestinal or colonic disease (<i>P</i> = 0.035). Gene–environment interactions revealed associations between rs2284553 and breastfeeding, sunshine exposure, and fridge-stored food, affecting age at diagnosis, intestinal involvement, and intestinal stricture. Interaction of rs4263839 and breastfeeding influenced small intestinal lesions and intestinal stricture in CD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study provided information on the genetic background in Chinese CD patients. Incorporating these SNPs into predictive models may improve risk assessment and outcome prediction. Gene–environment interaction contributes to the understanding of CD pathogenesis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 6","pages":"368-379"},"PeriodicalIF":2.3,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Chinese consensus on the management of liver cirrhosis 中国肝硬化管理共识。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-23 DOI: 10.1111/1751-2980.13294

Chinese Society of Gastroenterology, Chinese Medical Association

Liver cirrhosis, characterized by diffuse necrosis, insufficient regeneration of hepatocytes, angiogenesis, severe fibrosis, and the formation of pseudolobules, is a progressive, chronic liver disease induced by a variety of causes. It is clinically characterized by liver function damage and portal hypertension, and many complications may occur in its late stage. Based on the updated practice guidelines, expert consensuses, and research advances on the diagnosis and treatment of cirrhosis, the Chinese Society of Gastroenterology of Chinese Medical Association established the current consensus to standardize the clinical diagnosis and management of liver cirrhosis and guide clinical practice. This consensus contains 43 statements on the etiology, pathology and pathogenesis, clinical manifestations, major complications, diagnosis, treatment, prognosis, and chronic disease control of liver cirrhosis. Since several practice guidelines and expert consensuses on the complications of liver cirrhosis have been published, this consensus emphasizes the research progress of liver cirrhosis itself.

肝硬化以弥漫性坏死、肝细胞再生不足、血管生成、严重纤维化和假小叶形成为特征，是一种由多种原因诱发的进行性慢性肝病。其临床特点是肝功能损害和门静脉高压，晚期可出现多种并发症。中华医学会消化病学分会根据最新的肝硬化诊治指南、专家共识和研究进展，制定了本共识，以规范肝硬化的临床诊治，指导临床实践。该共识包含 43 项声明，内容涉及肝硬化的病因、病理和发病机制、临床表现、主要并发症、诊断、治疗、预后和慢性病控制。鉴于已有多份关于肝硬化并发症的实践指南和专家共识出版，本共识强调了肝硬化本身的研究进展。

引用次数: 0

Single-operator single-balloon enteroscopy is safe and effective: A 6-year retrospective study 单人单气囊肠镜既安全又有效：一项为期 6 年的回顾性研究。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-16 DOI: 10.1111/1751-2980.13300

Guan Jun Kou, Chao Liu, Yan Bo Yu, Yan Qing Li, Xiu Li Zuo

Objectives

Single-balloon enteroscopy (SBE) is an effective tool for the detection of small intestine lesions. Because it is conventionally performed by two operators, the efficacy of single-operator SBE method has not yet been elucidated. We aimed to evaluate the diagnostic yield, total enteroscopy rate, procedure time, and complications of single-operator SBE for small intestinal disease.

Methods

This was a single-center, retrospective study including consecutive patients who underwent single-operator SBE for suspicious small intestinal disorders or required therapeutic interventions between December 2014 and January 2019. The SBE procedures were performed by four endoscopists. Diagnostic yield, total enteroscopy rate, procedure time, incubation depth, and complications were analyzed, and stratification analysis was performed.

Results

Altogether 922 patients with 1422 SBE procedures were included for analysis, among whom 250, 172, and 500 patients underwent SBE via the oral route, the anal route and a combined route, respectively. The overall diagnostic yield was 78.52% (724/922). And 253 patients achieved total enteroscopy, with a total enteroscopy rate of 56.10%. The average procedure time for the oral and anal routes were 69.28 ± 14.72 min and 64.95 ± 13.87 min, respectively. While the incubation depth was 389.95 ± 131.42 cm and 191.81 ± 83.67 cm, respectively. Jejunal perforation was observed in one patient, which was managed by endoclips. Stratification analysis showed that the diagnostic yield and total enteroscopy rate significantly increased with operation experience together with decreased procedure time.

Conclusion

Single-operator SBE is effective and safe for the detection of small intestinal lesions, and is easy to master.

目的：单气囊肠镜（SBE）是检测小肠病变的有效工具。由于传统的单气囊肠镜由两名操作者完成，因此单人操作的 SBE 方法的有效性尚未得到阐明。我们的目的是评估单人 SBE 治疗小肠疾病的诊断率、总肠镜检查率、手术时间和并发症：这是一项单中心、回顾性研究，包括 2014 年 12 月至 2019 年 1 月间因可疑小肠疾病或需要治疗干预而接受单器械 SBE 的连续患者。SBE手术由四名内镜医师完成。分析了诊断率、总肠镜检查率、手术时间、潜伏深度和并发症，并进行了分层分析：共有922名患者接受了1422次SBE手术，其中分别有250人、172人和500人通过口腔途径、肛门途径和综合途径进行了SBE手术。总诊断率为 78.52%（724/922）。253 名患者进行了全肠镜检查，全肠镜检查率为 56.10%。口腔和肛门途径的平均手术时间分别为（69.28 ± 14.72）分钟和（64.95 ± 13.87）分钟。孵育深度分别为 389.95 ± 131.42 厘米和 191.81 ± 83.67 厘米。一名患者出现空肠穿孔，经内镜夹处理。分层分析表明，随着手术经验的增加和手术时间的缩短，诊断率和总肠镜检查率也明显增加：结论：单人操作的 SBE 可有效、安全地检测小肠病变，且易于掌握。

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引用次数: 0

Primary sclerosing cholangitis with IgG4-positive plasma cells in bile duct biopsies ― Frequency and characterization 胆管活检中出现 IgG4 阳性浆细胞的原发性硬化性胆管炎--频率和特征。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-15 DOI: 10.1111/1751-2980.13295

Taotao Zhou, Florian Fronhoffs, Glen Kristiansen, Leona Dold, Dominik J. Kaczmarek, Christian P. Strassburg, Tobias J. Weismüller

Objectives

Patients diagnosed with primary sclerosing cholangitis (PSC) but with characteristics of immunoglobulin G4 (IgG4)-associated cholangitis (IAC) have been described. IAC often presents with biliary IgG4-positive plasma cell (IgG4+ PC) infiltration and responds to corticosteroids. In PSC, the frequencies or implications of biliary IgG4+ PC are unknown. We aimed to characterize the phenomenon of biliary IgG4+ PC in patients with an established PSC diagnosis.

Methods

Bile duct biopsies from 191 surveillance or therapeutic endoscopic retrograde cholangiography of 58 PSC patients were retrospectively analyzed for IgG4+ PC infiltration. Patients with ≥10 IgG4+ PC per high-power field (HPF) were identified and characterized by clinical parameters, including serum IgG4 and cholangiographic presentations.

Results

Altogether 39.7% of the PSC patients showed ≥10 IgG4+ PC/HPF in bile duct biopsies. Patients with biliary IgG4+ PC infiltration were significantly younger at diagnosis of PSC (P = 0.023). There was no association between biliary IgG4+ PC infiltration and transplant-free survival (P = 0.618). Patients with IgG4+ PC infiltration in bile duct biopsies showed significantly higher baseline (P = 0.002) and maximum (P = 0.001) serum IgG4 compared to those without. Biliary IgG4+ PC infiltration was associated with high-grade bile duct strictures (P = 0.05). IgG4-positive plasma cell infiltrations were found multifocally in 72.7% of this subgroup of PSC patients.

Conclusions

IgG4+ PC ≥10/HPF can be found abundantly in bile duct biopsies in PSC. Histological findings correlated with serum IgG4, age, and high-grade bile duct strictures. IgG4+ PC was located multifocally, hinting at a systemic biliary phenotype.

目的：有患者被诊断为原发性硬化性胆管炎（PSC），但却具有免疫球蛋白 G4（IgG4）相关性胆管炎（IAC）的特征。IAC 通常表现为胆道 IgG4 阳性浆细胞（IgG4+ PC）浸润，并对皮质类固醇有反应。在 PSC 中，胆汁 IgG4+ PC 的频率或影响尚不清楚。我们的目的是描述已确诊为 PSC 患者的胆道 IgG4+ PC 现象：我们对 58 例 PSC 患者的 191 例监测性或治疗性内镜逆行胆管造影的胆管活检进行了回顾性分析，以确定是否存在 IgG4+ PC 浸润。对每个高倍视野（HPF）IgG4+ PC ≥10 例的患者进行鉴定，并根据临床参数（包括血清 IgG4 和胆管造影表现）对其进行特征描述：结果：总共有 39.7% 的 PSC 患者在胆管活检中发现 IgG4+ PC≥10 个/HPF。有胆道 IgG4+ PC 浸润的患者在确诊为 PSC 时明显更年轻（P = 0.023）。胆道 IgG4+ PC 浸润与无移植生存率之间没有关联（P = 0.618）。胆管活检中出现 IgG4+ PC 浸润的患者的血清 IgG4 基线（P = 0.002）和最高值（P = 0.001）均明显高于未出现 IgG4 浸润的患者。胆道 IgG4+ PC 浸润与高级别胆管狭窄有关（P = 0.05）。在这一亚组PSC患者中，72.7%的患者发现IgG4阳性浆细胞多灶性浸润：结论：在 PSC 患者的胆管活检中可发现大量 IgG4+ PC ≥10/HPF。组织学发现与血清 IgG4、年龄和高级别胆管狭窄相关。IgG4+ PC分布在多个部位，提示存在系统性胆道表型。

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引用次数: 0

Goblet cell adenocarcinoma of the gallbladder: Report of two cases and a review 胆囊腺癌：两个病例的报告和综述。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-15 DOI: 10.1111/1751-2980.13298

Fatma Khanchel, Imen Helal, Amira Hmidi, Maissa Ben Thayer, Haithem Zaafouri, Dhafer Hadded, Raweh Hedhli, Ehsen Ben Brahim, Raja Jouini, Aschraf Chadli-Debbiche

引用次数: 0

Reassessment of EUS features in preoperative diagnosis of pancreatic serous cystic neoplasm: Lessons to avoid misdiagnosis 重新评估胰腺浆液性囊性瘤术前诊断中的 EUS 特征：避免误诊的经验。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-07-14 DOI: 10.1111/1751-2980.13299

Xiao Lan Zhang, Ke Chen, Yi Ping He, Xiu Jiang Yang, Jian Qiang Liu

Objectives

Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis.

Methods

Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed.

Results

Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of the lesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin-producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%.

Conclusions

Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin-producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN.

目的：胰腺浆液性囊性肿瘤（SCN）是一种良性囊性肿瘤，很可能因术前误诊或即使使用内镜超声检查（EUS）也无法做出初步诊断而被手术切除。我们旨在分析与误诊相关的 SCN 的 EUS 结果：方法：纳入2012年1月至2023年9月期间经组织学确诊的胰腺SCN患者，并回顾性分析其EUS特征：结果：共纳入 294 例患者，300 例经手术切除的 SCN。患者的中位年龄为 51 岁，75.9% 为女性。病变主要位于胰体/胰颈/胰尾（63.0%）。SCN的总体术前诊断率为36.3%，最常见的误诊为导管内乳头状粘液瘤（IPMN）（31.3%），16.3%仍未确定。不同内镜形态的 SCN 术前诊断率各不相同，少囊型、大囊型、小囊型和实变型的诊断率分别为 12.8%、37.9%、76.5% 和 19.2%。值得注意的是，中央疤痕和血管的存在提高了诊断的准确性，分别正确识别了 41.4% 和 52.3% 的病变。而粘液或胰管（PD）沟通则大大增加了误诊的可能性，尤其是误诊为 IPMN。多变量分析显示，形态模式、粘液分泌征象、壁增厚、血管和胰管沟通是导致术前误诊的独立因素，总体准确率为82.3%：结论：SCN的术前诊断仍具有挑战性。微囊型是一个可靠的特征，而粘液分泌征象，包括壁层结节、粘液和PD沟通，尽管存在SCN常见的典型中央瘢痕或血管，但仍会造成诊断误区。

{"title":"Reassessment of EUS features in preoperative diagnosis of pancreatic serous cystic neoplasm: Lessons to avoid misdiagnosis","authors":"Xiao Lan Zhang, Ke Chen, Yi Ping He, Xiu Jiang Yang, Jian Qiang Liu","doi":"10.1111/1751-2980.13299","DOIUrl":"10.1111/1751-2980.13299","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of the lesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin-producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin-producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 7","pages":"463-469"},"PeriodicalIF":2.3,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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