Scandinavian Journal of Gastroenterology最新文献

Background and aims: Prior studies indicate that serum calprotectin (SC) and plasma calprotectin (PC) can be used as biomarkers in Crohn's disease (CD). The aim of this study was to investigate the diagnostic accuracy of SC and PC in patients with a clinical suspicion of CD.

Method: This biobank study included patients from a prospective, blinded, multicenter study examining minimally invasive modalities for diagnosing CD. Patients had a standardized work-up including ileocolonoscopy, pan-enteric capsule endoscopy, and blood samples within a 2-week period. Plasma and serum were stored at - 80 °C until further analysis. A routine C-reactive protein (CRP) was measured on the same day. Pan-endoscopy served as reference standard.

Results: 126 patients entered the study, and 58 (46.0%) were diagnosed with CD. Patients with CD had a median PC of 0.37 mg/L (IQR 0.20-0.70) compared to 0.29 mg/L (IQR 0.16-0.41) in non-CD patients (p = 0.03). The median SC was 1.09 mg/L (IQR 0.80-1.80) and 0.93 mg/L (IQR 0.66-1.25), respectively (p = 0.01). Receiver operating characteristics curves showed an AUC of 0.63 (CI 0.53-0.73) for SC and 0.61 (CI 0.51-0.71) for PC for detection of CD, which was inferior to that of CRP (AUC = 0.76, CI 0.68-0.85) (p < 0.02). None of the biomarkers reflected the endoscopic severity of CD.

Conclusion: Although levels of PC and SC are elevated in patients with CD, diagnostic accuracies are inferior to CRP. SC and PC are not reliable as stand-alone blood-based biomarkers for diagnosing CD and selecting patients for endoscopy.

Background: The aim of screening for colorectal cancer (CRC) is to find the cancer in its early stages, thereby improving the prognosis of cancer patients by preventing cancer-related deaths. In Finland, the national CRC screening program was initiated in 2022, with fecal immunochemical test (FIT) being the primary screening test. The FIT-threshold used was 25 µg hemoglobin/g feces. The aim of this retrospective study was to evaluate the results of the first screening round that was implemented by the wellbeing services county of Southwest Finland.

Materials and methods: Participants were screened for CRC between March 1^st, 2022 and April 14^th, 2023. Participants aged 60-70 years had their health records scrutinized retrospectively.

Results: Out of 36 397 FIT-invitees 23 388 (64%) returned a FIT-sample. 1407 (6%) subjects gave a FIT-positive stool sample of which 1118 (79%) attended the recommended screening colonoscopy. A total of 63 (6%) CRCs were found. 31 (49%) CRCs were classified as early stage I tumors, 12 (19%) of which were solely suitable for endoscopic treatment. Endoscopically removable adenomas were detected in 709 (63%) of the colonoscopies, which resulted in a recommendation of a 3-year follow-up colonoscopy for 427 (38%) cases. There were 3 (0.27%) acute polypectomy related complications and 5 (0.45%) late post-colonoscopy complications.

Conclusions: This is the first study to show the prevalence of CRC amongst participants of the newly implemented Finnish national CRC-screening program. Nearly half of the patients with CRC were diagnosed in the early stage. The adenoma detection rate was high.

Background: Colorectal adenomas (CRA) exhibit high recurrence rates following endoscopic resection. Insulin resistance (IR) and chronic inflammation, increasingly prevalent due to unhealthy lifestyles, are key factors in CRA development. This study aimed to evaluate the predictive power of combining the inflammation score with the triglyceride-glucose (TyG) index for CRA recurrence.

Methods: We conducted a comprehensive analysis of the clinical characteristics of 847 CRA patients who underwent endoscopic resection. Postoperative recurrence of CRA was assessed using logistic regression analyses to determine odds ratios (ORs) and 95% confidence intervals (CIs). The receiver operating characteristic (ROC) curve analysis was utilized to predict the risk of CRA recurrence based on the inflammation score and TyG index.

Results: Among the 847 CRA included in the study, 126 experienced recurrences. Logistic regression analysis identified NLR (OR 2.641, 95% CI 1.982-3.549), TyG (OR 1.494, 95% CI 1.146-1.956), three or more adenomas (OR 2.182, 95% CI 1.431-3.322) and CRA larger than 10 mm (OR 1.917, 95% CI 1.267-2.921) as independent risk factors for CRA recurrence. ROC curves demonstrated the efficacy of NLR (AUC 0.701, 95% CI 0.652-0.750) and TyG (AUC 0.607, 95% CI 0.553-0.660) in predicting CRA recurrence. The combination of NLR, TyG and adenoma characteristics showed improved performance in predicting CRA recurrence (AUC 0.762, 95% CI 0.718-0.805).

Conclusions: Elevated NLR and TyG were associated with an increased risk of CRA recurrence. The integration of NLR and TyG with CRA characteristics significantly enhanced the predictive power for CRA recurrence.

Objective: To investigate the effectiveness of endorectal advancement flaps for middle and low rectovaginal fistulas.

Methods: A retrospective cohort of 57 patients who underwent surgery via an endorectal advancement flap in the RVF between July 2007 and March 2022 was generated. The clinical features of the patients were reviewed. The associations between fistula closure and diverse clinical parameters, including age, body mass index, diameter of the fistula, prior repair, pathological type, diverting stoma and operative method, were analyzed.

Results: Congenital (n = 19, 33.33%) and obstetric (n = 19, 33.33%) injuries were the most common etiologies of rectovaginal fistulas. The success rate in patients who underwent a first repair was 66.7%, and the overall success rate was 70.2% after repetition of the same technique. There were no significant differences in the closure rate between the success and failure groups in age, body mass index, prior repair, preoperative colostomy, or pathological type (p > 0.05). However, a diameter greater than 1 cm predicted a lower success rate for both the first repair (p < 0.05) and the overall procedure (p < 0.05). Two cases of failure with a diameter greater than 1 cm succeeded after a sphincter repair procedure half a year later.

Conclusion: The endorectal advancement flap is safe and effective for removing simple rectovaginal fistulas at the middle and lower positions. A diameter greater than 1 cm is an independent risk factor for this surgical technique, and sphincteroplasty may be a better choice for this condition.

Aim: Periampullary diverticulum (PAD) is a common anatomical variant that can potentially impact the technical difficulty and outcomes of endoscopic retrograde cholangiopancreatography (ERCP), necessitating a comprehensive understanding of its effects on the procedure. To evaluate the effect of PAD subtypes and diameter on ERCP cannulation success and clinical outcomes.

Materials and methods: The study included patients with PAD and papilla-naïve patients undergoing ERCP for suspected common bile duct stones or distal benign strictures (due to PAD compression). PAD subtyping was based on Lobo and Li-Tanaka classifications. Diverticulum size was categorized as small (<1 cm), medium (1-2 cm), and giant (≥2 cm).

Results: Of the 907 patients analyzed, 164 (18%) had PAD with a median age of 63 years. PAD patients were significantly older than non-PAD patients and had more comorbidities . The most frequent PAD type was 2B (34.1%) based on the Li-Tanaka classification. Subgroup analysis of PAD types 1, 2, 3, and 4 showed no statistically significant differences in cannulation time, success, total procedure time, or adverse events (AEs). . Overall cannulation success rates were similar between PAD and non-PAD groups (99.4% vs 99.6%). Analysis based on diverticulum size revealed higher probabilities of giant stones and procedure-related AEs in giant diverticula. The risk of post-ERCP pancreatitis was notably low at 1.8% in the PAD group.

Conclusion: Diverticulum size, rather than PAD subtype, may be more closely associated with cannulation success and procedure-related AEs in ERCP. Individualized management considering diverticulum size may improve outcomes in PAD patients undergoing ERCP.

Objective: To clarify the short- and long-term validity of pancreatoduodenectomy in octogenarian patients with biliary tract carcinoma.

Methods: We compared 23 and 141 patients aged ≥80 and <80 years, who underwent pancreatoduodenectomy for biliary tract carcinoma (distal cholangiocarcinomas and ampullary carcinomas) and evaluated the relationship between age, clinicopathological factors, and surgical and oncological outcomes, especially in terms of recurrence.

Results: Median overall survival time of distal cholangiocarcinoma and ampullary carcinoma was 92 and 109 months (p = 0.13). Postoperative complications, mortality, and adjuvant chemotherapy rates did not differ between the groups. Although the 5-year recurrence-free survival rate was similar, the 5-year disease-specific survival and overall survival rate were significantly shorter in octogenarians (≥80 years: 43.5, 47.1, and 35.3%; <80 years: 54.1, 69.2, and 63.0%; p = 0.41, 0.016, and 0.034, respectively). The median time from recurrence to death for octogenarian patients was significantly shorter than that of younger patients (3.3 vs. 16.1 months, p < 0.001). At recurrence, the serum albumin level, prognostic nutritional index, controlling nutritional status score, and treatment rate for recurrence were lower in octogenarians. The multivariate analysis identified age ≥80 years (hazard ratio: 3.8), low prognostic nutritional index (hazard ratio: 2.9), high serum carbohydrate antigen 19-9 (hazard ratio: 2.6), and failure to implement treatment after recurrence (hazard ratio: 3.0) as independent risk factors for a short time from recurrence to death. Furthermore, age ≥80 years (odds ratio 0.09) was an independent risk factor for treatment implementation after recurrence.

Conclusions: Octogenarians had a shorter survival time after recurrence, resulting from low nutritional indices and a reduced rate of treatment implementation at the time of recurrence.

Objective: This study aimed to provide insight about clinical management of ciliated hepatic foregut cysts (CHFC) at a tertiary centre.

Background: CHFC is a rare cystic lesion of the liver with malignant potential according to previous reports. However, the current recommendation to resect all cysts in fit patients is based on limited evidence.

Methods: Retrospective observational single-centre study including all patients with radiological suspicion of CHFC at Karolinska University Hospital during the years 2015-2022. Patients were characterised, mainly descriptively, regarding baseline characteristics, radiological and histopathological data, as well as data on follow-up.

Results: A total of 41 patients with suspected CHFC were identified. Of these, 23 were operated and 18 only diagnosed radiologically. Of the operated, 19 patients (83%) had a histopathological examination confirming CHCF diagnosis. No patient had dysplasia or cancer in the specimen, and no patient developed cancer during a follow-up length (from first radiology) of 82 months (3-215).

Conclusions: CHFC can be diagnosed radiologically with acceptable accuracy. No patient in this study had malignant transformation, neither in the specimens nor during follow-up. Surgical treatment of CHCF for all patients fit for surgery should probably be challenged, but further studies supporting this change of management are needed.

Objectives: The full thickness resection is an innovative technique that enables non-exposed endoscopic full-thickness resection (EFTR) of superficial and subepithelial gastrointestinal lesions. This retrospective, multicenter study evaluated the effectiveness and safety of EFTR in gastroduodenal and colorectal resections.

Materials and methods: Data from 105 consecutive EFTR procedures at 6 Polish endoscopic centers were analyzed. Patients were divided into three groups: 'difficult adenoma', adenocarcinoma, or subepithelial lesion (SEL). Outcomes assessed were R0 resection and adverse event rates, with subgroup analysis.

Results: The study included 105 patients (mean age: 67 ± 10.3 years; 59% male): 48 (46%) with 'difficult adenoma', 31 (30%) with adenocarcinoma, and 26 (25%) with SEL. Of these, 82 patients (78%) underwent colorectal EFTR, while 23 (22%) underwent gastroduodenal EFTR. Technical success was achieved in 101 procedures (96%), with a median time of 30 (20; 40) minutes. Among the technically successful EFTRs, R0 resection was confirmed in 86 patients (97%): 18 (95%) in the SEL group, 45 (100%) in the 'difficult adenoma' group, and 23 (92%) in the adenocarcinoma group (p = 0.1806). In 13 EFTR procedures (13%), a scar from a previous endoscopic resection was removed without any pathological lesion. Curative resections were obtained in 21 (88%) patients in the SEL group and 20 (67%) patients in the adenocarcinoma group (p = 0.0001). Clinical adverse events occurred in 12 patients (11%): Clavien-Dindo grade I (5%), II (2%), and IIIb (5%).

Conclusions: EFTR is reasonably safe and effective for resection of colorectal and gastroduodenal lesions, which would otherwise most likely require surgical treatment.

Objectives: The only treatment with curative potential for distal cholangiocarcinoma (dCCA) is radical surgery which can be complemented with adjuvant chemotherapy. The aim of the present study was to perform an independent external validation of a prognostic model for 3-year overall survival based on routine clinicopathological variables for patients treated with pancreatoduodenectomy for dCCA.

Materials and methods: All patients with a histopathological confirmed dCCA that underwent pancreatoduodenectomy in Sweden from 2009 through 2019 were identified in the Swedish National Registry for Pancreatic and Periampullary Cancer. Model performance was estimated using the C-index and calibration plots.

Results: In total 220 patients were included in the study. The median survival was 33 months (IQR 26-40) and 3-year survival rate 47% (95% CI 40-53%). The prognostic model had a C-index of 0.69 (95% CI 0.62-0.72). Calibration plots revealed overestimated risk of death across risk groups in the full cohort. Calibration was good in the subgroup of patients that did not receive adjuvant treatment.

Conclusions: The prognostic model showed reasonable discriminative ability but some miscalibration likely since the effect of adjuvant treatment is not included in the model. Given that the model was developed in cohorts treated prior to the current adjuvant standard of care the model can be used to estimate baseline risk prior to risk/benefit decision for adjuvant treatment as well as stratification for clinical trials but with a risk to underestimate 3-year overall survival for patients that receive adjuvant treatment.

Background: The Charlson Comorbidity Index (CCI) and prognostic nutritional index (PNI) have proven to be valuable tools in predicting prognosis based on comorbidities and nutritional status in the context of surgical procedures and endoscopic resections. The age-Adjusted CCI (ACCI) has also shown utility in surgical settings, but its application to early gastric cancer (EGC) remains unexplored. Consequently, we aimed at clarifying the prognostic factors for EGC treated with endoscopic submucosal dissection (ESD).

Methods: Patients who underwent ESD for EGC at the First Affiliated Hospital of Dalian Medical University from January 2015 to February 2023 were included. The overall survival (OS) and prognostic predictive ability were evaluated based on patients and lesion characteristics.

Results: During a median follow-up period of 50 months, 15 patients died, but none from the gastric cancer. The 5-year survival rate was 90.0%. In univariate and multivariate analyses, a high ACCI (>4.5) was the only significant prognostic factor (Hazard ratio, 27.78; 95% confidence interval, 3.62-213.40; p < 0.01). The 5-year survival rates for patients with low ACCI (<4.5) and high ACCI were 98.9% and 72.9%, respectively (p < 0.01).

Conclusions: A high ACCI is a significant prognostic indicator for 5-year survival and the risk of mortality caused by other comorbidities. EGC suitable for ESD is unlikely to serve as a prognostic factor, and ACCI should be considered as an important reference when considering additional surgical procedures in high-ACCI patients after ESD with endoscopic curability (eCura) C-2 for EGC.