Pub Date : 2024-04-26DOI: 10.14309/ajg.0000000000002763
Shungo Yamamoto
{"title":"Caution on Interpretation of Noninferiority Trial Results.","authors":"Shungo Yamamoto","doi":"10.14309/ajg.0000000000002763","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002763","url":null,"abstract":"","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.14309/ajg.0000000000002802
A. Mahajan, Athish Shetty, Ganesh Bhat
{"title":"Duration of Antibiotic in Cholangitis: Better to Have a Tailored Approach.","authors":"A. Mahajan, Athish Shetty, Ganesh Bhat","doi":"10.14309/ajg.0000000000002802","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002802","url":null,"abstract":"","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140652363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.14309/ajg.0000000000002830
Alexandra Strauss Starling, Yue Ren, Hongzhe Li, J. Spergel, Amanda B Muir, Kristle L. Lynch, C. Liacouras, G. W. Falk
OBJECTIVES There is limited longitudinal data on the impact of chronic therapy on the natural history of eosinophilic esophagitis [EoE], a chronic allergic disease of the esophagus. The purpose of this study was to evaluate if patients with well-controlled EoE were less likely to develop fibrostenotic complications. METHODS Subjects were identified from a database of pediatric EoE patients at the Children's Hospital of Philadelphia started in 2000. Patients were then searched in adult medical records to identify patients who transitioned care. All office visits, emergency department (ED) visits and endoscopic, histologic, and imaging reports were reviewed for the primary outcome of strictures and the secondary outcomes of food impactions and dysphagia. Cox proportional hazard regression was performed for outcomes. RESULTS 105 patients were identified with mean follow up of 11.4 + 4.9 years. 52.3% (n=55) had a period of histologic disease control defined as > 2 consecutive endoscopies with histologic remission. These patients were less likely to develop strictures compared to patients who did not have a period of histologic control (HR 0.232; 95% CI 0.084-0.64, p=0.005). Patients who were diagnosed at younger ages were less likely to develop strictures. Presentation with dysphagia or impaction was associated with higher rate of stricture development. CONCLUSIONS In this cohort study with > 10 years of follow up, children with EoE with a period of histologic disease control and diagnosed at younger ages were less likely to develop esophageal strictures. While this suggests histologic remission is associated with reduction of remodeling complications, additional prospective data with long-term follow up is needed.
{"title":"\"Reducing Eosinophil Counts in Eosinophilic Esophagitis in Children Is Associated with Reduction in Later Stricture Development\".","authors":"Alexandra Strauss Starling, Yue Ren, Hongzhe Li, J. Spergel, Amanda B Muir, Kristle L. Lynch, C. Liacouras, G. W. Falk","doi":"10.14309/ajg.0000000000002830","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002830","url":null,"abstract":"OBJECTIVES\u0000There is limited longitudinal data on the impact of chronic therapy on the natural history of eosinophilic esophagitis [EoE], a chronic allergic disease of the esophagus. The purpose of this study was to evaluate if patients with well-controlled EoE were less likely to develop fibrostenotic complications.\u0000\u0000\u0000METHODS\u0000Subjects were identified from a database of pediatric EoE patients at the Children's Hospital of Philadelphia started in 2000. Patients were then searched in adult medical records to identify patients who transitioned care. All office visits, emergency department (ED) visits and endoscopic, histologic, and imaging reports were reviewed for the primary outcome of strictures and the secondary outcomes of food impactions and dysphagia. Cox proportional hazard regression was performed for outcomes.\u0000\u0000\u0000RESULTS\u0000105 patients were identified with mean follow up of 11.4 + 4.9 years. 52.3% (n=55) had a period of histologic disease control defined as > 2 consecutive endoscopies with histologic remission. These patients were less likely to develop strictures compared to patients who did not have a period of histologic control (HR 0.232; 95% CI 0.084-0.64, p=0.005). Patients who were diagnosed at younger ages were less likely to develop strictures. Presentation with dysphagia or impaction was associated with higher rate of stricture development.\u0000\u0000\u0000CONCLUSIONS\u0000In this cohort study with > 10 years of follow up, children with EoE with a period of histologic disease control and diagnosed at younger ages were less likely to develop esophageal strictures. While this suggests histologic remission is associated with reduction of remodeling complications, additional prospective data with long-term follow up is needed.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multidisciplinary Collaborative Team for Screening of Autoimmune Gastritis.","authors":"Xiaobo Huang, Xin Tong, Lianjun Xing, Dinghong Xiao","doi":"10.14309/ajg.0000000000002793","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002793","url":null,"abstract":"","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140657114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.14309/ajg.0000000000002829
Rui Guo, Jingzhai Wang, L. Min, Ningning Dong, Li Zhang, Ruyun Song, Yang Zhang, Qian Zhang, Huihong Zhai, Peng Li, Shutian Zhang
OBJECTIVE To evaluate the effect of Embrella, a novel-designed colonoscopic distal attachment, on adenoma detection rate (ADR) and adenoma per colonoscopy (APC), compared with standard colonoscopy in routine practice. METHODS All consecutive patients who underwent routine colonoscopic examinations at three endoscopy centers in China were enrolled. Participants were randomly assigned in a 1:1 ratio to the Embrella-assisted colonoscopy (EAC) or standard colonoscopy (SC) groups. ADR, APC, inspection time, pain scores, and adverse events were recorded. RESULTS Overall, 1179 patients were randomized into the EAC (n = 593) and SC groups (n = 586). EAC increased the overall ADR from 24.6% to 34.2% (P < .001) and improved APC from 0.44 to 0.64 (P = .002). Subgroup analyses indicated that EAC significantly improved ADR for adenomas < 10 mm (13.8% vs. 8.5%, P = .004 for 5-9 mm and 27.0% vs. 17.2%, P < .001 for < 5 mm), non-pedunculated adenomas (26.6% vs. 18.8%, P < .001), and adenomas in the transverse (10.8% vs. 6.1%, P = .004) and left colon (21.6% vs. 13.7%, P < .001). APC in the subgroup analyses was consistent with ADR. The mean inspection time was shorter with EAC (6.52 min vs. 6.68 min, P = .046), with no significant impact on patients' pain scores (P = .377). Moreover, no EAC-related adverse events occurred. CONCLUSION EAC significantly increased ADR and APC compared with SC, particularly for adenomas < 10 mm, non-pedunculated adenomas, and adenomas in the transverse and left colon.
{"title":"Improved adenoma detection rate using a novel colonoscopic distal attachment: a multicenter randomized controlled trial.","authors":"Rui Guo, Jingzhai Wang, L. Min, Ningning Dong, Li Zhang, Ruyun Song, Yang Zhang, Qian Zhang, Huihong Zhai, Peng Li, Shutian Zhang","doi":"10.14309/ajg.0000000000002829","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002829","url":null,"abstract":"OBJECTIVE\u0000To evaluate the effect of Embrella, a novel-designed colonoscopic distal attachment, on adenoma detection rate (ADR) and adenoma per colonoscopy (APC), compared with standard colonoscopy in routine practice.\u0000\u0000\u0000METHODS\u0000All consecutive patients who underwent routine colonoscopic examinations at three endoscopy centers in China were enrolled. Participants were randomly assigned in a 1:1 ratio to the Embrella-assisted colonoscopy (EAC) or standard colonoscopy (SC) groups. ADR, APC, inspection time, pain scores, and adverse events were recorded.\u0000\u0000\u0000RESULTS\u0000Overall, 1179 patients were randomized into the EAC (n = 593) and SC groups (n = 586). EAC increased the overall ADR from 24.6% to 34.2% (P < .001) and improved APC from 0.44 to 0.64 (P = .002). Subgroup analyses indicated that EAC significantly improved ADR for adenomas < 10 mm (13.8% vs. 8.5%, P = .004 for 5-9 mm and 27.0% vs. 17.2%, P < .001 for < 5 mm), non-pedunculated adenomas (26.6% vs. 18.8%, P < .001), and adenomas in the transverse (10.8% vs. 6.1%, P = .004) and left colon (21.6% vs. 13.7%, P < .001). APC in the subgroup analyses was consistent with ADR. The mean inspection time was shorter with EAC (6.52 min vs. 6.68 min, P = .046), with no significant impact on patients' pain scores (P = .377). Moreover, no EAC-related adverse events occurred.\u0000\u0000\u0000CONCLUSION\u0000EAC significantly increased ADR and APC compared with SC, particularly for adenomas < 10 mm, non-pedunculated adenomas, and adenomas in the transverse and left colon.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140655572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.14309/ajg.0000000000002828
R. Stidham, Binu Enchakalody, Stewart C Wang, Grace L Su, Brian Ross, Mahmoud Al-Hawary, A. Wasnik
OBJECTIVE Assessing the cumulative degree of bowel injury in ileal Crohn's disease (CD) is difficult. We aimed to develop machine learning (ML) methodologies for automated estimation of cumulative ileal injury on CT-enterography (CTE) to help predict future bowel surgery. METHODS Adults with ileal CD using biologic therapy at a tertiary care center underwent ML analysis of CTE scans. Two fellowship trained radiologists graded bowel injury severity at granular spatial increments along the ileum (1cm), called mini-segments. ML segmentation methods were trained on radiologist grading with predicted severity then spatially mapped to the ileum. Cumulative injury was calculated as the sum (S-CIDSS) and mean of severity grades along the ileum. Multivariate models of future small bowel resection were compared cumulative ileum injury metrics and traditional bowel measures, adjusting for laboratory values, medications, and prior surgery at the time of CTE. RESULTS In 229 CTEs, 8424 mini-segments underwent analysis. Agreement between ML and radiologists injury grading was strong (κ=0.80, 95%CI 0.79-0.81) and similar to inter-radiologist agreement (κ=0.87, 95%CI 0.85-0.88). S-CIDSS (46.6 vs. 30.4, P=0.0007) and mean cumulative injury grade scores (1.80 vs. 1.42, P<0.0001) were greater in CD biologic users that went to future surgery. Models using cumulative spatial metrics (AUC=0.76) outperformed models using conventional bowel measures, laboratory values, and medical history (AUC=0.62) for predicting future surgery in biologic users. CONCLUSION Automated cumulative ileal injury scores show promise for improving prediction of outcomes in small bowel CD. Beyond replicating expert judgement, spatial enterography analysis can augment the personalization of bowel assessment in CD.
目的评估回肠克罗恩病（CD）肠道损伤的累积程度非常困难。我们的目标是开发机器学习（ML）方法，自动估算 CT 肠道造影（CTE）的回肠累积损伤程度，帮助预测未来的肠道手术。方法在一家三级医疗中心接受生物治疗的回肠克罗恩病成人患者接受了 CTE 扫描的 ML 分析。两名接受过研究培训的放射科医生按照回肠（1 厘米）的颗粒空间增量对肠道损伤严重程度进行了分级，这些空间增量被称为小段。ML 分段方法是根据放射科医生的分级和预测的严重程度进行训练，然后在空间上映射到回肠。累积损伤以回肠严重程度分级的总和（S-CIDSS）和平均值计算。对未来小肠切除术的多变量模型进行了比较，比较了累积回肠损伤指标和传统的肠道测量指标，并对实验室值、药物和 CTE 时的既往手术进行了调整。ML与放射科医生损伤分级之间的一致性很强（κ=0.80，95%CI 0.79-0.81），与放射科医生之间的一致性相似（κ=0.87，95%CI 0.85-0.88）。在今后接受手术的 CD 生物制剂使用者中，S-CIDSS（46.6 vs. 30.4，P=0.0007）和平均累积损伤等级评分（1.80 vs. 1.42，P<0.0001）更高。在预测生物制剂使用者未来手术方面，使用累积空间指标的模型（AUC=0.76）优于使用传统肠道测量、实验室值和病史的模型（AUC=0.62）。除了复制专家的判断外，空间肠造影分析还能增强 CD 肠道评估的个性化。
{"title":"Artificial Intelligence for Quantifying Cumulative Small Bowel Disease Severity on CT-Enterography in Crohn's Disease.","authors":"R. Stidham, Binu Enchakalody, Stewart C Wang, Grace L Su, Brian Ross, Mahmoud Al-Hawary, A. Wasnik","doi":"10.14309/ajg.0000000000002828","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002828","url":null,"abstract":"OBJECTIVE\u0000Assessing the cumulative degree of bowel injury in ileal Crohn's disease (CD) is difficult. We aimed to develop machine learning (ML) methodologies for automated estimation of cumulative ileal injury on CT-enterography (CTE) to help predict future bowel surgery.\u0000\u0000\u0000METHODS\u0000Adults with ileal CD using biologic therapy at a tertiary care center underwent ML analysis of CTE scans. Two fellowship trained radiologists graded bowel injury severity at granular spatial increments along the ileum (1cm), called mini-segments. ML segmentation methods were trained on radiologist grading with predicted severity then spatially mapped to the ileum. Cumulative injury was calculated as the sum (S-CIDSS) and mean of severity grades along the ileum. Multivariate models of future small bowel resection were compared cumulative ileum injury metrics and traditional bowel measures, adjusting for laboratory values, medications, and prior surgery at the time of CTE.\u0000\u0000\u0000RESULTS\u0000In 229 CTEs, 8424 mini-segments underwent analysis. Agreement between ML and radiologists injury grading was strong (κ=0.80, 95%CI 0.79-0.81) and similar to inter-radiologist agreement (κ=0.87, 95%CI 0.85-0.88). S-CIDSS (46.6 vs. 30.4, P=0.0007) and mean cumulative injury grade scores (1.80 vs. 1.42, P<0.0001) were greater in CD biologic users that went to future surgery. Models using cumulative spatial metrics (AUC=0.76) outperformed models using conventional bowel measures, laboratory values, and medical history (AUC=0.62) for predicting future surgery in biologic users.\u0000\u0000\u0000CONCLUSION\u0000Automated cumulative ileal injury scores show promise for improving prediction of outcomes in small bowel CD. Beyond replicating expert judgement, spatial enterography analysis can augment the personalization of bowel assessment in CD.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140658216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.14309/ajg.0000000000002839
Erin Walsh, Amanda J. Krause, Madeline Greytak, Alexander M. Kaizer, P. Weissbrod, Kelli Liu, Tiffany Taft, R. Yadlapati
BACKGROUND Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. This study aimed to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms symptoms undergoing evaluation of gastroesophageal reflux disease (GERD). METHODS Adults with chronic laryngopharyngeal symptoms referred for evaluation of GERD to a single center were prospectively followed. Inclusion criteria included >2 SLP directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient reported outcomes were collected when available. The primary outcome was symptom response. RESULTS Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6kg/m2 (6.8), mean of 3.7 (1.9) LRT sessions. Overall, 55 (85%) participants met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15 (87%)) and concomitant laryngopharyngeal/esophageal symptoms (42/50 (84%)). Among participants that underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 (86%), 8/9 (89%), 10/13 (77%)). CONCLUSION 85% of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation that underwent LRT experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD as well as patients with or without concomitant esophageal reflux symptoms. SLP directed LRT is an effective approach to incorporate into multi-disciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.
{"title":"Laryngeal Recalibration Therapy Improves Laryngopharyngeal Symptoms in Patients with Suspected Laryngopharyngeal Reflux Disease.","authors":"Erin Walsh, Amanda J. Krause, Madeline Greytak, Alexander M. Kaizer, P. Weissbrod, Kelli Liu, Tiffany Taft, R. Yadlapati","doi":"10.14309/ajg.0000000000002839","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002839","url":null,"abstract":"BACKGROUND\u0000Laryngopharyngeal symptoms such as cough, throat clearing, voice change, paradoxic vocal fold movement or laryngospasm are hyper-responsive behaviors resulting from local irritation (e.g., refluxate) and heightened sympathetic tone. Laryngeal recalibration therapy (LRT) guided by a speech-language pathologist (SLP) provides mechanical desensitization and cognitive recalibration to suppress hyper-responsive laryngeal patterns. This study aimed to assess symptom response to LRT among patients with chronic laryngopharyngeal symptoms symptoms undergoing evaluation of gastroesophageal reflux disease (GERD).\u0000\u0000\u0000METHODS\u0000Adults with chronic laryngopharyngeal symptoms referred for evaluation of GERD to a single center were prospectively followed. Inclusion criteria included >2 SLP directed LRT sessions. Data from endoscopy, ambulatory reflux monitoring, and patient reported outcomes were collected when available. The primary outcome was symptom response.\u0000\u0000\u0000RESULTS\u0000Sixty-five participants completed LRT: mean age 55.4 years (SD 17.2), 46 (71%) female, mean body mass index 25.6kg/m2 (6.8), mean of 3.7 (1.9) LRT sessions. Overall, 55 (85%) participants met criteria for symptom response. Specifically, symptom response was similar between those with isolated laryngopharyngeal symptoms (13/15 (87%)) and concomitant laryngopharyngeal/esophageal symptoms (42/50 (84%)). Among participants that underwent reflux monitoring, symptom response was similar between those with proven, inconclusive for, and no GERD (18/21 (86%), 8/9 (89%), 10/13 (77%)).\u0000\u0000\u0000CONCLUSION\u000085% of patients with chronic laryngopharyngeal symptoms referred for GERD evaluation that underwent LRT experienced laryngeal symptom response. Rates of symptom response were maintained across patients with or without proven GERD as well as patients with or without concomitant esophageal reflux symptoms. SLP directed LRT is an effective approach to incorporate into multi-disciplinary management of chronic laryngopharyngeal symptoms/laryngopharyngeal reflux disease.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.14309/ajg.0000000000002820
Brent Hiramoto, Thomas R McCarty, N. Lodhia, Andrew Jenkins, A. Elnaiem, Mayssan Muftah, Ryan Flanagan, Walter W. Chan
INTRODUCTION Divergent recommendations for periprocedural management of GLP-1 receptor agonist (GLP-1 RA) medications rely on limited evidence. We performed a systematic review and meta-analysis to provide quantitative measures of gastric emptying relevant to mechanisms of weight loss and to periprocedural management of GLP-1 RA. We hypothesized that the magnitude of gastric emptying delay would be low and of limited clinical significance to procedural sedation risks. METHODS A protocolized search identified studies on GLP-1 RA that quantified gastric emptying measures. Pooled estimates using random effects were presented as weighted mean difference with 95% confidence intervals (CI). Univariate meta-regression was performed to assess the influence of GLP-1 RA type, short- vs long-acting mechanism of action, and duration of treatment on gastric emptying. RESULTS Fifteen studies met inclusion criteria. Five studies (n=247) utilized scintigraphy (GES). Mean T1/2 was 138.4 minutes (CI:74.5-202.3) for GLP-1 RA versus 95.0 minutes (CI:54.9-135.0) for placebo, with pooled mean difference of 36.0 minutes (CI:17.0-55.0, p<0.01, I2=79.4%). Ten studies (n=411) utilized the acetaminophen absorption test (AAT), with no significant delay in gastric emptying measured by Tmax, AUC4hr, and AUC5hr with GLP-1 RA (p>0.05). On meta-regression, type of GLP-1 RA, mechanism of action, and treatment duration did not impact gastric emptying (p>0.05). CONCLUSIONS While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods. There were no substantial differences in gastric emptying on modalities reflective of liquid emptying (AAT), particularly at time points relevant to periprocedural care.
引言 GLP-1 受体激动剂（GLP-1 RA）药物的围手术期管理建议因证据有限而存在分歧。我们进行了一项系统回顾和荟萃分析，以提供与体重减轻机制和 GLP-1 RA 围手术期管理相关的胃排空定量指标。我们假设胃排空延迟的程度较低，且对手术镇静风险的临床意义有限。方法通过协议检索确定了有关 GLP-1 RA 的量化胃排空测量的研究。使用随机效应的汇总估计值以加权平均差和 95% 置信区间 (CI) 表示。进行了单变量元回归，以评估 GLP-1 RA 类型、短效与长效作用机制以及治疗持续时间对胃排空的影响。五项研究（n=247）采用了闪烁成像（GES）。GLP-1 RA的平均T1/2为138.4分钟（CI:74.5-202.3），而安慰剂的平均T1/2为95.0分钟（CI:54.9-135.0），两者的平均差异为36.0分钟（CI:17.0-55.0，P0.05）。在元回归中，GLP-1 RA 的类型、作用机制和治疗持续时间均不影响胃排空（P>0.05）。结论虽然 GLP-1 RA 药物可量化胃排空延迟 36 分钟，但相对于标准的围手术期禁食时间而言，其幅度有限。反映液体排空的模式（AAT）在胃排空方面没有实质性差异，特别是在与围手术期护理相关的时间点。
{"title":"Quantified Metrics of Gastric Emptying Delay by GLP-1 Agonists: A Systematic Review and Meta-Analysis with Insights for Periprocedural Management.","authors":"Brent Hiramoto, Thomas R McCarty, N. Lodhia, Andrew Jenkins, A. Elnaiem, Mayssan Muftah, Ryan Flanagan, Walter W. Chan","doi":"10.14309/ajg.0000000000002820","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002820","url":null,"abstract":"INTRODUCTION\u0000Divergent recommendations for periprocedural management of GLP-1 receptor agonist (GLP-1 RA) medications rely on limited evidence. We performed a systematic review and meta-analysis to provide quantitative measures of gastric emptying relevant to mechanisms of weight loss and to periprocedural management of GLP-1 RA. We hypothesized that the magnitude of gastric emptying delay would be low and of limited clinical significance to procedural sedation risks.\u0000\u0000\u0000METHODS\u0000A protocolized search identified studies on GLP-1 RA that quantified gastric emptying measures. Pooled estimates using random effects were presented as weighted mean difference with 95% confidence intervals (CI). Univariate meta-regression was performed to assess the influence of GLP-1 RA type, short- vs long-acting mechanism of action, and duration of treatment on gastric emptying.\u0000\u0000\u0000RESULTS\u0000Fifteen studies met inclusion criteria. Five studies (n=247) utilized scintigraphy (GES). Mean T1/2 was 138.4 minutes (CI:74.5-202.3) for GLP-1 RA versus 95.0 minutes (CI:54.9-135.0) for placebo, with pooled mean difference of 36.0 minutes (CI:17.0-55.0, p<0.01, I2=79.4%). Ten studies (n=411) utilized the acetaminophen absorption test (AAT), with no significant delay in gastric emptying measured by Tmax, AUC4hr, and AUC5hr with GLP-1 RA (p>0.05). On meta-regression, type of GLP-1 RA, mechanism of action, and treatment duration did not impact gastric emptying (p>0.05).\u0000\u0000\u0000CONCLUSIONS\u0000While a gastric emptying delay of ∼36 minutes is quantifiable on GLP-1 RA medications, it is of limited magnitude relative to standard periprocedural fasting periods. There were no substantial differences in gastric emptying on modalities reflective of liquid emptying (AAT), particularly at time points relevant to periprocedural care.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.14309/ajg.0000000000002821
Daniel B Maselli, Lauren L Donnangelo, P. Jirapinyo, Christopher C Thompson, Christopher McGowan
Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous. As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. Here, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.
{"title":"Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting.","authors":"Daniel B Maselli, Lauren L Donnangelo, P. Jirapinyo, Christopher C Thompson, Christopher McGowan","doi":"10.14309/ajg.0000000000002821","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002821","url":null,"abstract":"Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous. As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. Here, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.14309/ajg.0000000000002818
Nicholas J. Shaheen, Robert D Odze, Mendel E. Singer, W. Salyers, Sachin Srinivasan, Vivek Kaul, Arvind J Trindade, Amit Aravapalli, Robert D Herman, Michael S Smith, Matthew J McKinley
BACKGROUND Patients with gastroesophageal reflux (GERD) symptoms undergoing screening upper endoscopy for Barrett's esophagus (BE) frequently demonstrate columnar-lined epithelium (CLE), with forceps biopsies (FB) failing to yield intestinal metaplasia (IM). Repeat endoscopy is often necessary. AIM Assess the yield of IM leading to a diagnosis of BE by the addition of Wide-Area Trans-epithelial Sampling (WATS-3D) to FB in the screening of GERD patients. METHODS We performed a prospective registry study of GERD patients undergoing screening upper endoscopy. Patients had both WATS-3D and FB. Patients were classified by their Z line appearance: regular, irregular (<1 cm CLE), possible short-segment BE (1-<3cm), and possible long-segment BE (≥3cm). Demographics, IM yield, and dysplasia yield were calculated. Adjunctive yield was defined as cases identified by WATS-3D not detected by FB, divided by cases detected by FB. Clinicians were asked if WATS-3D results impacted patient management. RESULTS Of 23,933 patients, 6,829(28.5%) met endoscopic criteria for BE. Of these, 2,878(42.1%) had IM identified by either FB or WATS-3D. Among patients fulfilling endoscopic criteria for BE, the adjunctive yield of WATS-3D was 76.5%, and absolute yield was 18.1%. 1,317 patients (19.3%) who fulfilled endoscopic BE criteria had IM detected solely by WATS-3D. Of 240 patients with dysplasia, 107(44.6%) were found solely by WATS-3D. Among patients with positive WATS-3D but negative FB, the care plan changed in 90.7%. CONCLUSION The addition of WATS-3D to FB in GERD patients being screened for BE resulted in confirmation of BE in an additional 1/5th of patients. Furthermore, dysplasia diagnoses approximately doubled.
{"title":"Adjunctive Use of WATS-3D in Symptomatic GERD Patients Increases Detection of Barrett's Esophagus and Dysplasia.","authors":"Nicholas J. Shaheen, Robert D Odze, Mendel E. Singer, W. Salyers, Sachin Srinivasan, Vivek Kaul, Arvind J Trindade, Amit Aravapalli, Robert D Herman, Michael S Smith, Matthew J McKinley","doi":"10.14309/ajg.0000000000002818","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002818","url":null,"abstract":"BACKGROUND\u0000Patients with gastroesophageal reflux (GERD) symptoms undergoing screening upper endoscopy for Barrett's esophagus (BE) frequently demonstrate columnar-lined epithelium (CLE), with forceps biopsies (FB) failing to yield intestinal metaplasia (IM). Repeat endoscopy is often necessary.\u0000\u0000\u0000AIM\u0000Assess the yield of IM leading to a diagnosis of BE by the addition of Wide-Area Trans-epithelial Sampling (WATS-3D) to FB in the screening of GERD patients.\u0000\u0000\u0000METHODS\u0000We performed a prospective registry study of GERD patients undergoing screening upper endoscopy. Patients had both WATS-3D and FB. Patients were classified by their Z line appearance: regular, irregular (<1 cm CLE), possible short-segment BE (1-<3cm), and possible long-segment BE (≥3cm). Demographics, IM yield, and dysplasia yield were calculated. Adjunctive yield was defined as cases identified by WATS-3D not detected by FB, divided by cases detected by FB. Clinicians were asked if WATS-3D results impacted patient management.\u0000\u0000\u0000RESULTS\u0000Of 23,933 patients, 6,829(28.5%) met endoscopic criteria for BE. Of these, 2,878(42.1%) had IM identified by either FB or WATS-3D. Among patients fulfilling endoscopic criteria for BE, the adjunctive yield of WATS-3D was 76.5%, and absolute yield was 18.1%. 1,317 patients (19.3%) who fulfilled endoscopic BE criteria had IM detected solely by WATS-3D. Of 240 patients with dysplasia, 107(44.6%) were found solely by WATS-3D. Among patients with positive WATS-3D but negative FB, the care plan changed in 90.7%.\u0000\u0000\u0000CONCLUSION\u0000The addition of WATS-3D to FB in GERD patients being screened for BE resulted in confirmation of BE in an additional 1/5th of patients. Furthermore, dysplasia diagnoses approximately doubled.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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