JGH Open最新文献

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.

Purpose

Proton pump inhibitors (PPIs) remain the standard treatment option for erosive esophagitis (EE) but have notable limitations due to side effects associated with long-term use. Tegoprazan, a novel potassium-competitive acid suppressant (P-CAB), may provide an alternative treatment option. In this study, we aim to evaluate the healing rates of EE using tegoprazan versus PPIs, along with their respective safety profiles.

Methods

A comprehensive literature search was conducted in PubMed, Embase, and ClinicalTrials.gov from inception to March 2025. Risk of bias was evaluated using the Cochrane RoB 2.0 tool. Pooled estimates were calculated using random-effects models in Review Manager 5.4.

Results

Three RCTs encompassing a total of 766 patients were included in the analysis. Tegoprazan demonstrated comparable healing rates to PPIs at both 4 weeks (risk ratio [RR] 1.05; 95% confidence interval [CI]: 0.99–1.11; p = 0.12) and 8 weeks (RR 1.02; 95% CI: 0.98–1.06; p = 0.35). Subgroup analyses by dose (50 and 100 mg) showed no significant differences. While overall adverse event rates were similar between groups, the incidence of headache was numerically lower in the tegoprazan group (1.3% vs. 4.2%; RR = 0.40; 95% CI: 0.08–2.00; p = 0.26), though this difference was not statistically significant.

Conclusion

Tegoprazan shows comparable efficacy and safety to standard PPIs for treating EE. While healing rates were slightly higher, particularly with the 100 mg dose, the differences were not statistically significant. Tegoprazan may be a suitable alternative for patients intolerant to PPIs, though larger, long-term, multiethnic studies are warranted to confirm these findings and assess patient-centered outcomes.

Objective

To investigate the risk factors associated with exposed cardiac glands and their circumferential distribution in the esophagus and to establish a theoretical foundation for the occurrence and progression of these glands.

Methods

Prospectively enrolled patients who underwent gastroscopy in our hospital from December 2023 to March 2024. Patients who met the inclusion and exclusion criteria and were found to have exposed cardiac glands during gastroscopy were included in the exposed cardiac glands group, while those who met the inclusion and exclusion criteria without exposed cardiac glands during endoscopy were included in the control group. The risk factors for exposed cardiac glands were obtained through statistical analysis by comparing various factors between the two groups. The circumferential distribution of exposed cardiac glands in the esophagus was studied by means of a radar map.

Results

Waist circumference, drinking, irritating food, right side sleeping position, calcium antagonists, Helicobacter pylori infection, and gastroesophageal reflux disease were the risk factors for exposed cardiac glands. The exposed cardiac glands usually occur on the lesser curved side and posterior wall of the distal esophagus.

Conclusion

There is a correlation between exposed cardiac glands and gastroesophageal reflux disease, and the prone site of exposed cardiac glands is roughly consistent with the prone site of reflux. Affected by reflux, exposed cardiac glands may coalesce and progress. Waist circumference, drinking, irritating food, right side sleeping position, calcium antagonists, and Helicobacter pylori infection were independent risk factors for exposed cardiac glands.