Pub Date : 2024-11-01Epub Date: 2024-10-20DOI: 10.20524/aog.2024.0913
Om Parkash, Abhishek Lal, Tushar Subash, Ujala Sultan, Hasan Nawaz Tahir, Zahra Hoodbhoy, Shiyam Sundar, Jai Kumar Das
Background: Helicobacter pylori (H. pylori) infection is associated with various gastrointestinal diseases and may lead to gastric cancer. Currently, endoscopy is the gold standard modality used for diagnosing H. pylori infection, but it lacks objective indicators and requires expert interpretation. In the past few years, the use of artificial intelligence (AI) for diagnosing gastrointestinal pathologies has increased tremendously and may improve the diagnostic accuracy of endoscopy for H. pylori infection. This study aimed to evaluate the diagnostic accuracy of AI algorithms for detecting H. pylori infection using endoscopic images.
Methods: Three investigators searched the PubMed, CINHAL and Cochrane databases for studies that compared AI algorithms with endoscopic histopathology for diagnosing H. pylori infection using endoscopic images. We assessed the methodological quality of studies using the QUADAS-2 tool and performed a meta-analysis to estimate the pooled sensitivity, specificity, and accuracy of AI for detecting H. pylori infection.
Results: A total of 11 studies were identified that met our inclusion criteria. All were conducted in different countries based in Asia. Our meta-analysis showed that AI had high sensitivity (0.93, 95% confidence interval [CI] 0.90-0.95), specificity (0.92, 95%CI 0.89-0.94), and accuracy (0.92, 95%CI 0.90-0.94) for detecting H. pylori infection using endoscopic images. However, there was also high heterogeneity among the studies (Tau2=0.87, I2=76.10% for generalized effect size; Tau2=1.53, I2=80.72% for sensitivity; Tau2=0.57, I2=70.86% for specificity).
Conclusion: This systematic review and meta-analysis showed that AI had high diagnostic accuracy for detecting H. pylori infection using endoscopic images.
{"title":"Use of artificial intelligence for the detection of <i>Helicobacter pylori</i> infection from upper gastrointestinal endoscopy images: an updated systematic review and meta-analysis.","authors":"Om Parkash, Abhishek Lal, Tushar Subash, Ujala Sultan, Hasan Nawaz Tahir, Zahra Hoodbhoy, Shiyam Sundar, Jai Kumar Das","doi":"10.20524/aog.2024.0913","DOIUrl":"10.20524/aog.2024.0913","url":null,"abstract":"<p><strong>Background: </strong><i>Helicobacter pylori</i> (<i>H. pylori</i>) infection is associated with various gastrointestinal diseases and may lead to gastric cancer. Currently, endoscopy is the gold standard modality used for diagnosing <i>H. pylori</i> infection, but it lacks objective indicators and requires expert interpretation. In the past few years, the use of artificial intelligence (AI) for diagnosing gastrointestinal pathologies has increased tremendously and may improve the diagnostic accuracy of endoscopy for <i>H. pylori</i> infection. This study aimed to evaluate the diagnostic accuracy of AI algorithms for detecting <i>H</i>. <i>pylori</i> infection using endoscopic images.</p><p><strong>Methods: </strong>Three investigators searched the PubMed, CINHAL and Cochrane databases for studies that compared AI algorithms with endoscopic histopathology for diagnosing <i>H. pylori</i> infection using endoscopic images. We assessed the methodological quality of studies using the QUADAS-2 tool and performed a meta-analysis to estimate the pooled sensitivity, specificity, and accuracy of AI for detecting <i>H. pylori</i> infection.</p><p><strong>Results: </strong>A total of 11 studies were identified that met our inclusion criteria. All were conducted in different countries based in Asia. Our meta-analysis showed that AI had high sensitivity (0.93, 95% confidence interval [CI] 0.90-0.95), specificity (0.92, 95%CI 0.89-0.94), and accuracy (0.92, 95%CI 0.90-0.94) for detecting <i>H. pylori</i> infection using endoscopic images. However, there was also high heterogeneity among the studies (Tau<sup>2</sup>=0.87, <i>I</i> <sup>2</sup>=76.10% for generalized effect size; Tau<sup>2</sup>=1.53, <i>I</i> <sup>2</sup>=80.72% for sensitivity; Tau<sup>2</sup>=0.57, <i>I</i> <sup>2</sup>=70.86% for specificity).</p><p><strong>Conclusion: </strong>This systematic review and meta-analysis showed that AI had high diagnostic accuracy for detecting <i>H. pylori</i> infection using endoscopic images.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"665-673"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-20DOI: 10.20524/aog.2024.0916
Spyridon Pantzios, Antonia Syriha, Ioanna Stathopoulou, Orestis Sidiropoulos, Sofia Rellou, Georgia Barla, Nikolaos Ptohis, Dimitris P Korkolis, Georgios C Sotiropoulos, Ioannis Elefsiniotis
Background: The pattern of hepatocellular carcinoma (HCC) recurrence after resection/ablation is intrahepatic and/or systemic. The efficacy of atezolizumab-bevacizumab treatment as early therapy after recurrence has not been extensively evaluated.
Methods: We evaluated 32 patients (group A) with early HCC recurrence after resection/ablation and 24 patients (group B) initially diagnosed as Barcelona Clinic Liver Cancer (BCLC)-C, all treated with atezolizumab-bevacizumab. Group A was subdivided in group A1 (progression to BCLC-C, n=14) and group A2 (progression to BCLC-B, n=18).
Results: Groups A1/A2 were comparable for all baseline parameters. Objective response was observed in 14.3% and 33.3% of patients in groups A1 and A2, respectively. Median overall survival (OS) was impressive and comparable between the 2 groups (22 and 26 months, respectively, P=0.71), as was median progression-free survival (PFS) (15 and 6 months, respectively, P=0.126). Patients categorized in the advanced stage (groups A1/B) were comparable for all baseline characteristics. Median OS was significantly higher in group A1 compared to B (26 vs. 6 months, P<0.001), as was median PFS (6 vs. 3 months, P=0.086).
Conclusions: Early initiation of atezolizumab-bevacizumab after recurrence following curative therapy results in impressive survival rates, irrespective of recurrence pattern. Survival of atezolizumab-bevacizumab treated patients who were initially diagnosed in the BCLC-C stage is significantly different from those who recurred to BCLC-C following potentially curative therapies.
{"title":"Efficacy of atezolizumab-bevacizumab combination therapy early after recurrence of hepatocellular carcinoma following resection or ablation with a curative intent.","authors":"Spyridon Pantzios, Antonia Syriha, Ioanna Stathopoulou, Orestis Sidiropoulos, Sofia Rellou, Georgia Barla, Nikolaos Ptohis, Dimitris P Korkolis, Georgios C Sotiropoulos, Ioannis Elefsiniotis","doi":"10.20524/aog.2024.0916","DOIUrl":"10.20524/aog.2024.0916","url":null,"abstract":"<p><strong>Background: </strong>The pattern of hepatocellular carcinoma (HCC) recurrence after resection/ablation is intrahepatic and/or systemic. The efficacy of atezolizumab-bevacizumab treatment as early therapy after recurrence has not been extensively evaluated.</p><p><strong>Methods: </strong>We evaluated 32 patients (group A) with early HCC recurrence after resection/ablation and 24 patients (group B) initially diagnosed as Barcelona Clinic Liver Cancer (BCLC)-C, all treated with atezolizumab-bevacizumab. Group A was subdivided in group A1 (progression to BCLC-C, n=14) and group A2 (progression to BCLC-B, n=18).</p><p><strong>Results: </strong>Groups A1/A2 were comparable for all baseline parameters. Objective response was observed in 14.3% and 33.3% of patients in groups A1 and A2, respectively. Median overall survival (OS) was impressive and comparable between the 2 groups (22 and 26 months, respectively, P=0.71), as was median progression-free survival (PFS) (15 and 6 months, respectively, P=0.126). Patients categorized in the advanced stage (groups A1/B) were comparable for all baseline characteristics. Median OS was significantly higher in group A1 compared to B (26 vs. 6 months, P<0.001), as was median PFS (6 vs. 3 months, P=0.086).</p><p><strong>Conclusions: </strong>Early initiation of atezolizumab-bevacizumab after recurrence following curative therapy results in impressive survival rates, irrespective of recurrence pattern. Survival of atezolizumab-bevacizumab treated patients who were initially diagnosed in the BCLC-C stage is significantly different from those who recurred to BCLC-C following potentially curative therapies.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"708-717"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-24DOI: 10.20524/aog.2024.0925
Janine B Kastelijn, A Merel van den Berg, Raju Talwar, Marije S Koks, Marije Marsman, Karel J van Erpecum, Paul Didden, Leon M G Moons, Frank P Vleggaar
Background: With the increasing complexity and prolonged duration of endoscopic retrograde cholangiopancreatography (ERCP) procedures, sedation shifted from conscious sedation with benzodiazepines to deep sedation with propofol. We assessed the technical success and adverse event rates of ERCP with deep versus conscious sedation.
Methods: Consecutive patients treated with ERCP in the University Medical Center Utrecht over a 7-year period (2010-2016) were screened for eligibility. Gastroenterologist-administered conscious sedation with midazolam was used from 2010-2013, whilst anesthesiology-administered deep sedation with propofol was used from 2013-2016. Data were retrospectively collected from electronic medical records. Outcomes were technical success and procedure-related adverse events within 30 days after ERCP. Associations of sedation type with outcomes were analyzed in univariable and multivariable analyses.
Results: A total of 725 patients were included: 336 (46%) with conscious sedation and 389 (54%) with deep sedation. Technical success was significantly higher when propofol-based sedation was used (317 [82%] vs. 252 [75%], P=0.034). Adverse events also occurred significantly more often in the propofol group (77 [20%] vs. 38 [11%], P=0.002), due to higher rates of post-ERCP cholangitis (21 [5%] vs. 8 [2%], P=0.039), and post-ERCP pancreatitis (29 [7%] vs. 11 [3%], P=0.014). After adjustment, propofol-based sedation remained significantly associated with technical success and adverse events, with odds ratios of 1.53 (95% confidence interval [CI] 1.05-2.21) and 1.95 (95% CI 1.25-3.04), respectively.
Conclusion: Propofol-based sedation resulted significantly more often in technical success of ERCP compared with midazolam-based sedation, but adverse events were almost twice as common, with higher rates of post-ERCP pancreatitis and cholangitis.
背景:随着内镜逆行胰胆管造影术(ERCP)的复杂性增加和持续时间延长,镇静方式从使用苯二氮卓类药物的清醒镇静转变为使用异丙酚的深度镇静。我们评估了深度镇静与清醒镇静ERCP的技术成功率和不良事件发生率:筛选了乌得勒支大学医学中心在 7 年内(2010-2016 年)接受 ERCP 治疗的连续患者。2010-2013年期间,消化内科医生使用咪达唑仑进行有意识镇静,2013-2016年期间,麻醉科使用异丙酚进行深度镇静。数据通过电子病历进行回顾性收集。结果为ERCP术后30天内的技术成功率和手术相关不良事件。通过单变量和多变量分析分析了镇静类型与结果的相关性:结果:共纳入 725 名患者:结果:共纳入 725 例患者:336 例(46%)采用意识镇静,389 例(54%)采用深度镇静。使用异丙酚镇静时,技术成功率明显更高(317 [82%] 对 252 [75%],P=0.034)。异丙酚组的不良事件发生率也明显更高(77 [20%] vs. 38 [11%],P=0.002),这是因为异丙酚术后胆管炎(21 [5%] vs. 8 [2%],P=0.039)和异丙酚术后胰腺炎(29 [7%] vs. 11 [3%],P=0.014)的发生率更高。经调整后,异丙酚镇静仍与技术成功率和不良事件显著相关,几率比分别为 1.53(95% 置信区间 [CI] 1.05-2.21)和 1.95(95% CI 1.25-3.04):结论:与咪达唑仑镇静法相比,丙泊酚镇静法可显著提高ERCP的技术成功率,但不良事件的发生率几乎是咪达唑仑镇静法的两倍,ERCP术后胰腺炎和胆管炎的发生率更高。
{"title":"Technical success and adverse event rates after endoscopic retrograde cholangiopancreatography using deep sedation with propofol.","authors":"Janine B Kastelijn, A Merel van den Berg, Raju Talwar, Marije S Koks, Marije Marsman, Karel J van Erpecum, Paul Didden, Leon M G Moons, Frank P Vleggaar","doi":"10.20524/aog.2024.0925","DOIUrl":"10.20524/aog.2024.0925","url":null,"abstract":"<p><strong>Background: </strong>With the increasing complexity and prolonged duration of endoscopic retrograde cholangiopancreatography (ERCP) procedures, sedation shifted from conscious sedation with benzodiazepines to deep sedation with propofol. We assessed the technical success and adverse event rates of ERCP with deep versus conscious sedation.</p><p><strong>Methods: </strong>Consecutive patients treated with ERCP in the University Medical Center Utrecht over a 7-year period (2010-2016) were screened for eligibility. Gastroenterologist-administered conscious sedation with midazolam was used from 2010-2013, whilst anesthesiology-administered deep sedation with propofol was used from 2013-2016. Data were retrospectively collected from electronic medical records. Outcomes were technical success and procedure-related adverse events within 30 days after ERCP. Associations of sedation type with outcomes were analyzed in univariable and multivariable analyses.</p><p><strong>Results: </strong>A total of 725 patients were included: 336 (46%) with conscious sedation and 389 (54%) with deep sedation. Technical success was significantly higher when propofol-based sedation was used (317 [82%] vs. 252 [75%], P=0.034). Adverse events also occurred significantly more often in the propofol group (77 [20%] vs. 38 [11%], P=0.002), due to higher rates of post-ERCP cholangitis (21 [5%] vs. 8 [2%], P=0.039), and post-ERCP pancreatitis (29 [7%] vs. 11 [3%], P=0.014). After adjustment, propofol-based sedation remained significantly associated with technical success and adverse events, with odds ratios of 1.53 (95% confidence interval [CI] 1.05-2.21) and 1.95 (95% CI 1.25-3.04), respectively.</p><p><strong>Conclusion: </strong>Propofol-based sedation resulted significantly more often in technical success of ERCP compared with midazolam-based sedation, but adverse events were almost twice as common, with higher rates of post-ERCP pancreatitis and cholangitis.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"726-733"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pancreatic cancer is a neoplastic condition with a high disease burden. It is projected to be the second most common cause of cancer-related deaths by 2030. However, evidence supporting the long-term use of aspirin in cancer prevention and treatment remains insufficient. We aimed to investigate the association between aspirin use and pancreatic cancer outcomes in the elderly population group.
Methods: The 2020 National Inpatient Sample was used to investigate records of elderly patients admitted with pancreatic cancer, identified by ICD-10 CM codes. The data were categorized based on long-term aspirin use. We assessed inpatient mortality as the primary outcome, while secondary outcomes included costs and length of stay, as well as other inpatient complications.
Results: We identified 19,249 hospitalizations of patients aged over 60 years. The mean age was 73.8 years, and 49.3% were male. In a survey multivariate logistic and linear regression model, adjusting for patient characteristics and hospital factors, long-term aspirin use was associated with lower inpatient mortality (adjusted odds ratio [aOR] 0.55, 95% confidence interval [CI] 0.33-0.92; P=0.023), a shorter hospital stay (beta coefficient -0.52, 95%CI -0.93 to -0.11; P=0.012), lower odds of acute kidney injury (aOR 0.76, 95%CI 0.59-0.98; P=0.039), and lower odds of shock (aOR 0.23, 95%CI 0.06-0.78; P=0.019]. Post-propensity matching revealed similar patterns.
Conclusions: Long-term aspirin use is associated with a lower rate of inpatient mortality and other clinical outcomes in hospitalized elderly patients with pancreatic cancer. The etiologies behind this relationship should be explored with a view to better understanding.
{"title":"Impact of aspirin on pancreatic cancer in the elderly: analysis of socioeconomic status and outcomes of national matched cohorts.","authors":"Thanathip Suenghataiphorn, Tuntanut Lohawatcharagul, Narathorn Kulthamrongsri, Pojsakorn Danpanichkul, Kanokphong Suparan, Natchaya Polpichai, Jerapas Thongpiya, Sakditad Saowapa","doi":"10.20524/aog.2024.09179","DOIUrl":"10.20524/aog.2024.09179","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer is a neoplastic condition with a high disease burden. It is projected to be the second most common cause of cancer-related deaths by 2030. However, evidence supporting the long-term use of aspirin in cancer prevention and treatment remains insufficient. We aimed to investigate the association between aspirin use and pancreatic cancer outcomes in the elderly population group.</p><p><strong>Methods: </strong>The 2020 National Inpatient Sample was used to investigate records of elderly patients admitted with pancreatic cancer, identified by ICD-10 CM codes. The data were categorized based on long-term aspirin use. We assessed inpatient mortality as the primary outcome, while secondary outcomes included costs and length of stay, as well as other inpatient complications.</p><p><strong>Results: </strong>We identified 19,249 hospitalizations of patients aged over 60 years. The mean age was 73.8 years, and 49.3% were male. In a survey multivariate logistic and linear regression model, adjusting for patient characteristics and hospital factors, long-term aspirin use was associated with lower inpatient mortality (adjusted odds ratio [aOR] 0.55, 95% confidence interval [CI] 0.33-0.92; P=0.023), a shorter hospital stay (beta coefficient -0.52, 95%CI -0.93 to -0.11; P=0.012), lower odds of acute kidney injury (aOR 0.76, 95%CI 0.59-0.98; P=0.039), and lower odds of shock (aOR 0.23, 95%CI 0.06-0.78; P=0.019]. Post-propensity matching revealed similar patterns.</p><p><strong>Conclusions: </strong>Long-term aspirin use is associated with a lower rate of inpatient mortality and other clinical outcomes in hospitalized elderly patients with pancreatic cancer. The etiologies behind this relationship should be explored with a view to better understanding.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"750-757"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Currently, laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) are the best treatment modalities for esophageal achalasia in children. The purpose of this systematic review and meta-analysis is to compare the efficacy of LHM and POEM.
Methods: A systematic literature search was performed in PubMed/Medline, Google Scholar and Web of Science for original articles comparing LHM and POEM. All articles were analyzed with respect to operation duration, length of hospital stay, pre- and postoperative Eckardt score (ES), and pre- and postoperative lower esophageal sphincter (LES) pressure.
Results: A total of 32 articles, reporting on 800 children, were selected and reviewed. Because of missing diagnostic values of ES and LES in the LHM group, the meta-analysis was limited to the POEM results. According to the random-effects model, the mean ES difference between pre- and post-operation was 4.387 (95% confidence interval [CI] 3.799-4.974), significantly different to zero (z=14.64, P<0.001), while the mean LES pressure difference was 3.63 mmHg mmHg (95%CI 2247-3.879), significantly different to zero (z=7.36, P<0.001). Operation duration was 130.15 min (95%CI 62.59-197.71) for the LHM method and 83.64 min (95%CI 55.14-112.14) for POEM. The pooled estimate of length of hospital stay was 3.4 days (95%CI 2.6-4.44) and it was comparable between the 2 methods.
Conclusions: POEM has positive outcomes regarding ES and LES pressure pre- and postoperatively, as well as operation duration, while the length of hospitalization was comparable between POEM and LHM. Well-designed studies are warranted to further clarify differences between the 2 methods.
背景:目前,腹腔镜海勒肌切开术(LHM)和口周内镜下肌切开术(POEM)是治疗儿童食管贲门失弛缓症的最佳方法。本系统综述和荟萃分析旨在比较 LHM 和 POEM 的疗效:方法:在 PubMed/Medline、谷歌学术和 Web of Science 中对比较 LHM 和 POEM 的原始文章进行了系统性文献检索。对所有文章的手术时间、住院时间、术前和术后 Eckardt 评分(ES)以及术前和术后下食管括约肌(LES)压力进行了分析:结果:共选取并审查了 32 篇文章,报告了 800 名儿童的情况。由于 LHM 组的 ES 和 LES 诊断值缺失,因此荟萃分析仅限于 POEM 结果。根据随机效应模型,手术前后的平均 ES 差异为 4.387(95% 置信区间 [CI] 3.799-4.974),与零有显著差异(z=14.64,PC 结论:POEM在术前、术后ES和LES压力以及手术持续时间方面都有积极的结果,而POEM和LHM的住院时间相当。有必要进行精心设计的研究,以进一步明确这两种方法之间的差异。
{"title":"Laparoscopic Heller myotomy versus peroral endoscopic myotomy in children with esophageal achalasia: a systematic review and meta-analysis.","authors":"Anastasia Dimopoulou, Dimitra Dimopoulou, Antonis Analitis, Konstantina Dimopoulou, Dionysios Dellaportas, Nikolaos Zavras","doi":"10.20524/aog.2024.0923","DOIUrl":"10.20524/aog.2024.0923","url":null,"abstract":"<p><strong>Background: </strong>Currently, laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) are the best treatment modalities for esophageal achalasia in children. The purpose of this systematic review and meta-analysis is to compare the efficacy of LHM and POEM.</p><p><strong>Methods: </strong>A systematic literature search was performed in PubMed/Medline, Google Scholar and Web of Science for original articles comparing LHM and POEM. All articles were analyzed with respect to operation duration, length of hospital stay, pre- and postoperative Eckardt score (ES), and pre- and postoperative lower esophageal sphincter (LES) pressure.</p><p><strong>Results: </strong>A total of 32 articles, reporting on 800 children, were selected and reviewed. Because of missing diagnostic values of ES and LES in the LHM group, the meta-analysis was limited to the POEM results. According to the random-effects model, the mean ES difference between pre- and post-operation was 4.387 (95% confidence interval [CI] 3.799-4.974), significantly different to zero (z=14.64, P<0.001), while the mean LES pressure difference was 3.63 mmHg mmHg (95%CI 2247-3.879), significantly different to zero (z=7.36, P<0.001). Operation duration was 130.15 min (95%CI 62.59-197.71) for the LHM method and 83.64 min (95%CI 55.14-112.14) for POEM. The pooled estimate of length of hospital stay was 3.4 days (95%CI 2.6-4.44) and it was comparable between the 2 methods.</p><p><strong>Conclusions: </strong>POEM has positive outcomes regarding ES and LES pressure pre- and postoperatively, as well as operation duration, while the length of hospitalization was comparable between POEM and LHM. Well-designed studies are warranted to further clarify differences between the 2 methods.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"655-664"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-20DOI: 10.20524/aog.2024.0914
Francesco Vitali, Marc Heinrich, Deike Strobel, Sebastian Zundler, Ali A Aghdassi, Michael Uder, Markus F Neurath, Robert Grützmann, Marco Wiesmueller, Luca Frulloni, Dane Wildner
Background: Paraduodenal pancreatitis (PP) is an inflammation involving the groove zone, delimited by the duodenum lumen, bile duct, and the head of the pancreas. This area may also be involved during acute pancreatitis (AP). The differential diagnosis is clinically relevant, since PP generally persists, whereas AP resolves. Hence, we compared a cohort of patients with PP and AP involving the groove area.
Methods: We retrospectively evaluated patients with pathology involving the groove area. The primary aim was to define the diagnostic features of PP compared to non-PP pancreatitis involving the groove area. PP was diagnosed by imaging, while AP was diagnosed according to the revised Atlanta classification and the clinical course, to exclude chronic pancreatitis.
Results: The study population consisted of 37 patients (32 men, age 56.9±9.1 years), 25 with a diagnosis of PP (23 men, mean age 54.9±8.5 years), and 12 (9 men, mean age 61.2±9.2 years) with AP involving the groove. All 25 patients with PP and 4 (33.3%) with AP reported a history of alcohol abuse, 23 patients (92%) with PP, and 3 (25%) with AP had a history of smoking. On imaging, PP patients presented a significantly thicker duodenal wall compared to the AP group (P=0.010). Chronic pancreatitis in the body/tail and exocrine insufficiency was prevalent in PP (P<0.001 and P=0.02). The medial displacement of the gastroduodenal artery was more frequent in the PP group (P=0.011).
Conclusion: PP has a different clinical and imaging profile compared to AP involving the groove area.
背景:十二指肠旁胰腺炎(PP十二指肠旁胰腺炎(PP)是一种涉及十二指肠腔、胆管和胰头所划定的沟区的炎症。急性胰腺炎(AP)时也可能累及该区域。鉴别诊断与临床相关,因为胰腺炎一般会持续存在,而急性胰腺炎则会缓解。因此,我们对涉及沟区的 PP 和 AP 患者进行了比较:我们回顾性地评估了沟区病变的患者。主要目的是确定涉及沟区的 PP 与非 PP 性胰腺炎的诊断特征。PP通过影像学诊断,而AP则根据修订后的亚特兰大分类和临床病程诊断,以排除慢性胰腺炎:研究对象包括 37 名患者(32 名男性,年龄为(56.9±9.1)岁),其中 25 名诊断为 PP(23 名男性,平均年龄为(54.9±8.5)岁),12 名诊断为 AP(9 名男性,平均年龄为(61.2±9.2)岁),涉及胰沟。所有 25 名 PP 患者和 4 名 AP 患者(33.3%)均有酗酒史,23 名 PP 患者(92%)和 3 名 AP 患者(25%)有吸烟史。在造影检查中,PP 患者的十二指肠壁明显比 AP 组厚(P=0.010)。慢性胰体/尾部胰腺炎和外分泌功能不全在 PP 中很常见(PC结论:PP 的临床和影像学特征与 AP 组不同:与涉及腹腔沟区域的 AP 相比,PP 具有不同的临床和影像学特征。
{"title":"Paraduodenal pancreatitis as diagnostic challenge: clinical and morphological features of patients with pancreatic pathology involving the pancreatic groove.","authors":"Francesco Vitali, Marc Heinrich, Deike Strobel, Sebastian Zundler, Ali A Aghdassi, Michael Uder, Markus F Neurath, Robert Grützmann, Marco Wiesmueller, Luca Frulloni, Dane Wildner","doi":"10.20524/aog.2024.0914","DOIUrl":"10.20524/aog.2024.0914","url":null,"abstract":"<p><strong>Background: </strong>Paraduodenal pancreatitis (PP) is an inflammation involving the groove zone, delimited by the duodenum lumen, bile duct, and the head of the pancreas. This area may also be involved during acute pancreatitis (AP). The differential diagnosis is clinically relevant, since PP generally persists, whereas AP resolves. Hence, we compared a cohort of patients with PP and AP involving the groove area.</p><p><strong>Methods: </strong>We retrospectively evaluated patients with pathology involving the groove area. The primary aim was to define the diagnostic features of PP compared to non-PP pancreatitis involving the groove area. PP was diagnosed by imaging, while AP was diagnosed according to the revised Atlanta classification and the clinical course, to exclude chronic pancreatitis.</p><p><strong>Results: </strong>The study population consisted of 37 patients (32 men, age 56.9±9.1 years), 25 with a diagnosis of PP (23 men, mean age 54.9±8.5 years), and 12 (9 men, mean age 61.2±9.2 years) with AP involving the groove. All 25 patients with PP and 4 (33.3%) with AP reported a history of alcohol abuse, 23 patients (92%) with PP, and 3 (25%) with AP had a history of smoking. On imaging, PP patients presented a significantly thicker duodenal wall compared to the AP group (P=0.010). Chronic pancreatitis in the body/tail and exocrine insufficiency was prevalent in PP (P<0.001 and P=0.02). The medial displacement of the gastroduodenal artery was more frequent in the PP group (P=0.011).</p><p><strong>Conclusion: </strong>PP has a different clinical and imaging profile compared to AP involving the groove area.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"742-749"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-29DOI: 10.20524/aog.2024.0927
Haily Vora, Ramez Ibrahim, Johanna Chan, Francis A Farraye, Jana G Hashash
Background: The terminal ileum is typically examined during colonoscopies, especially in patients with inflammatory bowel disease (IBD) and diarrhea. The yield from performing biopsies of endoscopically normal appearing terminal ileum is less clear, and may be associated with greater costs, healthcare utilization and risk. We aimed to determine whether the biopsy results from endoscopically normal terminal ileum affect clinical management.
Methods: This was a retrospective chart review of patients who underwent an ileocolonoscopy with terminal ileum biopsy at a multisite tertiary healthcare system. Patients with a diagnosis of IBD, prior ileocecal resection, or endoscopically abnormal appearing terminal ileum were excluded. Clinical and laboratory data were obtained from the electronic medical record. Comparison between patients was performed using Pearson's chi-square test.
Results: A total of 1018 consecutive patients were identified. Of the 299 who met the inclusion criteria, the majority were female (62.0%) and white (94.7%). Nearly 40% of the patients had a body mass index of 30 kg/m2 or above (38.1%). Terminal ileum biopsies were abnormal in 13 patients (4.3%): 5 patients had chronic ileitis, 6 had acute ileitis, 1 had acute and chronic ileitis, and 1 had amyloid deposition. All patients with either chronic or acute ileitis had chronic diarrhea listed as an indication for their colonoscopy.
Conclusions: In patients with a normal appearing terminal ileum, clinically significant histologic abnormalities on biopsies were found in a very small percentage. Based on our findings, the routine biopsy of endoscopically normal appearing terminal ileum has limited diagnostic and therapeutic utility.
{"title":"Are biopsies from endoscopically normal terminal ileum necessary?","authors":"Haily Vora, Ramez Ibrahim, Johanna Chan, Francis A Farraye, Jana G Hashash","doi":"10.20524/aog.2024.0927","DOIUrl":"10.20524/aog.2024.0927","url":null,"abstract":"<p><strong>Background: </strong>The terminal ileum is typically examined during colonoscopies, especially in patients with inflammatory bowel disease (IBD) and diarrhea. The yield from performing biopsies of endoscopically normal appearing terminal ileum is less clear, and may be associated with greater costs, healthcare utilization and risk. We aimed to determine whether the biopsy results from endoscopically normal terminal ileum affect clinical management.</p><p><strong>Methods: </strong>This was a retrospective chart review of patients who underwent an ileocolonoscopy with terminal ileum biopsy at a multisite tertiary healthcare system. Patients with a diagnosis of IBD, prior ileocecal resection, or endoscopically abnormal appearing terminal ileum were excluded. Clinical and laboratory data were obtained from the electronic medical record. Comparison between patients was performed using Pearson's chi-square test.</p><p><strong>Results: </strong>A total of 1018 consecutive patients were identified. Of the 299 who met the inclusion criteria, the majority were female (62.0%) and white (94.7%). Nearly 40% of the patients had a body mass index of 30 kg/m<sup>2</sup> or above (38.1%). Terminal ileum biopsies were abnormal in 13 patients (4.3%): 5 patients had chronic ileitis, 6 had acute ileitis, 1 had acute and chronic ileitis, and 1 had amyloid deposition. All patients with either chronic or acute ileitis had chronic diarrhea listed as an indication for their colonoscopy.</p><p><strong>Conclusions: </strong>In patients with a normal appearing terminal ileum, clinically significant histologic abnormalities on biopsies were found in a very small percentage. Based on our findings, the routine biopsy of endoscopically normal appearing terminal ileum has limited diagnostic and therapeutic utility.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"695-698"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-31DOI: 10.20524/aog.2024.0926
Afroditi Orfanidou, Konstantinos Katsanos, Theodoros Voulgaris, Aristeidis Kofinas, Maria Veatriki Christodoulou, Maria Konstandi, Dimitrios Christodoulou
Background: Infliximab monitoring correlates with improved outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the association between serum infliximab trough levels (TLs) and therapeutic outcomes in Greek patients with Crohn's disease (CD) or ulcerative colitis (UC).
Methods: This cross-sectional study included consecutive adult patients with IBD receiving intravenous infliximab maintenance therapy at a Greek tertiary center. Therapeutic outcomes assessed were clinical remission (CR), steroid-free clinical remission (SFCR), biochemical remission (BR: C-reactive protein <5 mg/L), and combined (steroid-free and biochemical) remission (SFCBR).
Results: Seventy-seven patients participated (62.3% with CD, 16.8% on concomitant immunomodulators), with a mean infliximab infusion duration of 5.1±4.6 years. Forty-seven (61%) patients underwent treatment escalation. Infliximab mean TLs were 7.2±4.9 μg/mL, correlating only with treatment escalation (9.7 vs. 3.6 μg/mL, P<0.001). CR was achieved in 88.3% of patients, SFCR in 80.5%, BR in 62.3%, and SFCBR in 55.8%. In a subgroup analysis, for patients without treatment escalation, higher mean TLs were significantly associated with BR (4.2 vs. 0.8 μg/mL, P=0.020) and SFCBR (4.3 vs. 1.5 μg/mL, P=0.035). In receiver operating characteristic analysis, TLs predicted SFCBR (P=0.016) with good accuracy (area under the curve [AUC] 0.768, 95% confidence interval [CI] 0.584-0.952), with an optimal TL cutoff at 3.4 μg/mL. For patients with treatment escalation, TLs predicted SFCBR (P=0.018) with fair accuracy (AUC 0.653, 95%CI 0.527-0.755), with an optimal TL cutoff at 11 μg/mL.
Conclusions: Infliximab TLs correlate with treatment escalation. Higher infliximab TLs may predict combined remission among patients with treatment escalation.
背景:监测英夫利西单抗可改善炎症性肠病(IBD)的治疗效果。我们旨在评估希腊克罗恩病(CD)或溃疡性结肠炎(UC)患者血清英夫利西单抗谷值水平(TL)与治疗效果之间的关联:这项横断面研究包括在希腊一家三级中心接受静脉注射英夫利西单抗维持治疗的连续成年 IBD 患者。评估的治疗结果包括临床缓解(CR)、无类固醇临床缓解(SFCR)和生化缓解(BR:C反应蛋白结果):77名患者(62.3%为CD患者,16.8%同时使用免疫调节剂)参加了此次研究,平均英夫利西单抗输注时间为5.1±4.6年。47名患者(61%)接受了治疗升级。英夫利西单抗的平均TL为7.2±4.9 μg/mL,仅与治疗升级相关(9.7 vs. 3.6 μg/mL,PC结论:英夫利西单抗TL与治疗升级相关。较高的英夫利西单抗TL可预示治疗升级患者的合并缓解。
{"title":"Infliximab trough levels among patients with inflammatory bowel disease in correlation with infliximab treatment escalation: a cross-sectional study from a Greek tertiary center.","authors":"Afroditi Orfanidou, Konstantinos Katsanos, Theodoros Voulgaris, Aristeidis Kofinas, Maria Veatriki Christodoulou, Maria Konstandi, Dimitrios Christodoulou","doi":"10.20524/aog.2024.0926","DOIUrl":"10.20524/aog.2024.0926","url":null,"abstract":"<p><strong>Background: </strong>Infliximab monitoring correlates with improved outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the association between serum infliximab trough levels (TLs) and therapeutic outcomes in Greek patients with Crohn's disease (CD) or ulcerative colitis (UC).</p><p><strong>Methods: </strong>This cross-sectional study included consecutive adult patients with IBD receiving intravenous infliximab maintenance therapy at a Greek tertiary center. Therapeutic outcomes assessed were clinical remission (CR), steroid-free clinical remission (SFCR), biochemical remission (BR: C-reactive protein <5 mg/L), and combined (steroid-free and biochemical) remission (SFCBR).</p><p><strong>Results: </strong>Seventy-seven patients participated (62.3% with CD, 16.8% on concomitant immunomodulators), with a mean infliximab infusion duration of 5.1±4.6 years. Forty-seven (61%) patients underwent treatment escalation. Infliximab mean TLs were 7.2±4.9 μg/mL, correlating only with treatment escalation (9.7 vs. 3.6 μg/mL, P<0.001). CR was achieved in 88.3% of patients, SFCR in 80.5%, BR in 62.3%, and SFCBR in 55.8%. In a subgroup analysis, for patients without treatment escalation, higher mean TLs were significantly associated with BR (4.2 vs. 0.8 μg/mL, P=0.020) and SFCBR (4.3 vs. 1.5 μg/mL, P=0.035). In receiver operating characteristic analysis, TLs predicted SFCBR (P=0.016) with good accuracy (area under the curve [AUC] 0.768, 95% confidence interval [CI] 0.584-0.952), with an optimal TL cutoff at 3.4 μg/mL. For patients with treatment escalation, TLs predicted SFCBR (P=0.018) with fair accuracy (AUC 0.653, 95%CI 0.527-0.755), with an optimal TL cutoff at 11 μg/mL.</p><p><strong>Conclusions: </strong>Infliximab TLs correlate with treatment escalation. Higher infliximab TLs may predict combined remission among patients with treatment escalation.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"674-681"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Collaborative surgery by both endoscopists and surgeons is considered effective for providing less invasive local resection of gastrointestinal tumors, to offset the limitations of either pure endoscopic treatments or surgical intervention. The clinical outcomes of collaborative surgery were evaluated to investigate the feasibility and safety of this approach.
Methods: In this single-center retrospective observational study, we collected data from consecutive patients who underwent collaborative surgery for lesions located from the laryngopharynx to the anus. The completeness of collaboration, technical success, procedure time, postoperative hospitalization period, and occurrence of adverse events were analyzed.
Results: Collaboration surgery was performed for 134 lesions (33 laryngopharyngeal, 2 esophageal, 89 gastric, 8 duodenal and 2 recto-anal) in 131 patients. Collaboration completeness was achieved in 129 lesions (96%). En bloc resection and pathological R0 resection of lesions were achieved in 127 (95%) and 124 (93%) lesions, respectively. The mean procedure time was 188 min. The mean time of discharge was the 11th postoperative day. Five patients (4%) developed relevant postoperative adverse events.
Conclusions: These results indicate that collaborative surgery by endoscopists and surgeons was feasible and safe, and may contribute to providing less invasive treatment than conventional surgery. Collaborative surgery is worth considering as a flexible and reliable surgical option, when cooperation may outperform either treatment alone.
{"title":"Real-world outcomes of collaborative surgery for gastrointestinal tumors by endoscopists and surgeons: a single-center retrospective analysis of 131 patients.","authors":"Kazutoshi Higuchi, Osamu Goto, Nobuyuki Sakurazawa, Atsuko Sakanushi, Koji Sakamoto, Akira Matsushita, Nobutoshi Hagiwara, Akihisa Matsuda, Toshihiko Hoashi, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Eriko Koizumi, Jun Omori, Naohiko Akimoto, Ryuji Ohashi, Hidehisa Saeki, Kimihiro Okubo, Hiroshi Yoshida, Katsuhiko Iwakiri","doi":"10.20524/aog.2024.0921","DOIUrl":"10.20524/aog.2024.0921","url":null,"abstract":"<p><strong>Background: </strong>Collaborative surgery by both endoscopists and surgeons is considered effective for providing less invasive local resection of gastrointestinal tumors, to offset the limitations of either pure endoscopic treatments or surgical intervention. The clinical outcomes of collaborative surgery were evaluated to investigate the feasibility and safety of this approach.</p><p><strong>Methods: </strong>In this single-center retrospective observational study, we collected data from consecutive patients who underwent collaborative surgery for lesions located from the laryngopharynx to the anus. The completeness of collaboration, technical success, procedure time, postoperative hospitalization period, and occurrence of adverse events were analyzed.</p><p><strong>Results: </strong>Collaboration surgery was performed for 134 lesions (33 laryngopharyngeal, 2 esophageal, 89 gastric, 8 duodenal and 2 recto-anal) in 131 patients. Collaboration completeness was achieved in 129 lesions (96%). <i>En bloc</i> resection and pathological R0 resection of lesions were achieved in 127 (95%) and 124 (93%) lesions, respectively. The mean procedure time was 188 min. The mean time of discharge was the 11<sup>th</sup> postoperative day. Five patients (4%) developed relevant postoperative adverse events.</p><p><strong>Conclusions: </strong>These results indicate that collaborative surgery by endoscopists and surgeons was feasible and safe, and may contribute to providing less invasive treatment than conventional surgery. Collaborative surgery is worth considering as a flexible and reliable surgical option, when cooperation may outperform either treatment alone.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"699-707"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2024-10-20DOI: 10.20524/aog.2024.0915
Ram Ragatha, Ibraheem Khalil, Rebecca Jones, Antonio Manzelli, Alex Reece-Smith, Yunli Ou, Shahjehan Wajed, Davide Di Mauro
Background: Percutaneous cholecystostomy (PC) is effective in controlling sepsis in patients with severe acute calculous cholecystitis (ACC). The long-term treatment of this group is still debated. We aimed to assess the clinical evolution of gallstones after severe ACC and the outcomes of laparoscopic cholecystectomy (LC) and conservative management, following PC.
Methods: This was a retrospective analysis of the rate of readmissions due to recurrent biliary disease and all-cause mortality in subjects who underwent a PC for severe ACC. We compared results between patients who underwent interval LC and those who received conservative management. Readmissions and late mortality were assessed using the Kaplan-Meier method and multivariate regression analysis.
Results: A total of 102 patients were included, of whom 30 underwent interval LC and 72 PC only. Overall, 51.6% were readmitted with recurrent biliary events and the rate did not differ between groups (P=0.583). The probability of recurrent gallstone events was higher in the first 30 weeks after PC; in the surgical cohort, 77.8% of them developed before LC. Late deaths occurred in 46.2% of patients: 13.3% LC vs. 61.9% conservative (P<0.001). Three years after PC, the estimated survival was 75% LC vs. 38% conservative (P=0.014). High-grade comorbidities and severity of ACC were positive predictors of all-cause mortality (P=0.004 and P=0.027), whereas LC was a negative predictor (P=0.003).
Conclusions: Recurrent biliary events were common following PC for ACC. Interval LC was associated with lower rates of readmissions and all-cause late mortality.
背景:经皮胆囊造口术(PC)能有效控制严重急性结石性胆囊炎(ACC)患者的败血症。但对这类患者的长期治疗仍存在争议。我们的目的是评估严重急性结石性胆囊炎后胆结石的临床演变以及PC术后腹腔镜胆囊切除术(LC)和保守治疗的效果:这是一项回顾性分析,研究对象是因重度 ACC 而接受 PC 手术的患者,研究对象因胆道疾病复发而再次入院的比例以及全因死亡率。我们比较了接受间期LC治疗和保守治疗的患者的结果。采用卡普兰-梅耶法和多变量回归分析评估了再住院率和晚期死亡率:结果:共纳入 102 例患者,其中 30 例接受了间歇期 LC 治疗,72 例仅接受 PC 治疗。总体而言,51.6%的患者因复发性胆道事件再次入院,组间比例无差异(P=0.583)。PC术后前30周内复发胆石症的概率较高;在手术组群中,77.8%的患者在LC术前发生胆石症。46.2%的患者在晚期死亡:13.3%的患者在LC术后死亡,61.9%的患者在保守治疗后死亡:ACC PC 术后复发胆道事件很常见。间隔期胆道切除术与较低的再入院率和全因晚期死亡率相关。
{"title":"Clinical evolution of gallstones following percutaneous cholecystostomy in patients with severe acute calculous cholecystitis: a single-center analysis of 102 cases.","authors":"Ram Ragatha, Ibraheem Khalil, Rebecca Jones, Antonio Manzelli, Alex Reece-Smith, Yunli Ou, Shahjehan Wajed, Davide Di Mauro","doi":"10.20524/aog.2024.0915","DOIUrl":"10.20524/aog.2024.0915","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous cholecystostomy (PC) is effective in controlling sepsis in patients with severe acute calculous cholecystitis (ACC). The long-term treatment of this group is still debated. We aimed to assess the clinical evolution of gallstones after severe ACC and the outcomes of laparoscopic cholecystectomy (LC) and conservative management, following PC.</p><p><strong>Methods: </strong>This was a retrospective analysis of the rate of readmissions due to recurrent biliary disease and all-cause mortality in subjects who underwent a PC for severe ACC. We compared results between patients who underwent interval LC and those who received conservative management. Readmissions and late mortality were assessed using the Kaplan-Meier method and multivariate regression analysis.</p><p><strong>Results: </strong>A total of 102 patients were included, of whom 30 underwent interval LC and 72 PC only. Overall, 51.6% were readmitted with recurrent biliary events and the rate did not differ between groups (P=0.583). The probability of recurrent gallstone events was higher in the first 30 weeks after PC; in the surgical cohort, 77.8% of them developed before LC. Late deaths occurred in 46.2% of patients: 13.3% LC vs. 61.9% conservative (P<0.001). Three years after PC, the estimated survival was 75% LC vs. 38% conservative (P=0.014). High-grade comorbidities and severity of ACC were positive predictors of all-cause mortality (P=0.004 and P=0.027), whereas LC was a negative predictor (P=0.003).</p><p><strong>Conclusions: </strong>Recurrent biliary events were common following PC for ACC. Interval LC was associated with lower rates of readmissions and all-cause late mortality.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"718-725"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}