United European Gastroenterology Journal最新文献

Background: Biliary acute pancreatitis (AP) during pregnancy is a challenging situation, and current guidelines for AP, pregnancy care, and surgery do not specifically address its management. This study investigated the safety and effectiveness of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy in AP.

Methods: This international retrospective multicenter cohort study encompassed questions related to demographic information, clinical presentation, management strategies, timing of cholecystectomy, approaches to the procedure, complications, and outcomes. Continuous variables were summarized as medians with interquartile ranges, and categorical variables as frequencies and percentages. Group comparisons used Welch's t-test, Pearson's chi-squared, or Fisher's exact tests.

Results: A total of 101 cases from 14 countries and 19 centers were enrolled. Cholecystectomy after mild AP during pregnancy had a lower rate of readmission due to recurrent AP or other gallstone-related complications compared with those who did not undergo surgery after a mild AP during pregnancy (0% vs. 24%; n = 0/17 vs. n = 12/49, p = 0.027). Cholecystectomy performed during pregnancy was associated with a low surgical complication rate, identical to that seen in postpartum procedures (12% vs. 10%; n = 2/17 vs. n = 3/30; p > 0.999). Preterm birth occurred in 7.1% (n = 1/14) of patients with cholecystectomy versus 11% (n = 5/45) without. Fetal loss after surgery occurred only in the first trimester (n = 3/17 vs. n = 1/49). No difference was seen in readmission (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138), fetal loss (5%, n = 1/21 vs. 27%, n = 4/15; p = 0.138) and preterm birth (6%, n = 1/17 vs. 8%, n = 1/12; p > 0.999) between the surgical and ERCP groups. The fetal loss (9.1%, n = 2/22 vs. 5.4%, n = 4/74; p = 0.618) and preterm birth rates (5.9%, n = 1/17 vs. 12%, n = 8/65; p = 0.677) did not significantly differ between patients with and without ERCP during pregnancy.

Conclusion: Cholecystectomy is effective and safe in pregnant patients during the second or third trimester in cases of mild biliary pancreatitis. ERCP is safe in any trimester.

Background: Early advanced inflammatory bowel disease (IBD) therapy is emphasised to prevent disease progression and restore quality of life.

Aims: To evaluate the potential advantages of early versus late anti-tumour necrosis factor (TNF) therapy in patients with IBD.

Methods: This retrospective study included patients with newly diagnosed IBD (2004-2018) who received anti-TNF therapy and had at least 1 year of follow-up. Patients were categorised as early or late users based on a 2-year post-diagnosis cut-off for first anti-TNF exposure. Outcomes included IBD-related surgeries, hospitalizations, emergency department (ED) visits, and drug persistence. Subgroup analysis examined concurrent immunomodulator use, and sensitivity analyses were employed 6 months or 1 year post-diagnosis cut-offs.

Results: Among 8105 patients with ulcerative colitis (UC) and 8465 with Crohn's disease (CD), distinct outcomes emerged. Early anti-TNF users with UC had significantly higher hospitalization (hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.91-1.96) and ED visit rates (HR 1.30, 95% CI 1.16-1.46) compared with late users. In CD, early users showed a non-significant trend toward fewer event rates. Drug persistence was longer among late users for both UC and CD. In UC, combining immunomodulators with early anti-TNF increased hospitalization and ED visits but not in CD. Sensitivity analyses confirmed the primary findings.

Conclusions: While early anti-TNF use was associated with differential outcomes in CD, the relationship between treatment timing and clinical course diverged in UC, challenging the assumption that early intervention is universally advantageous across IBD subtypes. These findings underscore the need for further research to identify patient subgroups that might benefit most from early intervention.

Background: Chronic pancreatitis is a risk factor for pancreatic cancer. Autoimmune pancreatitis is a unique form of chronic pancreatitis that is primarily characterized by its immune mediate etiology, clinically resembling pancreatic cancer, yet uniquely responsive to steroid treatment.

Objective: Early and accurate diagnosis of autoimmune pancreatitis is vital for effective treatment and patient prognosis, for which new diagnostic tools are urgently required. Gut microbiota dysbiosis has been identified to correlate with the development of pancreatic diseases, which provides new opportunities for the discovery of disease biomarkers.

Methods: We utilized a mass spectrometric global metabolomics investigation of patient autoimmune pancreatitis and chronic pancreatitis fecal samples, investigating microbiome, dietary and human metabolism.

Results: We discovered a series of newly identified metabolic signatures between both patient groups including enterolactone, 4-guanidinobutanoic acid, and methylthioadenosine sulfoxide. Additionally, the analysis revealed significant differences in several metabolic pathways such as fatty acids, alkaloids, amino acids and peptides.

Conclusion: Our observations provide novel insights into important metabolic human pathways and microbiome-derived metabolites to distinguish autoimmune pancreatitis from chronic pancreatitis. These findings reveal systemic metabolic responses and the identified metabolites may be developed into potential biomarkers for future diagnosis to distinguish between autoimmune pancreatitis and chronic pancreatitis.

Objectives: A novel partially self-expandable metal stent (PCSEMS) with an anti-migration system has recently become available during Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) but requires tract dilation. No previous study has compared the performance of dilation devices during EUS-HGS. The aim of this randomized controlled trial was to evaluate the technical success rate of tract dilation between a balloon catheter and drill dilator technique during EUS-HGS prior to insertion of SEMS with an anti-migration system.

Methods: A single-center, randomized controlled trial comparing the balloon dilation and drill dilator techniques for first-line tract dilation during EUS-HGS. The primary outcome was the initial technical success rate of tract dilation for each technique during EUS-HGS. The secondary outcome was adverse events associated with the procedures.

Results: Of 54 randomized patients who underwent EUS-HGS at our center, there were 27 in the balloon dilation group and 27 in the drill dilation group. The initial technical success rate was 92.6% (25/27) in the balloon dilation group and 100% (27/27) in the drill dilation group (p = 0.1495). The technical success rate of stent delivery system insertion was significantly higher in the balloon dilation group (88%, 22/25) than in the drill dilation group (45%, 13/27; p = 0.0013). Procedure time was significantly shorter in the balloon dilation group (mean, 9.7 min) than in the drill dilation group (mean, 14.0 min; p = 0.047). Adverse events were more frequent in the drill dilation group (7.4% vs. 29.6%, p = 0.038).

Conclusions: Balloon dilation appears more suitable than drill dilation for PCSEMS with 8.5 Fr stent delivery system deployment.

Clinical trial registration number: University Hospital Medical Information Network 000049550.