JGH Open最新文献

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.

Objective

To investigate the association between the incidence of colon polyps and colon cancer and the use of clinical medications, including nifedipine and insulin, thereby providing a scientific basis for the development of chemoprevention strategies for colorectal cancer and for guiding rational clinical drug use.

Method

In a cross-sectional study, we analyzed the clinical data of 2571 eligible patients who underwent colonoscopy in our hospital from 2014 to 2022, aiming to investigate the association between certain commonly used drugs and the incidence of benign and malignant colon polyps.

Results

(1) Significant differences were observed between nifedipine, aspirin, statins, and insulin when comparing the non-polyp group with the adenomatous polyp group (p < 0.05). (2) Significant differences were found between nifedipine, metformin, and insulin when comparing the single benign colonic polyps to multiple polyps (p < 0.05).

Conclusions

The use of nifedipine, insulin, and metformin was associated with an increased risk of developing colonic polyps, whereas statin therapy was linked to a decreased risk.

Background and Aim

Acute-on-chronic liver failure (ACLF) carries high short-term mortality, but real-world evidence under the Japanese ACLF criteria remains limited. We assessed incidence, clinical profile, outcomes, and prognostic factors at a tertiary center in urban Japan.

Methods

We retrospectively reviewed 363 consecutive hospitalizations of patients with cirrhosis (2014–2022) at a tertiary care center in Japan. ACLF per Japanese criteria was categorized as confirmed (meeting both PT INR/PT activity and bilirubin thresholds) or extended (meeting either biochemical criterion alone). We pre-specified a parsimonious Cox model with age (per 10 years) and MELD-Na (per 5 points); the primary outcome was time to all-cause death within 90 days (administrative censoring at day 90).

Results

ACLF occurred in 40/363 (11.0%) patients (confirmed n = 10, extended n = 30). Frequent precipitants were infection, gastrointestinal bleeding, and alcohol use, often in combination. The 90-day mortality by Kaplan–Meier was 30.5%. Age (per 10 years) was associated with higher 90-day mortality (HR, 2.29; 95% CI 1.31–4.00; p < 0.01), as was Model for End-Stage Liver Disease including sodium (MELD-Na) (per 5 points) (HR, 1.74; 95% CI 1.16–2.63; p < 0.01).

Conclusions

In this Japanese single center cohort, ACLF (per national criteria) was not rare and carried substantial short-term mortality. Age and MELD-Na were dominant prognostic factors, underscoring early trigger control (notably infection, gastrointestinal bleeding, and alcohol cessation) and timely risk stratification in routine care.

Objectives

We aimed to evaluate the safety and efficacy, and prognostic factors of colorectal endoscopic submucosal dissection (ESD) in patients aged ≥ 75 years.

Methods

We retrospectively collected cases of colorectal ESD performed between January 2008 and December 2023. Patients were divided into two groups: elderly (≥ 75 years) and nonelderly (< 75 years). We compared clinicopathological characteristics, clinical outcomes, overall survival (OS), and disease-specific survival (DSS) between the groups. We also analyzed factors associated with OS in the elderly group.

Results

A total of 523 patients with 548 lesions were enrolled. Among them, 168 patients with 175 lesions were classified as elderly, and 355 patients with 373 lesions were in the nonelderly group. No significant differences were found in en bloc resection, curative resection, or complication rates between the two groups (p = 1.000, 0.703, and 0.583, respectively). The OS of the elderly group was significantly worse (p < 0.001), while DSS did not differ significantly (p = 0.155). A high Charlson comorbidity index and low prognostic nutritional index were associated with poorer OS in the elderly group.

Conclusions

Colorectal ESD is a safe and effective treatment for patients aged ≥ 75 years. Indication for colorectal ESD should be carefully determined based on comorbidities and nutritional status to improve outcomes in this population.