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Pharyngeal Anomaly: As Rare as We Thought? 咽部异常--像我们想象的那样罕见?
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-03-14 DOI: 10.14309/ajg.0000000000002757
Jessica W Gregor
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引用次数: 0
Mortality in Acute Severe Ulcerative Colitis - Still an Alarming and Real Complication in the Era of Advanced Therapies. 急性重度溃疡性结肠炎的死亡率--在先进疗法时代仍是一个令人担忧的现实并发症。
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-16 DOI: 10.14309/ajg.0000000000002917
Brigid Pinnuck, Kate D Lynch
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引用次数: 0
Multicenter, Prospective Trial of Nonendoscopic Biomarker-Driven Detection of Barrett's Esophagus and Esophageal Adenocarcinoma. 非内窥镜生物标记物驱动的巴雷特食管和食管腺癌检测多中心前瞻性试验。
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-04-30 DOI: 10.14309/ajg.0000000000002850
Helen R Moinova, Suman Verma, John Dumot, Ashley Faulx, Prasad G Iyer, Marcia Irene Canto, Jean S Wang, Nicholas J Shaheen, Prashanthi N Thota, Lishan Aklog, Joseph E Willis, Sanford D Markowitz, Amitabh Chak

Introduction: Preliminary data suggest that an encapsulated balloon (EsoCheck), coupled with a 2 methylated DNA biomarker panel (EsoGuard), detects Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) with high accuracy. The initial assay requires sample freezing upon collection. The purpose of this study was to assess a next-generation EsoCheck sampling device and EsoGuard assay in a much-enlarged multicenter study clinically enhanced by using a Clinical Laboratory Improvement Amendments of 1988-compliant assay and samples maintained at room temperature.

Methods: Cases with nondysplastic BE (NDBE), dysplastic BE (indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia), EAC, junctional adenocarcinoma, plus endoscopy controls without esophageal intestinal metaplasia, were prospectively enrolled. Medical assistants at 6 institutions delivered the encapsulated balloon per orally with inflation in the stomach. The inflated balloon sampled the distal 5 cm of the esophagus and then was deflated and retracted into the capsule, preventing sample contamination. EsoGuard bisulfite sequencing assayed levels of methylated vimentin and methylated cyclin A1.

Results: A total of 243 evaluable patients-88 cases (median age 68 years, 78% men, 92% White) and 155 controls (median age 57 years, 41% men, 88% White)-underwent adequate EsoCheck sampling. The mean procedural time was approximately 3 minutes. Cases included 31 with NDBE, 16 with indefinite for dysplasia/low-grade dysplasia, 23 with high-grade dysplasia, and 18 with EAC/junctional adenocarcinoma. Thirty-seven NDBE and dysplastic BE cases (53%) were short-segment BE (<3 cm). Overall sensitivity was 85% (95% confidence interval 0.78-0.93) and specificity was 85% (95% confidence interval 0.79-0.90). Sensitivity for NDBE was 84%. EsoCheck/EsoGuard detected 100% of cancers (n = 18).

Discussion: EsoCheck/EsoGuard demonstrated high sensitivity and specificity in detecting BE and BE-related neoplasia.

背景:初步数据表明,封装气球(EsoCheckTM)与两个甲基化 DNA 生物标记物面板(EsoGuardTM)相结合,可高精度检测巴雷特食管(BE)和食管腺癌(EAC)。目的:在一项规模更大的多中心研究中评估新一代 EsoCheck 采样设备和 EsoGuard 检测方法,通过使用符合 CLIA 标准的检测方法和室温保存样本,提高临床检测效果:方法:前瞻性地纳入了非增生异常BE(NDBE)、增生异常BE(不定期=IND、低度增生异常=LGD、高度增生异常=HGD)、EAC、交界性腺癌(JAC)病例,以及无食管肠化生的内镜对照病例。六家机构的医疗助理口服封装球囊,在胃部充气。充气球囊在食管远端 5 厘米处取样,然后放气并缩回囊中,以防止样本污染。EsoGuard 亚硫酸氢盐测序法测定了甲基化波形蛋白(mVIM)和甲基化细胞周期蛋白 A1(mCCNA1)的水平:共有 243 名可评估患者接受了充分的 EsoCheck 采样,其中包括 88 名病例(中位年龄 68 岁,78% 为男性,92% 为白人)和 155 名对照组(中位年龄 57 岁,41% 为男性,88% 为白人)。平均手术时间约为 3 分钟。病例包括 31 例 NDBE、16 例 IND/LGD、23 例 HGD 和 18 例 EAC/JAC。37例(53%)非增生异常和增生异常BE为短节段BE(SSBE;小于3厘米)。总体敏感性为 85%(95% CI=0.78-0.93),特异性为 85%(95% CI=0.79-0.90)。对 NDBE 的敏感性为 84%。EsoCheck/EsoGuard检测出100%的癌症(18例):结论:EsoCheck/EsoGuard检测BE和BE相关肿瘤的灵敏度和特异性都很高。
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引用次数: 0
Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis. 内镜超声引导下胰腺囊性病变细针抽吸术后发生胰腺炎的风险:系统回顾与元分析》。
IF 5.4 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI: 10.14309/ajg.0000000000002942
Patrick T Magahis, Ankit Chhoda, Tyler M Berzin, James J Farrell, Drew N Wright, Anam Rizvi, Mark Hanscom, David L Carr-Locke, Kartik Sampath, Reem Z Sharaiha, SriHari Mahadev

Introduction: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is frequently used to risk-stratify pancreatic cystic lesions (PCLs). Rising PCL incidence and developments in tissue acquisition and specimen analysis necessitate updated appraisal of EUS-FNA safety, particularly the risk of postprocedure pancreatitis, the most common EUS-FNA-related adverse event. Our systematic review aims to accurately quantify the risk of EUS-FNA-related pancreatitis to best inform decisions regarding EUS-FNA's optimal role in PCL workup.

Methods: We performed systematic searches in 4 databases from inception to April 2024 for original English-language studies investigating EUS-FNA-related pancreatitis. We extracted data on demographics and EUS-FNA-related pancreatitis risk, severity, and risk factors. These were meta-analyzed through the DerSimonian Laird Method using a random-effects model. Meta-regression of pancreatitis risk was performed to delineate associations with clinical and procedural characteristics.

Results: Sixty-four studies comprised 8,086 patients and reported 110 EUS-FNA-related pancreatitis events. Pooled risk of EUS-FNA-related pancreatitis was 1.4% (95% confidence intervals, -0.8% to 3.5%; I2 = 0.00), which was predominantly of mild severity (67%) and uniformly nonfatal. Pancreatitis risk lacked significant association with sample size, age, sex, cyst size, needle caliber, or passes, although we noted trends toward higher risk in studies published after 2015, those using higher gauge needles (19 G vs 22 G/25 G), and those performing EUS-guided through-the-needle biopsy.

Discussion: We note with high certainty that pancreatitis after EUS-FNA of PCLs is infrequent and mild in severity with no mortality in the included cohort. EUS-guided through-the-needle biopsy may serve as a significant risk factor for EUS-FNA-related pancreatitis risk; however, further studies are needed to delineate other predisposing characteristics.

背景:内镜超声引导下细针抽吸术(EUS-FNA)常用于对胰腺囊性病变(PCL)进行风险分级。PCL 发病率的上升以及组织采集和标本分析的发展要求对 EUS-FNA 的安全性进行最新评估,尤其是术后胰腺炎的风险,这是 EUS-FNA 相关不良事件中最常见的一种。我们的系统性综述旨在准确量化 EUS-FNA 相关胰腺炎的风险,为 EUS-FNA 在 PCL 检查中的最佳作用提供最佳参考:我们在四个数据库中系统检索了从开始到 2024 年 4 月调查 EUS-FNA 相关胰腺炎的原始英文研究。我们提取了有关人口统计学、EUS-FNA 相关胰腺炎风险、严重程度和风险因素的数据。我们采用随机效应模型,通过 DerSimonian Laird 方法对这些数据进行了元分析。对胰腺炎风险进行了元回归,以确定与临床和手术特征的关联:64项研究包括8086名患者,报告了110起EUS-FNA相关胰腺炎事件。EUS-FNA 相关胰腺炎的汇总风险为 1.4% [95% CI, -0.8-3.5%; I2 = 0.00],主要为轻度(67%),且均不致命。胰腺炎风险与样本大小、年龄、性别、囊肿大小、针头口径或通过率无明显关联,但我们注意到2015年后发表的研究、使用较高规格针头(19G vs. 22G/25G)的研究以及进行EUS-TTNB的研究存在风险较高的趋势:我们非常肯定地注意到,在纳入的队列中,PCL 的 EUS-FNA 术后胰腺炎并不常见,且严重程度较轻,无死亡病例。EUS-TTNB可能是EUS-FNA相关胰腺炎风险的一个重要风险因素;但是,还需要进一步的研究来确定其他易感特征。
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引用次数: 0
Fecal Microbiota Transplantation in the Treatment of Severe Constipation in Children: Is It the Future? 粪便微生物群移植治疗儿童严重便秘:它是未来的趋势吗?
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-25 DOI: 10.14309/ajg.0000000000002985
Michele Di Stefano
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引用次数: 0
Role of Biliary Stent in Recurrence Recurrent Biliary Events Postendoscopic Retrograde Cholangiopancreatography: A Comment. 胆道支架在内镜逆行胰胆管造影术后胆道事件复发中的作用:评论。
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI: 10.14309/ajg.0000000000002894
Tao He, Jieyu Zou
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引用次数: 0
Continuing Medical Education Questions: November 2024. 继续医学教育问题:2024 年 11 月。
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI: 10.14309/ajg.0000000000003112
Mashal A Batheja

Article Title: Early Diagnostic Paracentesis Improves Outcomes of Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis.

文章标题:早期诊断性腹腔穿刺术可改善肝硬化腹水住院患者的预后:系统回顾和元分析》。
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引用次数: 0
Response to Pinnuck and Lynch. 对 Pinnuck 和 Lynch 的回应。
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-08-19 DOI: 10.14309/ajg.0000000000002982
Arshdeep Singh, Manjeet Kumar Goyal, Vandana Midha, Ajit Sood
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引用次数: 0
A Comprehensive Comparative Study of Potassium-Competitive Acid Blockers Is Necessary. 有必要对钾竞争性酸阻滞剂进行全面的比较研究。
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-12 DOI: 10.14309/ajg.0000000000002896
Sang Kil Lee
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引用次数: 0
Natural History of Indeterminate Liver Nodules in Patients With Advanced Liver Disease: A Multicenter Retrospective Cohort Study. 晚期肝病患者肝脏不确定结节的自然史:一项多中心回顾性队列研究
IF 8 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-11-01 Epub Date: 2024-04-30 DOI: 10.14309/ajg.0000000000002827
Amit G Singal, Neehar D Parikh, Kirti Shetty, Steven-Huy Han, Cassie Xie, Jing Ning, Jo Ann Rinaudo, Ashwini Arvind, Anna S Lok, Fasiha Kanwal

Introduction: Indeterminate liver nodules (ILNs) are frequently encountered on diagnostic imaging after positive hepatocellular carcinoma (HCC) surveillance results, but their natural history remains unclear.

Methods: We conducted a multicenter retrospective cohort study among patients with ≥1 newly detected LI-RADS 3 (LR-3) lesion ≥1 cm or LI-RADS 4 (LR-4) lesion of any size (per LI-RADS v2018) between January 2018 and December 2019. Patients were followed with repeat imaging at each site per institutional standard of care. Multivariable Fine-Gray models were used to evaluate associations between potential risk factors and patient-level time-to-HCC diagnosis, with death and liver transplantation as competing risks.

Results: Of 307 patients with ILNs, 208 had LR-3 lesions, 83 had LR-4 lesions, and 16 had both LR-3 and LR-4 lesions. HCC incidence rates for patients with LR-3 and LR-4 lesions were 110 (95% CI 70-150) and 420 (95% CI 310-560) per 1,000 person-year, respectively. In multivariable analysis, incident HCC among patients with LR-3 lesions was associated with older age, thrombocytopenia (platelet count ≤150 ×10 9 /L), and elevated serum alpha-fetoprotein levels. Among those with LR-4 lesions, incident HCC was associated with a maximum lesion diameter >1 cm. Although most patients had follow-up computed tomography or magnetic resonance imaging, 13.7% had no follow-up imaging and another 14.3% had follow-up ultrasound only.

Discussion: ILNs have a high but variable risk of HCC, with 4-fold higher risk in patients with LR-4 lesions than those with LR-3 lesions, highlighting a need for accurate risk stratification tools and close follow-up in this population.

背景:肝脏结节(ILN肝细胞癌(HCC)监测结果阳性后,在诊断成像中经常会遇到不确定肝结节(ILNs),但其自然史仍不清楚:我们在2018年1月至2019年12月期间对新发现≥1个≥1厘米的LI-RADS 3(LR-3)病变或任何大小的LI-RADS 4(LR-4)病变(根据LI-RADS v2018)的患者进行了一项多中心回顾性队列研究。根据机构护理标准,对患者进行随访,并在每个部位重复成像。多变量Fine-Gray模型用于评估潜在风险因素与患者级别的HCC诊断时间之间的关联,死亡和肝移植为竞争风险:在307例ILN患者中,208例为LR-3病变,83例为LR-4病变,16例同时为LR-3和LR-4病变。LR-3和LR-4病变患者的HCC发病率分别为每千人年110例(95%CI 70 - 150)和420例(95%CI 310 - 560)。在多变量分析中,LR-3病变患者中发生的HCC与年龄较大、血小板减少症(血小板计数≤150 x109/L)和血清甲胎蛋白(AFP)水平升高有关。在 LR-4 病变患者中,发生 HCC 与最大病变直径大于 1 厘米有关。虽然大多数患者都进行了CT或MRI随访,但有13.7%的患者没有进行任何随访,另有14.3%的患者仅进行了超声随访:结论:ILN发生HCC的风险较高但不稳定,LR-4病变患者发生HCC的风险是LR-3病变患者的4倍,因此需要对这一人群进行准确的风险分层和密切随访。
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American Journal of Gastroenterology
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