Turkish Journal of Gastroenterology最新文献

Background/Aims: The objective of this study was to evaluate the impact of the resected caudate lobe on survival, particularly in the context of anatomical resection of liver metastases in colorectal cancers without metastases in the caudate lobe. Materials and Methods: Patient data were extracted from the dataset titled "Preoperative CT and Survival Data for Patients Undergoing Resection of Colorectal Liver Metastases (CRLM)." The analysis specifically concentrated on individuals who underwent complete cau- date lobe resection in the absence of radiological signs of metastasis within the caudate lobe itself. To discern the distinct impact of caudate lobe resection on patient outcomes, propensity score matching (PSM) was applied to control for variations across other relevant clinical parameters. Overall survival (OS) and liver disease-free survival (liver DFS) were calculated using the Kaplan-Meier method, while the log-rank test was used to compare survival outcomes between groups. Results: The analysis revealed that patients who underwent total caudate lobe resection exhibited significantly improved OS rates, both in the complete dataset and following PSM (P < .001, HR: 0.43, 95% CI: 0.26-0.72; P = .024, HR: 0.65, 95% CI: 0.59-0.79, respectively). Additionally, liver DFS outcomes were found to be superior in patients who had caudate lobe resection, in both the full dataset and the propensity-matched cohort (P = .014, HR = 0.46, 95% CI: 0.24-0.85; P = .026, HR = 0.5, 95% CI: 0.37-0.79, respectively). Conclusion: These findings suggest that incorporating total caudate lobe resection into the surgical management of CRLM may offer substantial benefits in terms of both OS and liver-specific disease-free survival.

Background/aims: Colon adenocarcinoma (COAD) is a prevalent malignant tumor of the digestive system. Previous research has indicated that RNA N6-methyladenosine (m6A) methyltransferase RNA-binding motif protein-15 (RBM15) is involved in various cancers. We aimed to investigate the function of RBM15 in COAD progression and its underlying molecular mechanism.

Materials and methods: TIMER and UALCAN databases were applied to analyze the relationship between COAD and Integrin β-like 1 protein (ITGBL1) or RBM15. RT-qPCR and Western blot were used to analyze ITGBL1, M2-type macrophage markers, EMT-related markers, and RBM15 expression. CCK-8, colony formation, and transwell experiments detected cell viability, proliferation, migration, and invasion. The effect of ITGBL1 on COAD tumor growth was examined using a xenograft tumor model. The effects of COAD cells on macrophage polarization and the proliferation and apoptosis of CD8+ T cells were analyzed using flow cytometry analysis. Relationships between RBM15 and ITGBL1 were validated using MeRIP and dual-luciferase reporter assay.

Results: ITGBL1 and RBM15 contents were elevated in COAD. ITGBL1 knockdown could hinder COAD cell proliferation, migration, invasion, M2-type macrophage polarization, and lymphocyte immunity. Meanwhile, the lack of RBM15 dampened tumor growth in vivo. Mechanistically, RBM15 could increase ITGBL1 expression by m6A methylation.

Conclusion: RBM15 could promote COAD progression by regulating ITGBL1 mRNA stability, providing a promising biomarker and a potential target for COAD.

Background/aims: Elevated intra-abdominal pressure (IAP) can lead to intra-abdominal hypertension (IAH) and, in severe cases, abdominal compartment syndrome (ACS) in patients with cirrhosis and ascites. Paracentesis reduces IAP and improves abdominal perfusion. Intra-abdominal hypertension can also trigger acute-on-chronic liver failure (ACLF) in decompensated cirrhosis. This study evaluates the association between IAH and short-term mortality in patients with cirrhosis and ascites.

Materials and methods: This prospective, single-center cohort study included 18 patients (7 females, 11 males; median age: 59) scheduled for therapeutic paracentesis. Intra-abdominal pressure was measured using the bladder technique. Patients were grouped based on initial Chronic Liver Failure Consortium Organ Failure (CLIF-C OF) scores as ACLF or non-ACLF and followed up for 3 months.

Results: The median model for end-stage liver disease score was 17 (IQR 11-19). The primary etiologies of cirrhosis were viral hepatitis and alcoholic liver disease. Independent risk factors for IAH included advanced liver disease and large-volume ascites. Pre-paracentesis IAP was higher in ACLF patients (22 vs. 18 mm Hg). Post-paracentesis IAP was also higher in ACLF patients (14 vs. 8 mm Hg, P = .007). The 3-month mortality rate was 50%, with worse survival in ACLF patients (24 vs. 76.9 days, P = .002). Pre-paracentesis IAP was significantly higher in patients who died (22 vs. 18 mm Hg, P = .034), and survival was worse in those with IAP ≥18.5 mm Hg (P = .026).

Conclusion: Intra-abdominal pressure is elevated in cirrhosis patients with grade 3 ascites. Despite similar paracentesis volumes, IAP remained higher in the ACLF group. Intra-abdominal pressure ≥18.5 mm Hg is associated with significantly reduced survival, indicating that IAH accelerates short-term mortality in these patients.

Background/aims: Levator ani syndrome (LAS) is a pathology that is both difficult to diagnose and treat. The effectiveness of current treatments, which are mostly administered with special devices in advanced healthcare centers, is controversial. The aim of the study is to investigate the effects of glyceryl trinitrate, which is easily accessible and can be applied by the patient, in the treatment of LAS.

Materials and methods: The study cohort comprised 16 patients with LAS diagnosed and received 0.4% topical glyceryl trinitrate treatment rectally.

Results: At the first month of treatment, it was observed that the symptoms and puborectal muscle tension of 15 (93.7%) patients had completely resolved. One patient with persisted symptoms was referred to an advanced center. Symptomatic relief continued in 14 (87.5%) of the 15 patients at the third month of treatment and there were no pathological findings in the rectal examination. The visual analog scale score significantly decreased after the treatment (P < .001).

Conclusion: It is thought that topical glyceryl trinitrate treatment may be at least as effective as current treatment methods. Although the number of patients is small, our study is inspiring as it is the first time this molecule has been tried in the treatment of LAS in the literature. More comprehensive randomized controlled studies with long-term follow-up of patients are needed.

Background/Aims: To evaluate invasive treatment outcomes for hepatocellular carcinoma (HCC) in patients aged over 90 years. Materials and methods: Twenty-six patients were included. Information on backgrounds, course of treatment, outcomes, and changes in Child-Pugh (CP) score and performance status (PS), as well as a comparison of treatment-related complications and 2-year survival after treatment, were retrospectively examined and compared with 311 patients aged under 90 years who were matched under the same conditions. Results: The mean patient age was 91.1 years. Seventeen patients had cirrhosis. The CP score was ≤ 7 across all cases. The Barcelona Clinic Liver Cancer stage was ≤B across all cases. The initial treatments were percutaneous local treatment and transcatheter arte- rial chemoembolization in 14 and 12 cases, respectively. Several patients with postoperative delirium and cognitive impairment were observed. No significant early post-treatment declines were observed in hepatic reserve and PS. The cumulative survival rates after treatment were 77.8% and 61.5% at 12 and 24 months, respectively. The 2-year survival after treatment for patients aged under 90 years was 87.4% and 75.7% at 12 and 24 months, respectively. No significant difference was observed in treatment-related complica- tions or 2-year survival rates between patients aged over and under 90 years. Conclusion: This is the first report to analyze the course of invasive treatment for HCC in patients aged over 90 years. Safety was ensured if hepatic reserve and PS were maintained. The 2-year survival was comparable with that of patients aged under 90 years, sug- gesting benefit from HCC treatment.

Background/aims: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential diagnostic and therapeutic method for pancreato-biliary disorders in adults, but its use in pediatric populations remains limited. This study aims to evaluate the indications, technical success, and safety of ERCP in pediatric patients.

Materials and methods: A retrospective analysis of all ERCP procedures performed on patients under 18 years of age was conducted at 2 tertiary centers in Türkiye (Harran University and Gaziantep University Hospital) during the period between January 2013 and May 2024. The data used for the study were obtained from patients' medical records.

Results: A total of 153 ERCP procedures were performed on 83 pediatric patients (64%, female) with a mean age of 12.9 years (range 3-17) at the time of ERCP. Common bile duct stones were the most frequent indication (n = 39, 47%) for ERCP, followed by biliary hydatid cyst-related complications (n = 24, 29%). The overall cannulation success rate was 98.7% (82/83). Endoscopic sphincterotomy was performed in 79 (95%) patients. More than one ERCP procedure was performed in 41 (49%) patients. Stones were extracted in 32 patients (30 were biliary and 2 pancreatic). Stent placement was performed in 33 patients (25 biliary and 8 pancreatic). Post-ERCP pancreatitis developed in 4.8% (n = 4) of patients, and all classified as mild. Ten (12%) patients developed mild/moderate cholangitis following ERCP. One patient (1.2%) experienced minor bleeding. About half of the patients (48%) were discharged within 1 day postprocedure. No patient experienced procedure-related mortality.

Conclusion: Our study results indicate that ERCP is both effective and safe in the pediatric population.

Background/aims: Endoscopic retrograde cholangiopancreatography (ERCP) is often recommended as the first choice for the treatment of choledocholithiasis in the elderly. This study aims to investigate the efficiency and safety of ERCP in choledocholithiasis patients of different age groups.

Materials and methods: Study searching was performed in the PubMed, Embase, Web of Science, and Cochrane Library databases from the inception to August 2024. The outcomes were complete stone clearance, mortality, overall complications, pancreatitis, perforation, biliary infection, bleeding, and pneumonia. Choledocholithiasis patients were divided into young (<65 years), general old (65 years ≤ age <80 years or 65 years ≤ age <90 years), and extremely old (≥80 years or ≥90 years) groups.

Results: Finally, 10 eligible studies were included for analysis. Compared to extremely old patients (≥90 years), the complete stone clearance was higher [odds ratio (OR) = 7.60, 95% CI: 1.89-30.57] and pneumonia was lower (OR = 0.16, 95% CI: 0.06-0.41) in general old patients (65 years ≤ age <90 years). Young (<65 years) patients had lower odds of mortality when compared to the age ≥65 years group (OR = 0.21, 95% CI: 0.17-0.27) and the age ≥80 years group (OR = 0.19, 95% CI: 0.15-0.24). In the comparison of 65-80 years versus ≥80 years, lower mortality (OR = 0.80, 95% CI: 0.65-0.98) was observed in the group of age range 65-80 years.

Conclusion: Our findings suggested that extremely old patients with choledocholithiasis should cautiously choose ERCP, and postoperative complications should be monitored in extremely old patients.

Background/aims: Cholangiocarcinoma (CCA) is a malignant and insidious tumor that is tricky to treat. Long non-coding RNA (LncRNA) LINC01123 is a biomolecule that influences cancer progression by regulating gene expression via influencing the regulatory function of microRNAs in gene expression. Therefore, this study investigated the connection between LINC01123 and CCA and explored the underlying mechanism. The objective of this study was to provide valuable information on the management of CCA.

Materials and methods: Tumor and normal paracancer tissue samples in this study were collected from 128 CCA patients. To measure LINC01123 and miR-641 expression characteristics, quantitative reverse transcription-polymerase chain reaction was used. To explore the biological functions of LINC01123 and miR-641 in CCA cells, cell counting Kit-8 (CCK-8) and transwell migration and invasion assays were used. The mechanism was investigated using dual luciferase reporter assays and rescue experiments.

Results: This study found that the expression levels of LINC01123 were higher in CCA tissues and cells than in normal tissues and cells. LINC01123 promoted the proliferation, migration and invasion ability of CCA cells and consequently became an indicator of lymph node metastasis and advanced TNM stage in CCA. Moreover, the expression of miR-641 was negatively correlated with the expression of LINC01123. LINC01123 affected CCA progression by downregulating miR-641.

Conclusion: There was an upregulation of LINC01123 in CCA tumor tissues and cells. LINC01123 promoted CCA aggravation by targeting miR-641. LINC01123 could be the target of future treatment for CCA.