JGH Open最新文献

Aim

Pancreatic cancer, marked by its high lethality and poor 5-year survival rate, requires a thorough understanding of its risk factors and etiological mechanisms. In this review, we collected the latest findings from Mendelian randomization (MR) studies to identify potential causal factors for pancreatic cancer.

Method and Results

The present analysis encompasses MR studies on the gut and oral microbiomes, non-malignant phenotypes, blood metabolites, immune cells, and chronic inflammation. Specific gut and oral microbiome species have been identified as potential causal factors for pancreatic cancer, some with protective effects, and others increasing the risk. The review also highlights causal associations between obesity, type 2 diabetes, and pancreatic cancer, as well as the impact of blood metabolites and immune cell phenotypes on disease risk. Additionally, it investigates the causal effects of inflammatory bowel disease, showing a significant risk increase associated with Crohn's disease.

Conclusion

These insights emphasize the need for interdisciplinary research and personalized medicine to enhance prevention and treatment strategies for pancreatic cancer.

Background

Walled-off necrosis (WON) is a potentially fatal condition best treated endoscopically with metal or plastic stents. This study compares the clinical outcomes of these stents.

Methods

PubMed and Cochrane were searched for trials comparing metal and plastic stents for WON. Primary outcomes were clinical and technical success.

Results

Seven studies with 230 metal stent patients and 226 plastic stent patients were included. Metal stents showed significantly shorter procedure times (SMD -0.80, 95% CI: -1.25 to −0.34), better 4-week clinical success (OR 1.94, 95% CI: 1.00 to 3.77), and higher procedure costs (SMD 1.38, 95% CI: 0.56 to 2.20). No significant differences were observed in hospital stay (SMD -0.05, 95% CI: -0.35 to 0.25), technical success (OR 1.45, 95% CI: 0.22 to 9.43), clinical success (OR 1.13, 95% CI: 0.54 to 2.39), interventions (SMD -0.02, 95% CI: -0.34 to 0.29), need for necrosectomy (RR 1.10, 95% CI: 0.59 to 2.04), necrosectomy sessions (SMD 0.35, 95% CI: -0.42 to 1.11), need for percutaneous drainage (RR 0.82, 95% CI: 0.36 to 1.85), stent migration (RR 0.88, 95% CI: 0.29 to 2.66), bleeding (RR 0.97, 95% CI: 0.53 to 1.75), WON recurrence (RR 1.66, 95% CI: 0.70 to 3.92), treatment failure (death) (RR 0.75, 95% CI: 0.37 to 1.53), disconnected pancreatic duct (RR 0.93, 95% CI: 0.79 to 1.11), and total cost (SMD -0.02, 95% CI: -0.29 to 0.26).

Conclusion

Metal stents offer shorter procedure time and better 4-week clinical success, although at a higher cost, with most clinical outcomes showing no significant differences between stent types.

Background

Cirrhosis is an irreversible stage of liver damage that decreases the ability of the liver to store and metabolize nutrients. Malnutrition is a common problem in patients with cirrhosis and increases the risk of mortality.

Aims

This study aimed to assess malnutrition and associated factors among patients with cirrhosis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.

Methods

A cross-sectional study was conducted at Tikur Anbessa Specialized Hospital. All patients with cirrhosis who were admitted to the hospital from August to November were included. Royal Free Hospital Global Assessment tool (RFH-GA) was used to assess nutritional status. Data were entered in Epi-data software version 4.6.0.2 and analyzed with STATA version 17/MP. Ordinal logistic regression analysis was fitted to determine factors associated with nutritional status. Statistical significance was declared at p value < 0.05.

Results

The prevalence of moderate malnutrition and severe malnutrition were 36.67% and 14.29%, respectively. Patients with ascites were five times at a higher risk of being severely malnourished (AOR = 5.08; 95% CI = 2.66–9.67). The odds of severe malnutrition decrease by 0.35 times for patients without a history of previous hospitalization (AOR = 0.35; 95% CI = 0.18–0.68). The odds of being in the higher category of nutritional status (severe malnutrition) are 10 times higher for patients with hepatic encephalopathy (AOR = 10.43; 95% CI = 4.66–23.31). As the level of creatinine blood urea nitrogen (Cr-BUN) increases, the risk of malnutrition increases by 2.57 times (AOR = 2.57; 95% CI = 1.02–5.78).

Conclusion

Malnutrition is high among cirrhotic patients at Tikur Anbessa Specialized Hospital. Ascites, history of hospitalization, Cr-BUN, and hepatic encephalopathy are significant predictors of malnutrition.

Background

Familial Mediterranean Fever (FMF) is a prevalent inherited monogenic autoinflammatory disease that predominantly affects populations from the Mediterranean basin. It is typically characterized by the recurrence of fever episodes and abdominal pain accompanied by recurrent short-lived inflammatory attacks that usually resolve spontaneously within 1–3 days. It is uncommon to see ascites with large amounts of peritoneal fluid as a manifestation of FMF.

Case Presentation

A 36-year-old Arab female presented with generalized abdominal pain and bloating. No family history of FMF. Analysis of peritoneal fluid identified low-grade ascites. A CT scan was performed, which did not reveal any suspicious lesions. Laparoscopic surgery was undertaken to rule out the differential diagnoses and obtain a peritoneal biopsy, even though the periton had a normal visual appearance. Histopathological examination of the biopsy specimens was compatible with a diagnosis of FMF, after other differential diagnoses were ruled out. The patient showed significant improvement within a month of taking colchicine. The ascites resolved progressively and completely, affirming the FMF diagnosis.

Conclusion

The occurrence of chronic ascites in a patient requires the consideration of FMF among the differential diagnoses. A diagnosis of FMF can also be suspected through a peritoneal biopsy, which may be sufficient for diagnosis without the need for genetic testing. Additionally, the patient's response to colchicine therapy can be considered for confirmation, as demonstrated in our case. Future research should focus on considering the inclusion of peritoneal biopsy among the diagnostic criteria for FMF particularly in cases with non-specific presentations.

Background and Aim

Managing benign biliary stricture endoscopically is complicated and challenging. This study aimed to evaluate the safety and efficacy of a 6-month placement of a fully covered self-expanding metallic stent for refractory benign biliary stricture.

Methods

Twenty-two patients with refractory benign biliary stricture (13 with chronic pancreatitis and 9 without) were recruited from five higher tertiary care centers. All patients received a planned 6-month fully covered self-expanding metallic stent placement. Primary outcomes included clinical success, technical success of stent removal, adverse events, and stricture recurrence.

Results

Of the 21 cases (one case was excluded owing to malignant findings), fully covered self-expanding metallic stent placement was successful in all cases, with contralateral bile duct plastic stents used in three patients and stents remaining in place for 6 months in 16 of 21 patients. Distal stent migration occurred in three cases, two of which had resolved strictures. Adverse events were observed in 19.0% of patients: one case of severe cholangitis, two cases of mild cholangitis, and one case of hyperplasia formation. No stent-induced pancreatitis or cholecystitis occurred. All stents were removed successfully, and the treatment success rate was 85%. One patient experienced recurrent stricture 6.5 months post-stent removal.

Conclusions

A six-month placement of a modified fully covered self-expanding metallic stent effectively improved strictures and minimized stent-induced Adverse events in patients with refractory benign biliary stricture.

Trial Registration

UMIN ID: UMIN000025027

Aim

This study aimed to compare the use of remimazolam and midazolam in upper gastrointestinal endoscopy in Japan as a sub-analysis of data from an investigator-initiated clinical trial of remimazolam.

Methods and Results

Patients in two groups were matched using propensity score matching. We evaluated the time from the end of the gastrointestinal endoscopy until discharge, the time from the end of the procedure until awakening, and adverse events. Overall, 36 participants from the clinical trial population who underwent upper gastrointestinal endoscopy using remimazolam and 199 patients who underwent the procedure with midazolam during the same period were included in this study. Following propensity score matching, 34 patients in both groups were matched. The median time from the end of the procedure until awakening was 27.0 min (23.0–40.5 min) in the midazolam group (Group M) and 0 min (0–5.0 min) in the remimazolam group (Group R); the median time from the end of the upper gastrointestinal endoscopy until discharge was 39.0 min (35.0–52.5 min) in Group M and 5.0 min (0–5.0 min) in Group R (p < 0.01). Reported adverse events were hypotension and hypoxemia in one patient in Group R.

Conclusion

Compared with midazolam, remimazolam significantly shortened the time to patient awakening and duration until the patient could leave the endoscopy room.

Trial Registration: The main study (REM-IICT JP1) is registered with the Japan Registry of Clinical Trails: jRCT2031200360

Background

Despite the popularity of a ketogenic diet, no randomized, controlled trials have evaluated its efficacy on metabolic dysfunction-associated steatotic liver disease (MASLD) progression.

Methods

We conducted an 8-week, open-label, randomized controlled trial involving 24 patients with MASLD who were randomly assigned to either the home delivery ketogenic diet or a nutrition education program on adherence to the DASH diet. The primary outcome was a reduction in hepatic steatosis as measured by transient elastography.

Results

There were no significant differences between groups in liver stiffness and steatosis measurement after interventions. Subjects on a ketogenic diet had lost more weight than subjects in the control group at 8 weeks (mean change [95% CI], −6.16 [−7.22, −5.10] vs. −2.14 [−4.49, 0.21] kg; p = 0.001). The decrease in waist circumference, systolic blood pressure, fat mass, and visceral fat area was significantly greater among subjects on a ketogenic diet than among those in the control group. Laboratory parameters, including AST, triglyceride, and HDL were also significantly decreased among subjects on a ketogenic diet than among those in the control group.

Conclusions

A ketogenic diet produced a significantly greater weight loss (absolute difference, approximately 4%) than did the general lifestyle advice intervention for the first 8 weeks. A ketogenic diet was associated with a greater improvement in some risk factors for coronary heart disease and MASLD. However, a ketogenic diet did not reduce steatosis nor worsen MASLD progression. Longer and larger studies are required to determine the long-term safety and efficacy of the ketogenic diet.

Trial Registration: TCTR20220426005

Background and Aim

Oxidative stress has been considered a factor in the development of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The present clinical trial evaluated whether adding intravenous mesna to rectal indomethacin could prevent or alleviate PEP.

Methods

An open-labeled clinical trial was done on 698 participants undergoing endoscopic retrograde cholangiopancreatography (ERCP). Eligible patients received 100 mg indomethacin suppository 30 min before undergoing ERCP. Randomly, the participants received 400 mg intravenous mesna or nothing 30 min before doing the procedure. The PEP incidence and degree were measured in the patients as the main outcome.

Results

The total rate of PEP was equal to 13.7%. No significant difference was seen in the rate and severity of PEP between the mesna plus indomethacin and indomethacin alone arms (14% vs. 13.4%, respectively, p = 0.671). In high-risk patients, PEP rate and severity were lower in the mesna plus indomethacin group compared with indomethacin alone group and the statistical analysis showed that the difference was significant (41.7% vs. 51.8%, respectively, p = 0.033).

Conclusion

In high-risk patients undergoing ERCP, a combination of intravenous mesna plus rectal indomethacin may decrease the PEP rate and severity.