JGH Open最新文献

Background

Solid organ transplant (SOT) recipients have an elevated malignancy risk due to long-term immunosuppression; however, the risk of colorectal cancer (CRC) is not well characterized, and current screening guidelines are not tailored to this population.

Methods

We used the TriNetX U.S. Collaborative Network to identify adults with SOT (kidney, liver, heart, or lung transplantation) between 2005 and 2025. SOT patients were propensity-score matched 1:1 to non-transplant controls, and CRC incidence at the 10-year and 20-year follow-up was compared. Sensitivity analyses evaluated CRC incidence before (2015–2019) and after (2020–2024) the COVID-19 pandemic onset.

Results

We identified 90 510 SOT recipients (matched to 90 510 controls from 9.8 million general patients). After matching, the baseline characteristics were balanced. SOT recipients had a higher cumulative incidence of CRC than controls at both 10 years (0.17% of kidney transplant patients vs. 0.02% of controls; p < 0.001) and 20 years posttransplantation. This elevated risk was observed across the kidney, liver, lung, and heart transplant cohorts (odds ratios: 1.3 for CRC in SOT vs. non-SOT at 10–20 years). Additionally, CRC incidence was higher in the post-COVID era compared to the pre-2019 era in all SOT groups (e.g., kidney 0.25% vs. 0.14%). This increase was most pronounced in older recipients (≥ 70 years) and Hispanic patients.

Conclusion

SOT recipients in the United States exhibit a significantly higher long-term CRC risk, a disparity that appears to have widened after the pandemic. These findings underscore the need to revisit CRC screening strategies in SOT recipients, particularly older and long-term transplant survivors.

Background

Patients with Inflammatory bowel disease (IBD) are at an increased risk of osteoporosis. There are limited studies internationally showing low screening rates for osteoporosis in IBD patients. There are no studies of osteoporosis screening in an Australian IBD cohort.

Aim

To determine the screening rate of osteoporosis in patients with IBD in an Australian tertiary IBD clinic using an extensive risk factor assessment.

Methods

A retrospective clinical audit; 252 individual patient records were reviewed from IBD clinic lists. A hybridized screening criterion was created from the European Crohn's and Colitis Organisation, British Society of Gastroenterology and Royal Australian College of General Practitioners guidelines. If patients were not up to date with screening, they were assessed as to whether they had met screening criteria during 2020/2021 and if they were recommended for a dual energy x-ray absorptiometry (DEXA) scan. If patients met criteria, DEXA scan results were collated.

Results

173 patients with IBD were included, 23 patients were up to date with screening and 150 required risk assessment. 101 patients met screening criteria, 12 had a DEXA completed during the study period. In the 35 DEXAs completed before or during the study, 37% showed osteoporosis, 40% showed osteopenia and 23% were normal.

Conclusion

A minority of patients who were identified as at risk of osteoporosis had a DEXA scan completed. Rates of reduced bone mineral density were high in the DEXA scans completed. Future directions should focus on validating expanded Medicare criteria to ensure at-risk patients may be screened.

Background

Patterns of steroid use in inflammatory bowel disease remain poorly characterized in real-world settings. Steroid exposure is associated with adverse effects and often indicates suboptimally controlled disease. Therefore, patterns and predictors of steroid use in a large inflammatory bowel disease cohort were examined.

Methods

Steroid exposure over a 3-year window was explored. Use was classified by duration—short (1–28 days), moderate (29–56 days), prolonged (> 56 days), and recency (within last year, prior years or no exposure). Associations with demographic and disease-related factors were assessed using multivariable logistic regression.

Results

Among 5436 people (median age 42 years, IQR 32–56), 18.3% (n = 994) were steroid exposed. 57.6% had Crohn's disease and 50.2% were female. Crohn's disease was associated with lower odds of both prolonged and recent exposure compared to ulcerative colitis (AOR 0.72, p = 0.001 and AOR 0.78, p = 0.037, respectively). Females had a greater likelihood of both prolonged and recent exposure (AOR 1.22, p = 0.048 and AOR 1.23, p = 0.041, respectively). Young adults (20–29 years) had higher odds of prolonged and recent use than those > 70 years (AOR 6.59 and 9.12, respectively, p < 0.001). Combination immunomodulator and advanced therapy use was associated with a higher likelihood of both prolonged and recent use compared to 5-aminosalicylic acid therapy alone (AOR 4.01, p = 0.002 and AOR 4.54, p < 0.001). Age at diagnosis had a modest effect size (AOR 1.03, p < 0.001).

Conclusion

Steroid use was modest, with over 80% unexposed over 3 years. Proactive optimization of therapy, particularly in younger individuals and those with ulcerative colitis, may further reduce steroid exposure.

Aims

Gastric epithelial neoplasm of fundic-gland mucosa lineage (GEN-FGML) has been increasingly recognized in recent years; however, few studies have investigated the histopathology of the background gastric mucosa surrounding the lesion. This study clarifies the histopathological features of the background gastric mucosa in GEN-FGML.

Methods and Results

A retrospective analysis was conducted of 30 GEN-FGML lesions (28 patients) diagnosed at our institution between December 2012 and 2023, excluding cases of gastric adenocarcinoma of fundic-gland mucosa type. Patients were classified according to Helicobacter pylori infection status, and clinicopathological features were compared. The background gastric mucosa was evaluated using the Updated Sydney System (USS). In total, 15 lesions (13 patients) were in the uninfected group, and 15 lesions (15 patients) were in the past H. pylori infection group (i.e., the infected group); no lesions from patients with current infection were included. In the uninfected group, none of the lesions showed histopathological atrophy or intestinal metaplasia. Conversely, histopathological atrophy was observed in 12 lesions in the infected group. Although 86.7% (13/15 lesions) of the infected cases were endoscopically located in nonatrophic areas, 10 displayed mild histopathological atrophy (USS 1+).

Conclusion

Oxyntic gland adenoma and gastric adenocarcinoma of fundic-gland type arise predominantly from mildly atrophic mucosa with preserved fundic glands in previously infected stomachs, and, albeit less frequently, from severely atrophic mucosa. During routine endoscopic examinations, careful observation of the fundic gland is warranted regardless of the presence of background mucosal atrophy.

Background

Capsule endoscopy (CE) is widely used for non-invasive evaluation of the small bowel; however, its effectiveness may be hindered by slow gastrointestinal transit and limited battery duration. A range of approaches—including pharmacologic agents, bowel-cleansing preparations, and magnetically guided control—has been introduced to improve the efficiency of the examination. This systematic review and meta-analysis compares the impact of these interventions on transit dynamics and examination completion.

Methods

Comprehensive searches of PubMed, Scopus, and Web of Science identified randomized controlled trials and observational studies assessing magnetic guidance, prokinetics, or purgatives in adults undergoing small-bowel capsule endoscopy. Outcomes of interest included gastric transit time (GTT), small bowel transit time (SBTT), and completion rate (CR). All pooled analyses were performed using a random-effects model.

Results

Fifty-three studies comprising 9095 participants met inclusion criteria. Erythromycin and magnetic guidance were consistently associated with faster gastric passage, while lubiprostone and polyethylene glycol (PEG) shortened SBTT compared with control groups. Metoclopramide and castor oil demonstrated the strongest associations with higher completion rates.

Conclusions

Interventions vary in their effects on CE performance, and no single strategy enhances all parameters simultaneously. Erythromycin and magnetic steering are most useful for expediting gastric transit, whereas lubiprostone and PEG are more effective within the small bowel. For improving overall completion, metoclopramide remains a dependable option. These findings support individualized preparation strategies tailored to the specific diagnostic goals of CE.

Background and Aims

Chronically elevated liver enzymes without a clear etiology remain a frequent diagnostic challenge. This study evaluated the diagnostic yield of liver biopsy in such cases and assessed if laboratory parameters predict histological clarification.

Methods

We retrospectively analyzed 71 patients with unexplained elevated liver enzymes who underwent percutaneous liver biopsy between 2015 and 2021 at a tertiary referral center in Germany. Clinical characteristics and lab values were compared between patients with clarified and unclarified diagnoses. ROC analysis was performed for ALT and AST. Histopathological characteristics and biopsy-related complications were recorded.

Results

A definitive diagnosis was reached in 47.9% of cases. The most frequent findings were autoimmune hepatitis (35.3%), drug-induced liver injury (23.5%), and NAFLD (23.5%). ALT and AST levels were significantly higher in patients with clarified diagnoses (ALT: p = 0.0079; AST: p = 0.0096). ROC analysis showed moderate performance (ALT AUC = 0.684; AST AUC = 0.679). Fibrosis stages ≥ F2 were found in 28.2% of patients. Biopsy complications occurred in 2.8%, all minor.

Conclusions

Liver biopsy clarified the etiology in nearly half of patients and revealed diagnoses not apparent through non-invasive work-up. While ALT and AST levels were associated with diagnostic yield, they lacked sufficient predictive value. Biopsy remains a valuable tool in selected patients with unexplained liver enzyme elevations.

Background

Most patients take bowel preparation agents at home before undergoing outpatient colonoscopy. However, some elderly patients undergo bowel preparation at the hospital. This study compared the outcomes of in-hospital (Group A) versus at-home (Group B) bowel preparation in elderly patients to clarify the usefulness of in-hospital bowel preparation.

Patients and Methods

From September 2022 to September 2023, 151 patients aged 70 years or older undergoing outpatient colonoscopy at Ureshino Medical Center were prospectively enrolled (51 in Group A and 100 in Group B). The primary endpoint was bowel preparation time. Secondary endpoints were the number of defecations, colonoscopy start time, and adverse events. Propensity score matching (PSM) was applied to account for baseline differences, and multivariate analysis was conducted to identify factors associated with bowel preparation time.

Results

After PSM, 26 matched pairs were analyzed. Group A had a significantly shorter bowel preparation time (192.1 ± 80.5 vs. 271.1 ± 57.9 min, p < 0.001), shorter time from preparation to colonoscopy (259.3 ± 70.2 vs. 341.4 ± 67.1 min, p < 0.001), and fewer defecations (8.5 ± 4.6 vs. 11.2 ± 4.1, p < 0.001) than Group B. There were no significant intergroup differences in adverse events or patient satisfaction. Multivariate analysis revealed that in-hospital preparation was strongly associated with shorter bowel preparation time (odds ratio 8.87, 95% CI 3.16–24.92, p < 0.001).

Conclusions

For elderly patients, in-hospital bowel preparation is beneficial because it significantly shortens preparation and colonoscopy start times and reduces defecations, while maintaining safety and satisfaction rates compared with at-home preparation.

Trial Registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000057045

Background/Aims

Soft pancreatic texture is a key risk factor for postoperative pancreatic fistula (POPF). However, preoperative quantification remains difficult. Intraoperative palpation is the current standard for assessing pancreatic hardness; however, this technique is not feasible in robot-assisted surgery. We prospectively evaluated whether endoscopic ultrasound strain elastography (EUS-SE) could predict pancreatic hardness.

Methods

Nine consecutive patients scheduled for pancreatectomies underwent preoperative EUS-SE. The strain ratio (SR) values from the nontumorous parenchyma were compared using intraoperative palpation (soft vs. hard). A receiver operating characteristic (ROC) analysis was used to determine the optimal SR cutoff. The associations between computed tomography (CT) attenuation, fibrosis, and postoperative outcomes were examined.

Results

Six pancreases were classified as soft, and three pancreases were classified as hard. The median SR was identical in both groups (6.0; interquartile range [IQR] of 4.7–7.7 vs. 5.5–6.3; p = 1.000). The ROC-derived SR cutoff of 7.0 yielded an area under the curve of 0.500, indicating no discriminatory ability. The SR was not correlated with CT attenuation, the fibrosis status, or POPF. No adverse events occurred during EUS-SE.

Conclusion

In this pilot study, preoperative EUS-SE did not predict intraoperative pancreatic textures. Strain-based elastography alone appears to be insufficient for hardness stratification and should be complemented by more quantitative modalities.