JGH Open最新文献_第6页

Forecasting Alcohol-Related Liver Disease Mortality Trends in Younger Populations Using Advanced Time-Series Models: A 1999–2030 Analysis 使用先进时间序列模型预测年轻人群酒精相关肝病死亡率趋势：1999-2030年分析

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-12-03 DOI: 10.1002/jgh3.70057

Hassam Ali, Vinay Jahagirdar, Hanna Blaney, Dushyant Singh Dahiya, Manesh K. Gangwani, Pratik Patel, Umar Hayat, Fouad Jaber, Douglas A. Simonetto, Sanjaya K. Satapathy

Objective

Alcohol-related liver disease (ALD) has emerged as a significant public health concern, particularly among younger populations. ALD remains the leading cause of alcohol-attributable deaths. This study aims to forecast ALD mortality trends up to 2030, focusing on individuals under 55 years.

Methods

We utilized data from the CDC WONDER database (1999–2022) to examine ALD-related deaths, identified by ICD-10 codes (K70.0–K70.9). Crude mortality rates (CMRs) per 100 000 were analyzed and temporal trends were assessed using annual and average annual percent changes (APC/AAPC) with empirical quantile confidence intervals. An Autoregressive Integrated Moving Average (ARIMA) model was employed to project mortality rates until 2030, validated through time series cross-validation.

Results

From 1999 to 2022, there were 181 862 ALD-related deaths among individuals under 55, with mortality rates increasing from 3.9 per 100 000 in 1999 to 9.7 per 100 000 in 2022 (AAPC 4.66%, 95% CI: 3.90%–5.86%). Projections suggest rates will continue to rise, reaching 14.4 per 100 000 by 2030. From 1999 to 2022, the 25–34 age group experienced the highest increase, with an AAPC of 10.27% (95% CI: 9.19%–11.35%), while the 35–44 and 45–54 age groups showed more moderate increases, with AAPCs of 5.03% and 4.38%, respectively. Projections indicate an AAPC of 3.86% for ages 25–34, 3.90% for ages 35–44, and 6.17% for ages 45–54 by 2030.

Conclusion

Forecasts indicate a continued rise in ALD mortality among individuals under 55, necessitating immediate public health strategies to mitigate this trend.

目的酒精相关性肝病（ALD）已成为一个重要的公共卫生问题，特别是在年轻人群中。ALD仍然是酒精导致死亡的主要原因。这项研究旨在预测到2030年的ALD死亡率趋势，重点关注55岁以下的个体。方法：我们利用CDC WONDER数据库（1999-2022）的数据，检查由ICD-10编码（K70.0-K70.9）确定的ald相关死亡。分析了每10万人的粗死亡率（CMRs），并利用具有经验分位数置信区间的年和年均百分比变化（APC/AAPC）评估了时间趋势。采用自回归综合移动平均（ARIMA）模型预测到2030年的死亡率，并通过时间序列交叉验证进行验证。结果1999 - 2022年，55岁以下人群中有18862例与ald相关的死亡，死亡率从1999年的3.9 / 10万上升到2022年的9.7 / 10万（AAPC 4.66%, 95% CI: 3.90% ~ 5.86%）。预测表明，这一比率将继续上升，到2030年将达到每10万人14.4人。从1999年到2022年，25-34岁年龄组的AAPC增幅最大，为10.27% (95% CI: 9.19%-11.35%)，而35-44岁和45-54岁年龄组的AAPC增幅较为温和，分别为5.03%和4.38%。预测显示，到2030年，25-34岁的AAPC为3.86%，35-44岁为3.90%，45-54岁为6.17%。预测表明，55岁以下人群的ALD死亡率持续上升，需要立即采取公共卫生策略来缓解这一趋势。

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引用次数: 0

A Case of Severe Post-Biopsy Bleeding and Perforation in Gastric Amyloidosis 胃淀粉样变性活检后严重出血穿孔1例

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-12-03 DOI: 10.1002/jgh3.70065

Sho Matsuyama, Akihisa Fukuda, Go Yamakawa, Taro Ueo, Hiroshi Seno

We herein describe a case of severe post-biopsy bleeding and perforation in gastric amyloidosis. A 70-year-old man who had been on dialysis underwent esophagogastroduodenoscopy and biopsy was performed. Post-biopsy bleeding occurred, and three times of coagulation hemostasis and once clip hemostasis were performed. After the hemostasis, he eventually had a gastric perforation and omental patch surgery was performed, however, he passed away after the surgery. From the pathological finding of biopsy specimen, he was diagnosed with gastric amyloidosis caused by dialysis-related amyloidosis. In patients of amyloidosis, the risk of bleeding and perforation is elevated due to vascular and tissue fragility. Therefore, when performing hemostasis in patients with gastrointestinal amyloidosis, clip hemostasis which minimizes tissue damage is considered preferable to coagulation hemostasis.

我们在此报告一例严重的活检后出血和穿孔的胃淀粉样变性。一位70岁的透析患者接受了食管胃十二指肠镜检查和活检。活检后出现出血，进行了3次凝血止血和1次夹血止血。止血后，他最终发生了胃穿孔，并进行了网膜修补手术，但手术后他去世了。从活检标本的病理发现，他被诊断为由透析相关淀粉样变引起的胃淀粉样变。在淀粉样变患者中，由于血管和组织的脆弱性，出血和穿孔的风险升高。因此，在对胃肠道淀粉样变性患者进行止血时，将组织损伤降到最低的夹止血被认为比凝血止血更可取。

引用次数: 0

NBI With Optical Magnification Shows Good Interobserver Agreement in Diagnosing H. Pylori Gastritis 光学放大NBI对幽门螺杆菌胃炎的诊断具有良好的观察一致性

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-12-01 DOI: 10.1002/jgh3.70067

Vijosh V. Kumar, K. G. Sabu, P. Javed, K. V. Vivek Kumar, Jaseem Ansari, Kavitha Rangan, Adila A. K. Parveen

Objective

To study the interobserver agreement for diagnosing Helicobacter pylori gastritis using narrow band imaging (NBI) with magnification.

Methods

This prospective study recruited patients who underwent gastroscopy for dyspepsia in the Department of Gastroenterology, Aster MIMS Hospital, Kannur.361 patients were included in the study. The gastroscopy was performed using high-definition white light endoscopy (WLE) and NBI with magnification. Histopathology and rapid urease test were used to detect HP infection. Endoscopy videos were analyzed by three trained endoscopists who were blinded to each other. NBI patterns were classified into four types (Types 1, 2A, 2B, and 3). Interobserver variability was examined using Kappa Statistics.

Results

164 of 361 patients had HP infection (45.42%). Of 361 people, 199 had Type 1 (55.12%), 54 Type 2a (14.95%), 65 Type 2b (18%), and 43 Type 3 cases (11.91%). There was good interobserver agreement with a kappa value of 0.730 (95% confidence interval (CI) 0.693–0.768). 87% of HP-negative patients had Type 1 NBI pattern. 79.5% of type 2A and 89.2% of Type 2b pattern were HP positive. The Type 1 pattern identified normal gastric mucosa with 84.75% sensitivity, 88.32% specificity and 87.4% negative predictive value. Type 2 and Type 3 NBI patterns had high positive predictive value and specificity for HP infection.

Conclusions

This study demonstrates excellent interobserver agreement among experienced endoscopists in using NBI to identify gastric mucosal patterns associated with HP infection. While biopsies remain essential for comprehensive evaluation of gastric pathologies, our findings suggest that NBI, with appropriate training and validation, may have the potential to reduce the need for biopsies in specific cases where the primary concern is HP infection. The good level of interobserver agreement seen in our study is encouraging and suggests that NBI has the potential to be a reliable tool for diagnosing HP infection.

目的探讨放大窄带显像（NBI）诊断幽门螺杆菌胃炎的一致性。方法本前瞻性研究招募在坎努尔Aster MIMS医院消化内科接受胃镜检查的消化不良患者361例。胃镜检查采用高清白光内镜（WLE）和放大的NBI。采用组织病理学和快速脲酶试验检测HP感染。内窥镜检查视频由三位训练有素的内窥镜医生进行分析，他们彼此互不知情。NBI模式分为四种类型（类型1、2A、2B和3）。使用Kappa统计方法检验观察者间变异。结果361例患者中有164例感染HP，占45.42%。361例患者中，1型199例（55.12%），2a型54例（14.95%），2b型65例（18%），3型43例（11.91%）。观察者间一致性良好，kappa值为0.730（95%置信区间（CI） 0.693-0.768）。87%的hp阴性患者为1型NBI型。79.5%的2A型和89.2%的2b型患者HP阳性。1型模式识别正常胃黏膜的敏感性为84.75%，特异性为88.32%，阴性预测值为87.4%。2型和3型NBI模式对HP感染具有较高的阳性预测值和特异性。结论：本研究表明经验丰富的内窥镜医师在使用NBI识别与HP感染相关的胃粘膜模式方面具有良好的观察者间一致性。虽然活组织检查仍然是全面评估胃病理的必要条件，但我们的研究结果表明，在适当的培训和验证下，NBI可能有可能减少主要关注HP感染的特定病例的活组织检查需求。在我们的研究中观察到的良好水平的观察者之间的一致是令人鼓舞的，并表明NBI有潜力成为诊断HP感染的可靠工具。

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引用次数: 0

Evaluating Disparities in COVID-19 Clinical Outcomes Among Patients With Cirrhosis in North America and Europe—An International Registry Study 评估北美和欧洲肝硬化患者COVID-19临床结局的差异-一项国际注册研究

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-29 DOI: 10.1002/jgh3.70064

Umar Hayat, Andrew M. Moon, Manesh K. Gangwani, Fariha Hasan, Thomas Marjot, A. Sidney Barritt IV, Wasique Mirza, Duane Deivert, Muhammad Aziz, Dushyant Singh Dahiya, Hassam Ali, Sumant Inamdar, Mauricio Garcia-Saenz-de-Sicilia

Background

Patients with decompensated cirrhosis have a higher risk of hospitalization, ICU admission, and death from COVID-19. The impact of demographics on these outcomes remains uncertain.

Methods

The SECURE-Liver and COVID-Hep databases were utilized to evaluate disparities in COVID-19 outcomes. Patients were stratified by North American and European cohorts. Bivariate and multivariable logistic regression was performed.

Results

A total of 718 cirrhosis patients with COVID-19 were evaluated. In the North American cohort, Black patients had more comorbidities (CI: 1.86 vs. 1.83, p < 0.01), higher rates of hospitalization (77% vs. 85%, p < 0.01), ICU admission (27% vs. 40%, p = 0.05), and death (18% vs. 28%, p = 0.07). Hispanic patients had the lowest adverse outcome rates. In the European cohort, White patients had more comorbidities (CI; 1.63 vs. 1.31, p = 0.02), but non-White patients had higher hospitalization rates (82% vs. 67%, p = 0.01), ICU admissions (15% vs. 18%, p = 0.04), and lower mortality rates (28% vs. 34%, p = 0.01).

Conclusion

Black patients in North America had higher hospitalization, ICU admission, and death rates. In the European subgroup, White patients had higher death rates than non-White patients. These disparities became statistically insignificant after adjusting for confounders, suggesting that non-liver-related comorbidities might increase the risk of adverse outcomes.

背景失代偿性肝硬化患者因COVID-19住院、ICU住院和死亡的风险较高。人口结构对这些结果的影响仍不确定。方法利用SECURE-Liver和COVID-Hep数据库评估COVID-19结局的差异。患者按北美和欧洲队列进行分层。进行了双变量和多变量logistic回归。结果共对718例肝硬化合并COVID-19患者进行评估。在北美队列中，黑人患者有更多的合并症（CI: 1.86比1.83,p < 0.01），更高的住院率（77%比85%，p < 0.01）， ICU住院率（27%比40%，p = 0.05）和死亡率（18%比28%，p = 0.07）。西班牙裔患者的不良结果发生率最低。在欧洲队列中，白人患者有更多的合并症(CI；1.63比1.31,p = 0.02)，但非白人患者的住院率较高（82%比67%，p = 0.01）， ICU入院率较高（15%比18%，p = 0.04），死亡率较低（28%比34%，p = 0.01）。结论北美黑人患者的住院率、ICU入院率和死亡率较高。在欧洲亚组中，白人患者的死亡率高于非白人患者。在调整混杂因素后，这些差异在统计学上变得微不足道，这表明非肝脏相关的合并症可能会增加不良结果的风险。

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引用次数: 0

Safety and performance of the HYBRIDknife flex in a porcine model of esophageal endoscopic submucosal dissection: A pilot study HYBRIDknife flex在猪食管内镜粘膜下解剖模型中的安全性和性能：一项初步研究

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-29 DOI: 10.1002/jgh3.70036

Christopher J L Khor, Katsuro Ichimasa, Stephen K K Tsao, Ulrich Biber, Yutaka Saito

Background and Aim

Endoscopic submucosal dissection (ESD) is considered the best modality for achieving en bloc resection of larger neoplastic mucosal lesions in the upper and lower gastrointestinal (GI) tract. Multiple devices are available for ESD, and refinements continue to be made to develop devices that improve the safety and efficiency of performing ESD. Submucosal injection with viscous fluids like glycerol, which prolong submucosal expansion, could facilitate the procedure. We aimed to evaluate the safety and performance of the new Erbe HYBRIDknife® flex, which combines electrosurgical dissection with waterjet-assisted injection in a slim and flexible form factor.

Methods

In a prospective animal study with six pigs, four endoscopists, each with 10–20 years of experience in ESD, performed 28 esophageal ESDs. One half was performed with physiological saline injectate, the other half with fructose-added glycerol. Various performance aspects were evaluated on a five-point scale [5 = best], including dissection properties, handling, and usability.

Results

No perforations or major bleeding occurred. All resections were performed en bloc, with one technical failure (3.6%, 1 of 28). Performance scores were similar for saline and glycerol (4.5 ± 0.31 vs. 4.5 ± 0.32, P = 0.36), as was dissection speed (13 ± 6.2 mm²/min vs. 15 ± 6.1 mm²/min, P = 0.22).

Conclusions

We demonstrated that esophageal ESD can be performed safely and rapidly using HYBRIDknife flex, with excellent performance evaluation by the endoscopists. Combining this device with glycerol or saline is precise and effective for ESD, although experience could compensate for the theoretical disadvantage of using normal saline.

背景与目的内镜下粘膜下剥离术（ESD）被认为是实现上下胃肠道较大肿瘤粘膜病变整体切除的最佳方式。用于ESD的器件有多种，并且不断改进以开发提高ESD执行安全性和效率的器件。粘膜下注射黏性液体如甘油，可延长粘膜下扩张，可促进手术。我们旨在评估新型Erbe HYBRIDknife®flex的安全性和性能，该产品将电外科解剖与水射流辅助注射相结合，具有纤细灵活的外形。方法在一项有6头猪的前瞻性动物研究中，4名具有10-20年ESD经验的内镜医师对28例食管ESD进行了手术。一半用生理盐水注射，另一半用果糖加甘油注射。各种性能方面以五分制进行评估[5 =最佳]，包括解剖性能，处理和可用性。结果无穿孔及大出血发生。所有手术全部完成，1例技术失败（3.6%,1 / 28）。生理盐水和甘油的性能评分相似（4.5±0.31比4.5±0.32,P = 0.36），解剖速度相似（13±6.2 mm2/min比15±6.1 mm2/min, P = 0.22）。结论使用HYBRIDknife flex可以安全、快速地完成食管ESD手术，内镜医师对其具有良好的评价。将该装置与甘油或生理盐水结合使用对于ESD是精确和有效的，尽管经验可以弥补使用生理盐水的理论上的缺点。

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引用次数: 0

Diverticular bleeding in the third part of the duodenum as a cause of overt obscure gastrointestinal bleeding 十二指肠第三段憩室出血是明显的不明显消化道出血的原因之一

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-27 DOI: 10.1002/jgh3.70051

Yasuhiko Hamada, Hayato Nakagawa

A 65-year-old man with a history of chronic renal failure and ischemic heart disease who was receiving aspirin therapy was admitted for recurrent melena. Initial evaluation revealed severe anemia. Other than a diverticulum in the third part of the duodenum, the findings of upper and lower gastrointestinal endoscopies and computed tomography were unremarkable. Capsule endoscopy detected altered blood in the ileum; however, balloon-assisted enteroscopy found no definitive source of bleeding. Three years later, he presented with recurrent melena and hemorrhagic shock. Upper gastrointestinal endoscopy identified Dieulafoy's lesion within the duodenal diverticulum. Hemostasis was achieved using hemoclips. No recurrence of bleeding was observed during 4 years of follow-up. The findings from this case highlight the diagnostic and therapeutic challenges of managing obscure gastrointestinal bleeding due to Dieulafoy's lesion in a diverticulum in the third part of the duodenum. Duodenal diverticular bleeding should be included in the differential diagnoses for patients with obscure gastrointestinal bleeding.

一名 65 岁的男子因反复出现血便而入院，他曾患有慢性肾衰竭和缺血性心脏病，目前正在接受阿司匹林治疗。初步评估显示他患有严重贫血。除了十二指肠第三部分有一个憩室外，上、下消化道内窥镜检查和计算机断层扫描结果均无异常。胶囊内镜检查发现回肠有血液改变，但球囊辅助肠镜检查没有发现明确的出血源。三年后，他反复出现血便和失血性休克。上消化道内镜检查在十二指肠憩室内发现了 Dieulafoy 病变。使用血夹进行了止血。在 4 年的随访中，未发现出血复发。本病例的研究结果凸显了在处理十二指肠第三部分憩室内的 Dieulafoy 病变引起的隐匿性消化道出血时所面临的诊断和治疗挑战。十二指肠憩室出血应列入隐匿性消化道出血患者的鉴别诊断中。

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引用次数: 0

Next-Generation Sequencing: An Advanced Diagnostic Tool for Detection of Pancreatic Disease/Disorder 下一代测序：检测胰腺疾病/紊乱的先进诊断工具

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-27 DOI: 10.1002/jgh3.70061

Suvro Biswas, Shamima Afrose, Mohasana Akter Mita, Md. Robiul Hasan, Mst. Sharmin Sultana Shimu, Shahriar Zaman, Md. Abu Saleh

The pancreas is involved in digestion and glucose regulation in the human body. Given the recognized link between chronic pancreatitis and pancreatic cancer, addressing pancreatic disorders and pancreatic cancer is particularly challenging. This review aims to highlight the limitations of traditional methods in diagnosing pancreatic disorders and cancer and explore several next-generation sequencing (NGS) approaches as a promising alternative. There are distinct clinical symptoms that are shared by a number of clinical phenotypes of pancreatic illness induced by particular genetic mutations. Traditional diagnostic methods encompass computed tomography, magnetic resonance imaging, contrast-enhanced Doppler ultrasound, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, transabdominal ultrasound, laparoscopy, and positron emission tomography have a prognostic ability of only 5% or less and a 5-year survival rate. Genetic sequencing can be employed as an alternative to conventional diagnostic techniques. Sanger sequencing and NGS are currently largely operated genome analysis, with no exception for pancreatic disease diagnosis. The NGS methods can sequence millions to billions of short DNA fragments, enabling enormous sample screening in a short amount of time with low-abundance detection, like in 0.1%–1% mutation prevalence declining approximate cost. Whole-genome sequencing, whole-exome sequencing, RNA sequencing, and single-cell NGS are a few NGS methods utilized to diagnose pancreatic disease. For both research and clinical applications, the NGS techniques can provide a precise diagnosis of pancreatic disorders in a short amount of time at a reasonable expenditure.

胰腺参与人体的消化和葡萄糖调节。鉴于慢性胰腺炎和胰腺癌之间存在公认的联系，解决胰腺疾病和胰腺癌问题尤其具有挑战性。本综述旨在强调传统方法在诊断胰腺疾病和癌症方面的局限性，并探讨几种下一代测序（NGS）方法作为一种有前途的替代方法。由特定基因突变诱发的胰腺疾病有许多临床表型，这些表型都有明显的临床症状。传统的诊断方法包括计算机断层扫描、磁共振成像、造影剂增强多普勒超声、内窥镜超声、内窥镜逆行胰胆管造影、经腹部超声、腹腔镜检查和正电子发射断层扫描，其预后能力仅为 5%或更低，5 年存活率仅为 5%。基因测序可作为传统诊断技术的替代方法。桑格测序和 NGS 目前主要用于基因组分析，胰腺疾病诊断也不例外。NGS 方法可对数百万至数十亿的短 DNA 片段进行测序，可在短时间内对大量样本进行筛查，并可进行低丰度检测，如在 0.1%-1% 的突变流行率下降低近似成本。全基因组测序、全外显子组测序、RNA 测序和单细胞 NGS 是用于诊断胰腺疾病的几种 NGS 方法。无论是在研究还是临床应用中，NGS 技术都能在短时间内以合理的费用提供胰腺疾病的精确诊断。

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引用次数: 0

Validation of the Updated Alternate Fistula Risk Score for Prediction of Postoperative Pancreatic Fistula After Pancreatoduodenectomy 用于预测胰十二指肠切除术后胰腺瘘的最新替代瘘管风险评分的验证

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-26 DOI: 10.1002/jgh3.70053

Yugal Limbu, Bidur Prasad Acharya, Sneha Raut, Sujan Regmee, Roshan Ghimire, Dhiresh Kumar Maharjan, Prabin Bikram Thapa

Background and Aim

Postoperative pancreatic fistula (POPF) remains a significant challenge following pancreatoduodenectomy (PD), contributing to morbidity and mortality. Various risk assessment models have been established to predict the likelihood of POPF. An updated alternate fistula risk score (ua-FRS) has been recently refined and validated within European cohorts. However, the validation of this score in South Asian cohorts remains relatively unexplored. This study aims to validate the applicability of ua-FRS for the prediction of POPF in patients undergoing PD in the South Asian population, particularly Nepal.

Methods

This cross-sectional, observational study was conducted by a single team across three tertiary care centers in Kathmandu, Nepal from July 2021 to October 2023. A total of 98 patients were studied in terms of their sex, body mass index (BMI), diameter of the main pancreatic duct (MPD), pancreatic consistency, pathological site, and estimated blood loss. The accuracy of ua-FRS for the prediction of postoperative pancreatic fistula after pancreatoduodenectomy was evaluated using the receiver operative characteristics curve.

Results

Univariate analysis revealed that sex, pancreatic gland texture, the diameter of the main pancreatic duct, the site of pathology, and BMI were statistically significant factors. However, in the multivariate analysis, only BMI and the diameter of the MPD retained their statistical significance, with p-values less than 0.005. The ua-FRS demonstrated high sensitivity and specificity in predicting postoperative pancreatic fistula, as evidenced by an area under the curve (AUC) of 0.802.

Conclusion

The ua-FRS has validation in the context of the South Asian population to predict POPF following PD, offering a reliable tool to guide perioperative management.

背景和目的术后胰瘘（POPF）仍然是胰十二指肠切除术（PD）后的一个重大挑战，会导致发病率和死亡率。目前已建立了各种风险评估模型来预测发生胰瘘的可能性。最近，一种最新的备用瘘管风险评分（ua-FRS）在欧洲队列中得到了完善和验证。然而，该评分在南亚队列中的验证工作仍相对欠缺。本研究旨在验证 ua-FRS 在南亚人群（尤其是尼泊尔）中预测接受腹腔镜手术患者 POPF 的适用性。方法这项横断面观察性研究由一个团队于 2021 年 7 月至 2023 年 10 月在尼泊尔加德满都的三个三级医疗中心进行。共研究了 98 名患者的性别、体重指数（BMI）、主胰管（MPD）直径、胰腺稠度、病理部位和估计失血量。使用接收手术特征曲线评估了ua-FRS预测胰十二指肠切除术后胰瘘的准确性。结果单变量分析显示，性别、胰腺质地、主胰管直径、病变部位和体重指数是具有统计学意义的因素。然而，在多变量分析中，只有体重指数和主胰管直径具有统计学意义，P 值均小于 0.005。ua-FRS 预测术后胰瘘的灵敏度和特异性都很高，其曲线下面积（AUC）为 0.802。结论 ua-FRS已在南亚人群中得到验证，可预测胰腺癌术后胰瘘，是指导围手术期管理的可靠工具。

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引用次数: 0

Endoscopic Full-Thickness Plication for the Treatment of Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Randomized Sham Controlled Trials 治疗胃食管反流病的内镜下全厚度钳夹术：随机阴性对照试验的系统回顾和元分析

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-26 DOI: 10.1002/jgh3.70056

Muhammad Shahzil, Ammad Javaid Chaudhary, Ali Akram Qureshi, Fariha Hasan, Muhammad Saad Faisal, Abdullah Sohail, Muhammad Ali Khaqan, Taher Jamali, Muhammad Zarrar Khan, Eva Alsheik, Tobias Zuchelli

Introduction

Gastroesophageal reflux disease (GERD) affects approximately 20% of adults in the United States. Proton pump inhibitors are the first-line treatment but are associated with long-term side effects. Endoscopic full-thickness plication (EFTP) is a minimally invasive alternative that improves the valvular mechanism of the gastroesophageal junction. This meta-analysis compared EFTP to a sham procedure for the treatment of refractory GERD.

Materials and Methods

This meta-analysis followed the Cochrane guidelines and PRISMA standards and was registered with PROSPERO (CRD42023485506). We searched MEDLINE, Embase, SCOPUS, and Cochrane Library through December 2023. Inclusion criteria targeted Randomized controlled trials comparing EFTP with sham procedures for GERD were included. Statistical analyses utilized RevMan with a random-effects model, and the results were considered significant at p < 0.05.

Results

Of the 2144 screened studies, three RCTs with 272 patients with GERD were included: 136 patients underwent EFTP and 136 underwent sham procedures. Primary outcomes showed a significant reduction in PPI usage (RR 0.51; 95% CI 0.35–0.73; p < 0.01) and more than 50% improvement in GERD-HRQL scores at 3 months (RR 15.81; 95% CI 1.40–178.71; p = 0.03). No significant difference was found in the DeMeester scores (MD: 12.57; 95% CI −35.12 to 9.98; p = 0.27). Secondary outcomes showed no significant difference in time with esophageal pH < 4, but a significant reduction in total reflux episodes.

Conclusions

EFTP significantly reduced PPI usage, improved GERD-HRQL scores, and decreased total reflux episodes compared with sham procedures, highlighting its potential as a minimally invasive treatment. Further research is needed to compare EFTP with other minimally invasive techniques to determine the most effective treatment option.

导言胃食管反流病（GERD）影响着美国约 20% 的成年人。质子泵抑制剂是一线治疗药物，但具有长期副作用。内镜下全厚壁成形术（EFTP）是一种微创替代疗法，可改善胃食管交界处的瓣膜机制。本荟萃分析比较了 EFTP 和假手术治疗难治性胃食管反流病的效果。材料与方法本荟萃分析遵循 Cochrane 指南和 PRISMA 标准，并在 PROSPERO（CRD42023485506）上注册。我们检索了 MEDLINE、Embase、SCOPUS 和 Cochrane 图书馆，直至 2023 年 12 月。纳入标准有针对性纳入了比较 EFTP 与治疗胃食管反流病的假手术的随机对照试验。统计分析采用 RevMan 随机效应模型，结果以 p < 0.05 为显著性。结果在筛选出的 2144 项研究中，有三项研究纳入了 272 名胃食管反流病患者：136名患者接受了EFTP治疗，136名患者接受了假性治疗。主要结果显示，PPI 使用量明显减少（RR 0.51；95% CI 0.35-0.73；p < 0.01），3 个月后胃食管反流病-HRQL 评分改善超过 50%（RR 15.81；95% CI 1.40-178.71；p = 0.03）。DeMeester 评分无明显差异（MD：12.57；95% CI -35.12-9.98；p = 0.27）。次要结果显示，食管 pH 值为 4 的时间无明显差异，但总反流次数明显减少。结论与假手术相比，EFTP 能明显减少 PPI 的使用，改善 GERD-HRQL 评分，减少总反流次数，突出了其作为微创治疗的潜力。还需要进一步研究将 EFTP 与其他微创技术进行比较，以确定最有效的治疗方案。

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引用次数: 0

Gastroduodenal Polyposis Secondary to Extrahepatic Portal Venous Obstruction 继发于肝外门静脉阻塞的胃十二指肠息肉病

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-11-25 DOI: 10.1002/jgh3.70060

Christopher Wen Wei Ho, Kenneth Tou En Chang, Fang Kuan Chiou

<p>This is a 16-year-old male who first presented in infancy for poor weight gain and splenomegaly. Ultrasound and computed tomography imaging of the abdomen revealed extrahepatic portal vein obstruction (EHPVO) and portal hypertension, with chronic portal vein thrombosis, cavernous transformation of the portal vein, splenomegaly, and portal venous shunts.</p><p>He developed his first variceal bleed at 3 years old, with endoscopic variceal ligation of esophageal varices and injection sclerotherapy of gastric varices done successfully. Over the years, there was no recurrence of variceal bleed, though his spleen size had gradually increased in size with hypersplenic effect of leukopaenia, thrombocytopaenia, and anemia. There was no evidence of liver cirrhosis. At 16 years of age, he presented with hepatic encephalopathy and a drop in hemoglobin (from 10.4 to 7.0 g/DL) with suspected occult gastrointestinal bleeding. There was no overt haematemesis or melaena. Oesophagogastroduodenoscopy showed non-bleeding Grade II esophageal varices for which endoscopic variceal ligation was performed. Multiple sessile polyps measuring approximately up to 5 mm were seen in the stomach antrum as well as in the second part of duodenum (Figure 1a–d). Overlying mucosa of these polyps appeared congested and although there was increased venous bleeding during biopsy, bleeding resolved without further intervention. Histology showed increased ectatic lamina proprial capillaries in the laminal propria with no dysplasia, findings which were in keeping with microscopic changes attributable to portal hypertension (Figure 1e).</p><p>Portal hypertensive polyps (PHP) have been described as a rare endoscopic feature of portal hypertension, along with other more common findings of oesphageal varices, gastropathy, gastric antral vascular ectasia, enteropathy, and colopathy [<span>1</span>]. It has been postulated that polyps develop because of neovascularization secondary to high portal pressure. PHP have been mainly described in the stomach and duodenal involvement is not common, with paucity of literature in children [<span>2</span>]. Differential diagnoses of PHP include pancreatic or gastric heterotopia, adenomatous polyps, and inflammatory polyps. Histological findings of proliferating capillaries in the lamina propria indicates a vascular etiology, distinguishing them from inflammatory polyps [<span>3</span>]. The absence of dysplasia rules out an adenomatous nature for these polyps. Other histological findings of PHP described are vascular ectasia/congestion/thrombi, gastric foveolar metaplasia, reactive nuclear atypia, fibrosis, and smooth muscle proliferation.</p><p>PHP have been associated with increased risk of bleeding due to underlying vascular congestion. In this case, the patient did not present with overt variceal bleeding, and ectopic bleeding from the PHP was postulated to have contributed to the anemia and triggered hepatic encephalopathy. Lowering portal pressur

这是一名 16 岁的男性患者，最初在婴儿期因体重增加缓慢和脾脏肿大而就诊。腹部超声波和计算机断层扫描成像显示他患有肝外门静脉阻塞（EHPVO）和门静脉高压症，并伴有慢性门静脉血栓形成、门静脉海绵样变、脾脏肿大和门静脉分流。他在 3 岁时出现了第一次静脉曲张出血，并成功进行了内镜下食管静脉曲张结扎和胃静脉曲张注射硬化剂治疗。多年来，虽然他的脾脏逐渐增大，并伴有白细胞减少、血小板减少和贫血等脾功能亢进症状，但静脉曲张出血并未复发。没有肝硬化的迹象。16 岁时，他出现肝性脑病，血红蛋白下降（从 10.4 克/升下降到 7.0 克/升），怀疑有隐性消化道出血。他没有明显的吐血或黄疸。食管胃十二指肠镜检查显示食管静脉曲张为不出血的二级，并进行了内镜下静脉曲张结扎术。在胃窦部和十二指肠的后半部分发现了多个约 5 毫米大小的无柄息肉（图 1a-d）。这些息肉的上覆粘膜出现充血，虽然活检时静脉出血增多，但无需进一步干预即可止血。组织学检查显示，固有层中异位的固有层毛细血管增多，但没有发育不良，这些结果与门静脉高压引起的显微镜下变化一致（图 1e）。门静脉高压性息肉（PHP）已被描述为门静脉高压的一种罕见内镜特征，其他更常见的发现包括食道静脉曲张、胃病、胃窦血管异位、肠病和结肠病[1]。据推测，息肉的形成是由于高门静脉压力导致的新生血管形成。PHP 主要发生在胃部，十二指肠受累并不常见，儿童受累的文献也很少[2]。PHP 的鉴别诊断包括胰腺或胃异位瘤、腺瘤性息肉和炎性息肉。组织学发现固有层中有增生的毛细血管，这表明病因是血管性的，从而与炎性息肉区分开来 [3]。这些息肉没有发育不良，排除了腺瘤性息肉的可能性。PHP 的其他组织学发现包括血管异位/充血/血栓、胃窝变性、反应性核不典型性、纤维化和平滑肌增生。在本病例中，患者并没有出现明显的静脉曲张出血，因此推测 PHP 的异位出血导致了贫血并引发了肝性脑病。据报道，使用β-受体阻滞剂降低门脉压力可改善临床（贫血和输血需求）和内镜特征[1]。经颈静脉肝内门体分流术（TIPS）后，小肠粘膜变化可能会有所改善，但对 PHP 的影响尚未见报道。对于无症状的患者，除了为诊断目的进行内镜下息肉切除术外，可能不需要治疗。本病例强调了对长期门静脉高压症患者隐匿性消化道出血这一门静脉高压症不寻常表现进行内镜和组织学评估的重要性。由于本病例是对患者临床结果的回顾性分析，因此无需获得机构审查委员会的批准。

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引用次数: 0