Underwater endoscopic mucosal resection (UEMR) has emerged as a promising alternative to conventional endoscopic mucosal resection (CEMR) for the treatment of colorectal laterally spreading tumors (LSTs). This study aimed to compare the efficacy and safety of UEMR and CEMR in managing LSTs measuring 10–30 mm.
Methods
A post hoc analysis was performed on 88 patients with 88 colorectal LSTs, who were randomly assigned to two treatment groups: 42 with CEMR and 46 with UEMR. The primary outcome was the rate of R0 resection, defined as the absence of neoplastic cells at the resection margin. The secondary outcomes included en bloc resection rates, procedure times, and postprocedural complications. The data were analyzed via chi-square tests, t tests, and the Mann–Whitney U test where appropriate.
Results
No significant difference was found in the R0 resection rate between UEMR and CEMR. However, UEMR achieved a significantly higher en bloc resection rate, particularly for LSTs ranging from 20 to 30 mm (42.9% for CEMR vs. 100% for UEMR; p = 0.009). Additionally, UEMR resulted in a shorter median procedure time (85.0 s for UEMR vs. 207.5 s for CEMR; p < 0.001). There was no significant difference in bleeding complications or the number of clips used between the two groups.
Conclusions
Compared with CEMR, UEMR offers a higher en bloc resection rate and a shorter procedure time, particularly for larger lesions, without increasing the risk of complications. UEMR should be considered a preferred option for managing colorectal LSTs, especially those measuring 20–30 mm.
{"title":"Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy","authors":"Quang Dinh Le, Nhan Quang Le, Duc Trong Quach","doi":"10.1002/jgh3.70075","DOIUrl":"10.1002/jgh3.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Underwater endoscopic mucosal resection (UEMR) has emerged as a promising alternative to conventional endoscopic mucosal resection (CEMR) for the treatment of colorectal laterally spreading tumors (LSTs). This study aimed to compare the efficacy and safety of UEMR and CEMR in managing LSTs measuring 10–30 mm.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A post hoc analysis was performed on 88 patients with 88 colorectal LSTs, who were randomly assigned to two treatment groups: 42 with CEMR and 46 with UEMR. The primary outcome was the rate of R0 resection, defined as the absence of neoplastic cells at the resection margin. The secondary outcomes included en bloc resection rates, procedure times, and postprocedural complications. The data were analyzed via chi-square tests, <i>t</i> tests, and the Mann–Whitney U test where appropriate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant difference was found in the R0 resection rate between UEMR and CEMR. However, UEMR achieved a significantly higher en bloc resection rate, particularly for LSTs ranging from 20 to 30 mm (42.9% for CEMR vs. 100% for UEMR; <i>p</i> = 0.009). Additionally, UEMR resulted in a shorter median procedure time (85.0 s for UEMR vs. 207.5 s for CEMR; <i>p</i> < 0.001). There was no significant difference in bleeding complications or the number of clips used between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared with CEMR, UEMR offers a higher en bloc resection rate and a shorter procedure time, particularly for larger lesions, without increasing the risk of complications. UEMR should be considered a preferred option for managing colorectal LSTs, especially those measuring 20–30 mm.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stefano Bargiggia, Davide Scalvini, Antonio Cilona, Nur Fardowza, Patrizia Busseni, Andrea Anderloni
<p>Approximately 10%–40% of patients with colorectal cancer, especially those with left side or rectosigmoid cancer, debut with an acute bowel obstruction, and the use of self-expandable metal stents has increasingly become a valid alternative to emergency surgery, primarily in the palliative setting [<span>1</span>].</p><p>However, there are a few situations in which colonic stenting may be less effective, such as colonic flexures or rectum resulting in a higher risk of migration or patient's intolerance.</p><p>In this case report, we present a colonic stenting in metastatic cancer, where the stent caused rectal discomfort that has been effectively managed by the use of argon plasma coagulation (APC) to trim the distal portion of the stent with a lower power than usually applied.</p><p>A non-resectable rectosigmoid malignant stenosis in a 75-year-old man was successfully managed by placing an uncovered single-wire self-expandable Nitinol stent.</p><p>We intentionally left ~15 mm of stent distal to the stenosis to prevent pressure decubitus on the healthy wall immediately downstream of the distal end of the neoplasm, precisely at the rectosigmoid junction.</p><p>A follow-up endoscopy performed a few weeks later, confirmed the successful resolution of the stenosis although with a slight distal stent displacement. The patient reported normal bowel movements but experienced remarkable discomfort in the rectal area. This pain intensified in a few months and became poorly tolerated by the patient.</p><p>Thus, a new rectosigmoidoscopy was performed and it evidenced a considerable contact area between the distal portion of the stent and the rectal wall.</p><p>We decided to cut a distal portion of the stent using APC technique.</p><p>We employed the ERBE VIO 200-D, set at a power of 50 W and a flow rate of 2 L/min, to perform the cutting was performed first sagittally, then longitudinally near the boundary with the neoplasm (Figure 1). Some fragments were removed with forceps as foreign bodies, while others remained in the rectum, and their softness facilitated their spontaneous expulsion.</p><p>The procedure was well-tolerated by the patient without any complications (Figure 2).</p><p>Subsequently, the patient's previously reported rectal symptoms disappeared and his bowel transit was always regular without tenesmus or rectal discomfort until his death 12 months after the stent implantation due to tumor cachexia.</p><p>The trimming of the distal portion of self-expandable metal stents has been previously described, primarily for biliary types [<span>2</span>]. Few cases have been reported involving stents rectosigmoid malignant stenosis [<span>3-7</span>], which were made of cobalt-chromium-nickel-molybdenum alloys or nitinol (nickel-titanium): Nitinol is a member of the shape-memory alloy, which, in turn, are part of the even broader category of Smart Materials. The particular feature of these materials is the ability to change their properties when su
{"title":"Remodeling of Colonic Self-Expandable Nitinol Stent Using Low Power Argon Plasma Coagulation: A Brief Report","authors":"Stefano Bargiggia, Davide Scalvini, Antonio Cilona, Nur Fardowza, Patrizia Busseni, Andrea Anderloni","doi":"10.1002/jgh3.70076","DOIUrl":"10.1002/jgh3.70076","url":null,"abstract":"<p>Approximately 10%–40% of patients with colorectal cancer, especially those with left side or rectosigmoid cancer, debut with an acute bowel obstruction, and the use of self-expandable metal stents has increasingly become a valid alternative to emergency surgery, primarily in the palliative setting [<span>1</span>].</p><p>However, there are a few situations in which colonic stenting may be less effective, such as colonic flexures or rectum resulting in a higher risk of migration or patient's intolerance.</p><p>In this case report, we present a colonic stenting in metastatic cancer, where the stent caused rectal discomfort that has been effectively managed by the use of argon plasma coagulation (APC) to trim the distal portion of the stent with a lower power than usually applied.</p><p>A non-resectable rectosigmoid malignant stenosis in a 75-year-old man was successfully managed by placing an uncovered single-wire self-expandable Nitinol stent.</p><p>We intentionally left ~15 mm of stent distal to the stenosis to prevent pressure decubitus on the healthy wall immediately downstream of the distal end of the neoplasm, precisely at the rectosigmoid junction.</p><p>A follow-up endoscopy performed a few weeks later, confirmed the successful resolution of the stenosis although with a slight distal stent displacement. The patient reported normal bowel movements but experienced remarkable discomfort in the rectal area. This pain intensified in a few months and became poorly tolerated by the patient.</p><p>Thus, a new rectosigmoidoscopy was performed and it evidenced a considerable contact area between the distal portion of the stent and the rectal wall.</p><p>We decided to cut a distal portion of the stent using APC technique.</p><p>We employed the ERBE VIO 200-D, set at a power of 50 W and a flow rate of 2 L/min, to perform the cutting was performed first sagittally, then longitudinally near the boundary with the neoplasm (Figure 1). Some fragments were removed with forceps as foreign bodies, while others remained in the rectum, and their softness facilitated their spontaneous expulsion.</p><p>The procedure was well-tolerated by the patient without any complications (Figure 2).</p><p>Subsequently, the patient's previously reported rectal symptoms disappeared and his bowel transit was always regular without tenesmus or rectal discomfort until his death 12 months after the stent implantation due to tumor cachexia.</p><p>The trimming of the distal portion of self-expandable metal stents has been previously described, primarily for biliary types [<span>2</span>]. Few cases have been reported involving stents rectosigmoid malignant stenosis [<span>3-7</span>], which were made of cobalt-chromium-nickel-molybdenum alloys or nitinol (nickel-titanium): Nitinol is a member of the shape-memory alloy, which, in turn, are part of the even broader category of Smart Materials. The particular feature of these materials is the ability to change their properties when su","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helicobacter pylori infection is a major cause of peptic ulcer disease and gastric cancer. Limited data exist on H. pylori prevalence and risk factors of infection among elderly individuals in Vietnam. This study aimed to determine the prevalence and associated risk factors of H. pylori infection in elderly Vietnamese patients with upper gastrointestinal symptoms.
Methods
A cross-sectional study was conducted on patients aged ≥ 60 years with upper gastrointestinal symptoms who underwent endoscopy. The exclusion criteria included recent antibiotic or proton pump inhibitor use, prior H. pylori eradication, or upper gastrointestinal surgery. Data on demographics, hygiene, diet, and history were collected through structured questionnaires. H. pylori was diagnosed by a rapid urease test. Logistic regression was used to analyze risk factors.
Results
Of 406 participants (mean age 65.4 ± 4.5 years, male-to-female ratio 1:2), H. pylori prevalence was 55.6%. The risk factors for H. pylori infection included infrequent tooth brushing (OR 18.14, 95% CI 3.94–83.55), overweight/obesity (OR 5.82, 95% CI 3.44–9.88), spicy food consumption (OR 5.18, 95% CI 2.74–9.79), a family history of upper gastrointestinal symptoms (OR 3.15, 95% CI 1.84–5.39), and cat ownership (OR 2.01, 95% CI 1.10–3.68). The vegetarian diet was protective (OR 0.04, 95% CI 0.01–0.18).
Conclusions
H. pylori prevalence in elderly Vietnamese is high, with risk factors including poor hygiene, obesity, spicy food, family history, and cat ownership. A vegetarian diet may be protective.
背景与目的：幽门螺杆菌感染是消化性溃疡和胃癌的主要原因。关于越南老年人幽门螺杆菌患病率和感染危险因素的数据有限。本研究旨在确定越南老年上胃肠道症状患者幽门螺杆菌感染的患病率及其相关危险因素。方法：对年龄≥60岁有上消化道症状且行内镜检查的患者进行横断面研究。排除标准包括近期使用抗生素或质子泵抑制剂，既往幽门螺杆菌根除，或上消化道手术。通过结构化问卷收集人口统计、卫生、饮食和病史数据。通过快速脲酶试验诊断出幽门螺旋杆菌。采用Logistic回归分析危险因素。结果：406名参与者（平均年龄65.4±4.5岁，男女比例1:2），幽门螺杆菌患病率为55.6%。幽门螺杆菌感染的危险因素包括不经常刷牙（OR 18.14, 95% CI 3.94-83.55）、超重/肥胖（OR 5.82, 95% CI 3.44-9.88）、食用辛辣食物（OR 5.18, 95% CI 2.74-9.79）、上消化道症状家族史（OR 3.15, 95% CI 1.84-5.39）和养猫（OR 2.01, 95% CI 1.10-3.68）。素食具有保护作用（OR 0.04, 95% CI 0.01-0.18）。结论：越南老年人幽门螺杆菌患病率较高，其危险因素包括卫生不良、肥胖、辛辣食物、家族史和养猫。素食可能有保护作用。
{"title":"Prevalence and Risk Factors of Helicobacter pylori Infection in Elderly Patients With Upper Gastrointestinal Symptoms in Vietnam","authors":"Loi N. Ho, Duc T. Quach","doi":"10.1002/jgh3.70074","DOIUrl":"10.1002/jgh3.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p><i>Helicobacter pylori</i> infection is a major cause of peptic ulcer disease and gastric cancer. Limited data exist on <i>H. pylori</i> prevalence and risk factors of infection among elderly individuals in Vietnam. This study aimed to determine the prevalence and associated risk factors of <i>H. pylori</i> infection in elderly Vietnamese patients with upper gastrointestinal symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted on patients aged ≥ 60 years with upper gastrointestinal symptoms who underwent endoscopy. The exclusion criteria included recent antibiotic or proton pump inhibitor use, prior <i>H. pylori</i> eradication, or upper gastrointestinal surgery. Data on demographics, hygiene, diet, and history were collected through structured questionnaires. <i>H. pylori</i> was diagnosed by a rapid urease test. Logistic regression was used to analyze risk factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 406 participants (mean age 65.4 ± 4.5 years, male-to-female ratio 1:2), <i>H. pylori</i> prevalence was 55.6%. The risk factors for <i>H. pylori</i> infection included infrequent tooth brushing (OR 18.14, 95% CI 3.94–83.55), overweight/obesity (OR 5.82, 95% CI 3.44–9.88), spicy food consumption (OR 5.18, 95% CI 2.74–9.79), a family history of upper gastrointestinal symptoms (OR 3.15, 95% CI 1.84–5.39), and cat ownership (OR 2.01, 95% CI 1.10–3.68). The vegetarian diet was protective (OR 0.04, 95% CI 0.01–0.18).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p><i>H. pylori</i> prevalence in elderly Vietnamese is high, with risk factors including poor hygiene, obesity, spicy food, family history, and cat ownership. A vegetarian diet may be protective.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amjad Khan, Syeda Qumreen Ahmad, Tayyab Saeed Akhtar, Hamama Tul Bushra, Muhammad Imran, Javeria Zahid Khan, Sanjida Shah, Nadia Haddayat, Saima Mushtaq, Yalin Dong, Weiyi Feng, Yu Fang
Background and Aim
Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to diagnose and treat bile duct and pancreatic disorders. Successful cannulation of the papilla is crucial for the effectiveness of ERCP; however, sometimes, it can be challenging to achieve. This study explores the relationship between net difficult ERCP cannulation with bile visibility, papilla orifice visibility, and papilla position and compares it with successful cannulation.
Methods
These data were collected from the ERCP database at the Center for Liver Disease, Holy Family Hospital, Rawalpindi, between November 2019 and November 2022. IBM SPSS version 26.0 software was used for statistical analysis.
Results
The study included 329 patients, with 186 (56.6%) female and 143 (43.5%) male participants. Most patients were in the 39–48 age group (28.3%), with a mean age of 51 ± 1. Bile visibility was noted in 268 (81.5%) cases, papilla orifice visibility in 296 (90%) participants, atypical papilla in 20 (6.1%), and typical papilla in 309 (93.9%) participants. Bile visibility (P = 0.004) and papilla orifice visibility (P = 0.006) were significantly associated with successful cannulation, while papilla position (P = 0.116) was not. Significant associations were also found between difficult cannulation and bile visibility (P = 0.000), papilla orifice visibility (P = 0.000), and papilla position (P = 0.000).
Conclusion
Understanding this relationship can improve success rates and reduce complications associated with difficult cannulation during ERCP procedures. Further research is needed to establish clear correlations and guidelines for endoscopists to plan appropriate strategies for challenging cases.
{"title":"Relationship of difficult endoscopic retrograde cholangiopancreatography cannulation and visual characteristics of papilla","authors":"Amjad Khan, Syeda Qumreen Ahmad, Tayyab Saeed Akhtar, Hamama Tul Bushra, Muhammad Imran, Javeria Zahid Khan, Sanjida Shah, Nadia Haddayat, Saima Mushtaq, Yalin Dong, Weiyi Feng, Yu Fang","doi":"10.1002/jgh3.70045","DOIUrl":"10.1002/jgh3.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to diagnose and treat bile duct and pancreatic disorders. Successful cannulation of the papilla is crucial for the effectiveness of ERCP; however, sometimes, it can be challenging to achieve. This study explores the relationship between net difficult ERCP cannulation with bile visibility, papilla orifice visibility, and papilla position and compares it with successful cannulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>These data were collected from the ERCP database at the Center for Liver Disease, Holy Family Hospital, Rawalpindi, between November 2019 and November 2022. IBM SPSS version 26.0 software was used for statistical analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 329 patients, with 186 (56.6%) female and 143 (43.5%) male participants. Most patients were in the 39–48 age group (28.3%), with a mean age of 51 ± 1. Bile visibility was noted in 268 (81.5%) cases, papilla orifice visibility in 296 (90%) participants, atypical papilla in 20 (6.1%), and typical papilla in 309 (93.9%) participants. Bile visibility (<i>P</i> = 0.004) and papilla orifice visibility (<i>P</i> = 0.006) were significantly associated with successful cannulation, while papilla position (<i>P</i> = 0.116) was not. Significant associations were also found between difficult cannulation and bile visibility (<i>P</i> = 0.000), papilla orifice visibility (<i>P</i> = 0.000), and papilla position (<i>P</i> = 0.000).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Understanding this relationship can improve success rates and reduce complications associated with difficult cannulation during ERCP procedures. Further research is needed to establish clear correlations and guidelines for endoscopists to plan appropriate strategies for challenging cases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad A. Mujtaba, Hussien Elsiesy, Sara Faiz, Syed A. Hussain, Ann Kathleen N. Gamilla-Crudo, Aftab Karim, Mohammad Irfan Khan, Muhammad Waqar Khattak, Zunaira Zafar, Michael Kueht, Khurram Jamil
Introduction
The degree of improvement in serum creatinine (SCr) has previously been suggested as a sensitive indicator of treatment response in patients with hepatorenal syndrome-acute kidney injury (HRS-AKI), while HRS reversal remains the primary endpoint in clinical trials.
Methods
A total of ≥ 30% SCr improvement was analyzed as an exploratory prespecified endpoint in the CONFIRM trial. In this post hoc analysis, intent-to-treat population data from three Phase 3 studies (OT-0401, REVERSE, and CONFIRM) conducted in North America in patients with HRS-AKI were pooled to assess the incidence of > 30% improvement in SCr and its association with clinical outcomes.
Results
Significantly more patients treated with terlipressin achieved > 30% improvement in SCr compared with those who received a placebo (42.9% vs. 23.4%; p < 0.001). Compared with patients who did not achieve > 30% improvement in SCr, those who achieved this threshold had a lower incidence of renal replacement therapy (RRT) (55.2% vs. 14%, respectively; p < 0.001) and greater overall survival at Day 90 (41.6% vs. 71.1%, respectively; p < 0.001); a greater proportion achieved durability of HRS reversal (1% [95% confidence interval, 95% CI: 0] vs. 68.9% [95% CI: 0.6, 0.8]) and more patients were alive without RRT (22.7% vs. 61.6%, respectively; p < 0.001) or transplant (11.6% vs. 43.0%, respectively; p < 0.0001). Additionally, the overall survival and RRT-free survival in the group that achieved > 30% improvement in SCr without HRS reversal were comparable to the overall group that achieved HRS reversal.
Conclusion
A total of > 30% improvement in SCr levels even without HRS reversal may serve as a clinically meaningful endpoint to define renal recovery in patients with HRS-AKI.
简介：血清肌酐（SCr）的改善程度以前被认为是肝肾综合征-急性肾损伤（HRS- aki）患者治疗反应的敏感指标，而HRS逆转仍然是临床试验的主要终点。方法：在CONFIRM试验中，总SCr改善≥30%作为探索性预先指定的终点进行分析。在这项事后分析中，汇总了在北美进行的三项3期研究（OT-0401， REVERSE和CONFIRM）的意向治疗人群数据，以评估bbb30 % SCr改善的发生率及其与临床结果的关系。结果：与接受安慰剂的患者相比，接受特利加压素治疗的患者的SCr改善率明显高于对照组(42.9% vs. 23.4%；当SCr改善30%时，达到这一阈值的患者肾替代治疗（RRT）的发生率较低(分别为55.2%和14%；p p p p无HRS逆转的SCr改善30%与实现HRS逆转的整体组相当。结论：即使在没有HRS逆转的情况下，SCr水平的总改善量也可作为定义HRS- aki患者肾脏恢复的临床有意义的终点。
{"title":"Defining Renal Recovery in Patients With Hepatorenal Syndrome-Acute Kidney Injury: Experience From North American Studies","authors":"Muhammad A. Mujtaba, Hussien Elsiesy, Sara Faiz, Syed A. Hussain, Ann Kathleen N. Gamilla-Crudo, Aftab Karim, Mohammad Irfan Khan, Muhammad Waqar Khattak, Zunaira Zafar, Michael Kueht, Khurram Jamil","doi":"10.1002/jgh3.70058","DOIUrl":"10.1002/jgh3.70058","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The degree of improvement in serum creatinine (SCr) has previously been suggested as a sensitive indicator of treatment response in patients with hepatorenal syndrome-acute kidney injury (HRS-AKI), while HRS reversal remains the primary endpoint in clinical trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of ≥ 30% SCr improvement was analyzed as an exploratory prespecified endpoint in the CONFIRM trial. In this post hoc analysis, intent-to-treat population data from three Phase 3 studies (OT-0401, REVERSE, and CONFIRM) conducted in North America in patients with HRS-AKI were pooled to assess the incidence of > 30% improvement in SCr and its association with clinical outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significantly more patients treated with terlipressin achieved > 30% improvement in SCr compared with those who received a placebo (42.9% vs. 23.4%; <i>p</i> < 0.001). Compared with patients who did not achieve > 30% improvement in SCr, those who achieved this threshold had a lower incidence of renal replacement therapy (RRT) (55.2% vs. 14%, respectively; <i>p</i> < 0.001) and greater overall survival at Day 90 (41.6% vs. 71.1%, respectively; <i>p</i> < 0.001); a greater proportion achieved durability of HRS reversal (1% [95% confidence interval, 95% CI: 0] vs. 68.9% [95% CI: 0.6, 0.8]) and more patients were alive without RRT (22.7% vs. 61.6%, respectively; <i>p</i> < 0.001) or transplant (11.6% vs. 43.0%, respectively; <i>p</i> < 0.0001). Additionally, the overall survival and RRT-free survival in the group that achieved > 30% improvement in SCr without HRS reversal were comparable to the overall group that achieved HRS reversal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A total of > 30% improvement in SCr levels even without HRS reversal may serve as a clinically meaningful endpoint to define renal recovery in patients with HRS-AKI.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A global increase in nonalcoholic fatty liver disease (NAFLD) prevalence has been observed in the last decade. This study assesses knowledge, awareness, and clinical practice gaps of hepatologists and non-hepatologists in NAFLD management across hospitals in China.
Methods
A web-based quantitative survey was conducted, and participants included hepatologists (gastroenterologists and infectious disease specialists) and non-hepatologists (internal medicine specialists, cardiologists, and pharmacists) from various hospitals across China.
Results
In total, 1627 healthcare practitioners (HCPs) responded to the survey. This included 658 hepatologists and 969 non-hepatologists. In comparison to 92.6% hepatologists, only 58.0% of non-hepatologists were aware of NAFLD. A higher proportion of hepatologists (82.8%) performed screening for NAFLD compared to non-hepatologists (56.9%). Majority of the hepatologists (70%) and non-hepatologists (67%) were aware of the four primary recommendations for managing NAFLD. Only 11% of hepatologists did not manage NAFLD patients, mainly because they felt they did not have enough time (66.7%). Of the 36% non-hepatologists who did not manage NAFLD, 78.4% stated that NAFLD is not their specialty, and 38.6% were not familiar with the treatment options.
Conclusion
Most hepatologists were aware of and agreed to performing screening for NAFLD compared to non-hepatologists. Both hepatologists and non-hepatologists exhibited similar level of understanding on NAFLD management. However, a small percentage of both hepatologists and non-hepatologists admitted that they did not manage NAFLD patients because they were not familiar with available treatment options. This underscores the importance of further educating HCPs involved in managing NAFLD.
{"title":"A Survey Assessing Nonalcoholic Fatty Liver Disease Knowledge Among Hepatologists and Non-Hepatologists in China","authors":"Laura Colombo","doi":"10.1002/jgh3.70054","DOIUrl":"10.1002/jgh3.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>A global increase in nonalcoholic fatty liver disease (NAFLD) prevalence has been observed in the last decade. This study assesses knowledge, awareness, and clinical practice gaps of hepatologists and non-hepatologists in NAFLD management across hospitals in China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A web-based quantitative survey was conducted, and participants included hepatologists (gastroenterologists and infectious disease specialists) and non-hepatologists (internal medicine specialists, cardiologists, and pharmacists) from various hospitals across China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 1627 healthcare practitioners (HCPs) responded to the survey. This included 658 hepatologists and 969 non-hepatologists. In comparison to 92.6% hepatologists, only 58.0% of non-hepatologists were aware of NAFLD. A higher proportion of hepatologists (82.8%) performed screening for NAFLD compared to non-hepatologists (56.9%). Majority of the hepatologists (70%) and non-hepatologists (67%) were aware of the four primary recommendations for managing NAFLD. Only 11% of hepatologists did not manage NAFLD patients, mainly because they felt they did not have enough time (66.7%). Of the 36% non-hepatologists who did not manage NAFLD, 78.4% stated that NAFLD is not their specialty, and 38.6% were not familiar with the treatment options.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most hepatologists were aware of and agreed to performing screening for NAFLD compared to non-hepatologists. Both hepatologists and non-hepatologists exhibited similar level of understanding on NAFLD management. However, a small percentage of both hepatologists and non-hepatologists admitted that they did not manage NAFLD patients because they were not familiar with available treatment options. This underscores the importance of further educating HCPs involved in managing NAFLD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delphine Napon-Zongo, Jeoffray Diendere, Armel M. Sanou, Abou Coulibaly, Abdoulaye Dera, Nina G. M. Ouattara, Augustin N. Zeba, Seni Kouanda
Aims
Liver steatosis prevalence is growing, linked to the current worldwide epidemics of obesity and Type 2 diabetes. In sub-Saharan Africa, data on apparent healthy workers must still be included. This study aimed to determine the prevalence of hepatic steatosis and its associated factors in the workplace.
Methods and Results
A cross-sectional study was conducted from July to October 2022 in seven selected public and private works places in Ouagadougou, Burkina Faso. Workers still in activity were enrolled by random sampling. Sociodemographic and anthropometric characteristics and blood pressure measurements were performed using standard procedures. Blood samples for fasting blood glucose, cholesterol (total, HDL, LDL), triglycerides, transaminases (AST, ALT), gamma-glutamyl-transferase, C reactive protein, uric acid, surface antigen of hepatitis B (HBsAg), antibody to hepatitis C virus (anti-HCV), and HIV antibodies have been realized. Liver steatosis was assessed by FIBROSCAN with controlled attenuation parameter (CAP). An adjusted logistic regression analysis was performed. A significance level of 5% was applied. A total of 500 workers were included in this study. Among them, 293 (58.6%) were men. The prevalence of hepatic steatosis was 18% (95% CI: 14.7–21.7). Factors associated with hepatic steatosis were age over 50 (p = 0.038), waist circumference (p = 0.0001), body mass index (p = 0.008), and cytolysis (p = 0.001).
Conclusion
Liver steatosis affects almost a fifth of working people. Health policies must step up the fight against obesity and other nutrition-related noncommunicable diseases.
{"title":"Prevalence of Liver Steatosis Among Workers in Ouagadougou and Associated Factors: A Cross-Sectional Study","authors":"Delphine Napon-Zongo, Jeoffray Diendere, Armel M. Sanou, Abou Coulibaly, Abdoulaye Dera, Nina G. M. Ouattara, Augustin N. Zeba, Seni Kouanda","doi":"10.1002/jgh3.70069","DOIUrl":"10.1002/jgh3.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Liver steatosis prevalence is growing, linked to the current worldwide epidemics of obesity and Type 2 diabetes. In sub-Saharan Africa, data on apparent healthy workers must still be included. This study aimed to determine the prevalence of hepatic steatosis and its associated factors in the workplace.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A cross-sectional study was conducted from July to October 2022 in seven selected public and private works places in Ouagadougou, Burkina Faso. Workers still in activity were enrolled by random sampling. Sociodemographic and anthropometric characteristics and blood pressure measurements were performed using standard procedures. Blood samples for fasting blood glucose, cholesterol (total, HDL, LDL), triglycerides, transaminases (AST, ALT), gamma-glutamyl-transferase, C reactive protein, uric acid, surface antigen of hepatitis B (HBsAg), antibody to hepatitis C virus (anti-HCV), and HIV antibodies have been realized. Liver steatosis was assessed by FIBROSCAN with controlled attenuation parameter (CAP). An adjusted logistic regression analysis was performed. A significance level of 5% was applied. A total of 500 workers were included in this study. Among them, 293 (58.6%) were men. The prevalence of hepatic steatosis was 18% (95% CI: 14.7–21.7). Factors associated with hepatic steatosis were age over 50 (<i>p</i> = 0.038), waist circumference (<i>p</i> = 0.0001), body mass index (<i>p</i> = 0.008), and cytolysis (<i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Liver steatosis affects almost a fifth of working people. Health policies must step up the fight against obesity and other nutrition-related noncommunicable diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hossein Azad, Ahmad Hotrmati, Seyed S Sarkeshikian, Abolfazl Mohammadbeigi, Fatemehsadat Razavinia, Mohammad Eshaghi Far, Mehdi Pezeshgi Modarres
Background and Aim
The treatment for Helicobacter pylori is considered to be a combination of several strict regimens, with patients' dissatisfaction and poor compliance. Probiotics are effective in patients' antibiotic regimens. This study investigated the efficacy of the Pyloshot probiotic in combination with standard four-drug therapy in patients with H. pylori infection.
Methods
This is an interventional study. The study population consisted of patients with H. pylori infection who were selected using the convenience sampling method and were randomly divided into two groups: (i) A or standard four-drug therapy (amoxicillin-clarithromycin-bismuth-pantoprazole) plus two placebo capsules (80 cases). (ii) B or Pyloshot group (standard four-drug therapy plus 2 Pyloshot probiotic capsules) (90 cases). Patients were followed up for 1 month after treatment completion. Eradication of H. pylori was also assessed using the stool antigen test. Data were analyzed using SPSS (v.26) statistical software.
Results
Based on the results from the present study, the number of negative stool antigen tests in group A was less than that in group B, and no statistically significant relationship was found between H. pylori eradication (based on stool antigen test) and the studied groups (P = 0.20). There was a statistically significant relationship between vomiting (P = 0.03), diarrhea (P = 0.04), constipation (P = 0.01), and headache (P = 0.04); vomiting and constipation were most frequent in the control group.
Conclusion
Based on the results of the present study, there was no significant difference between the effectiveness of treatment with Pyloshot probiotic and the standard four-drug therapy in patients with H. pylori infection. However, the incidence of side effects was lower in the group treated with Pyloshot.
{"title":"Efficacy of Pyloshot in combination with standard four-drug antimicrobial treatment for Helicobacter pylori eradication: A randomized clinical trial","authors":"Hossein Azad, Ahmad Hotrmati, Seyed S Sarkeshikian, Abolfazl Mohammadbeigi, Fatemehsadat Razavinia, Mohammad Eshaghi Far, Mehdi Pezeshgi Modarres","doi":"10.1002/jgh3.70046","DOIUrl":"10.1002/jgh3.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>The treatment for <i>Helicobacter pylori</i> is considered to be a combination of several strict regimens, with patients' dissatisfaction and poor compliance. Probiotics are effective in patients' antibiotic regimens. This study investigated the efficacy of the Pyloshot probiotic in combination with standard four-drug therapy in patients with <i>H. pylori</i> infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is an interventional study. The study population consisted of patients with <i>H. pylori</i> infection who were selected using the convenience sampling method and were randomly divided into two groups: (i) A or standard four-drug therapy (amoxicillin-clarithromycin-bismuth-pantoprazole) plus two placebo capsules (80 cases). (ii) B or Pyloshot group (standard four-drug therapy plus 2 Pyloshot probiotic capsules) (90 cases). Patients were followed up for 1 month after treatment completion. Eradication of <i>H. pylori</i> was also assessed using the stool antigen test. Data were analyzed using SPSS (v.26) statistical software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on the results from the present study, the number of negative stool antigen tests in group A was less than that in group B, and no statistically significant relationship was found between <i>H. pylori</i> eradication (based on stool antigen test) and the studied groups (<i>P</i> = 0.20). There was a statistically significant relationship between vomiting (<i>P</i> = 0.03), diarrhea (<i>P</i> = 0.04), constipation (<i>P</i> = 0.01), and headache (<i>P</i> = 0.04); vomiting and constipation were most frequent in the control group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Based on the results of the present study, there was no significant difference between the effectiveness of treatment with Pyloshot probiotic and the standard four-drug therapy in patients with <i>H. pylori</i> infection. However, the incidence of side effects was lower in the group treated with Pyloshot.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In terms of their longitudinal positioning, esophageal squamous cell carcinoma (ESCC) commonly arises in the middle segment of the esophagus. However, limited attention has been given to the circumferential aspect. This study aimed to investigate the prevalence and characteristics of ESCC lesions resected via endoscopic submucosal dissection (ESD), taking into consideration both longitudinal and circumferential positions.
Methods
We retrospectively evaluated 193 ESD-resected ESCC lesions and compared the occurrence rate of ESCC development and the degree of histopathological invasion across various circumferential and longitudinal positions. We scrutinized lesion characteristics by location, with a particular focus on the proportion of early-stage small lesions in each site.
Results
Regarding lesion location, 27 were situated on the anterior wall, 62 on the left, 66 on the posterior, and 38 on the right. Among the four circumferential positions, the anterior wall group had the smallest median tumor size. Additionally, the anterior wall group had the highest proportions of lesions with invasion depths limited to the epithelial layer and sizes < 10 mm, at 44.4% and 25.9%, respectively. Furthermore, a significant difference was noted among the four circumferential positions with respect to the proportion of ESCC lesions satisfying both criteria, with the highest proportion observed in the anterior wall group (p = 0.049).
Conclusions
Our findings suggest that while ESCC occurrence on the anterior wall is less frequent, these lesions may present as small lesions with superficial invasion depths.
{"title":"Characteristics of Esophageal Squamous Cell Carcinomas Based on Circumferential Localization","authors":"Natsuki Ishida, Satoshi Osawa, Kiichi Sugiura, Tomohiro Takebe, Kenichi Takahashi, Yusuke Asai, Satoshi Tamura, Tomoharu Matsuura, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Takanori Yamada, Ken Sugimoto","doi":"10.1002/jgh3.70063","DOIUrl":"10.1002/jgh3.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>In terms of their longitudinal positioning, esophageal squamous cell carcinoma (ESCC) commonly arises in the middle segment of the esophagus. However, limited attention has been given to the circumferential aspect. This study aimed to investigate the prevalence and characteristics of ESCC lesions resected via endoscopic submucosal dissection (ESD), taking into consideration both longitudinal and circumferential positions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated 193 ESD-resected ESCC lesions and compared the occurrence rate of ESCC development and the degree of histopathological invasion across various circumferential and longitudinal positions. We scrutinized lesion characteristics by location, with a particular focus on the proportion of early-stage small lesions in each site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Regarding lesion location, 27 were situated on the anterior wall, 62 on the left, 66 on the posterior, and 38 on the right. Among the four circumferential positions, the anterior wall group had the smallest median tumor size. Additionally, the anterior wall group had the highest proportions of lesions with invasion depths limited to the epithelial layer and sizes < 10 mm, at 44.4% and 25.9%, respectively. Furthermore, a significant difference was noted among the four circumferential positions with respect to the proportion of ESCC lesions satisfying both criteria, with the highest proportion observed in the anterior wall group (<i>p</i> = 0.049).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings suggest that while ESCC occurrence on the anterior wall is less frequent, these lesions may present as small lesions with superficial invasion depths.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic submucosal dissection (ESD) is an established treatment for laterally spreading tumors (LSTs). Hybrid ESD, a novel technique, is gaining popularity for colorectal neoplasms. This study aimed to compare hybrid ESD with conventional ESD for treating LSTs.
Methods
Data from patients with colorectal LSTs ≥ 10 mm who underwent ESD at six centers from May 2020 to April 2023 were analyzed retrospectively. The study assessed baseline characteristics, hospitalization costs, and outcomes (operative time, R0 resection rate, complications).
Results
890 patients were included: 490 underwent conventional ESD and 400 hybrid ESD. Hybrid ESD showed significantly shorter procedure times and lower hospitalization costs compared to conventional ESD. However, the R0 resection rate and lifting sign positivity were lower with hybrid ESD. Subgroup analysis indicated potential cost savings and shorter operative times for lesions 10–30 mm with hybrid ESD, without compromising R0 resection rates. For lesions ≥ 30 mm, hybrid ESD had lower R0 resection rates despite cost savings.
Conclusion
Hybrid ESD offers a viable alternative to conventional ESD for LSTs sized 10–30 mm, reducing procedure duration and costs while ensuring R0 resection.
{"title":"Hybrid Versus Conventional Endoscopic Submucosal Dissection for Laterally Spreading Tumors (LSTs): A Retrospective Multicenter Study","authors":"Hongxia Li, Yiping Hong, Linhua Yao, Xia Ji, Dan Chen, Maogen Tao, Huihui Yan, Jiamin Chen, Lingling Wang, Liyi Xu, Leilei Wang, Erfei Luo, Jianting Cai, Wei Wei","doi":"10.1002/jgh3.70066","DOIUrl":"10.1002/jgh3.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Endoscopic submucosal dissection (ESD) is an established treatment for laterally spreading tumors (LSTs). Hybrid ESD, a novel technique, is gaining popularity for colorectal neoplasms. This study aimed to compare hybrid ESD with conventional ESD for treating LSTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from patients with colorectal LSTs ≥ 10 mm who underwent ESD at six centers from May 2020 to April 2023 were analyzed retrospectively. The study assessed baseline characteristics, hospitalization costs, and outcomes (operative time, R0 resection rate, complications).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>890 patients were included: 490 underwent conventional ESD and 400 hybrid ESD. Hybrid ESD showed significantly shorter procedure times and lower hospitalization costs compared to conventional ESD. However, the R0 resection rate and lifting sign positivity were lower with hybrid ESD. Subgroup analysis indicated potential cost savings and shorter operative times for lesions 10–30 mm with hybrid ESD, without compromising R0 resection rates. For lesions ≥ 30 mm, hybrid ESD had lower R0 resection rates despite cost savings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hybrid ESD offers a viable alternative to conventional ESD for LSTs sized 10–30 mm, reducing procedure duration and costs while ensuring R0 resection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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