首页 > 最新文献

Annals of Gastroenterology最新文献

英文 中文
Results of the COLDWATER randomized controlled trial: enhanced performance of underwater cold snare polypectomy for colorectal polyps 5-10 mm, independent of endoscopist experience. COLDWATER 随机对照试验结果:针对 5-10 毫米大肠息肉的水下冷套管息肉切除术效果更佳,与内镜医师的经验无关。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-14 DOI: 10.20524/aog.2024.0889
Maria Zachou, Martha Nifora, Theodoros Androutsakos, Georgios Katsaras, Konstantinos Varytimiadis, Christina Zoumpouli, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica, Dionisia Thermou, Georgios Mavrogenis, Evangelia Ntikoudi, Nikolaos Nikiteas, Stavros Sougioultzis, Evangelos Kalaitzakis, Stilianos Kykalos

Background: The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety.

Methods: This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for non-pedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the muscularis mucosa resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, en bloc resection rate, adverse events, and recurrence rate.

Results: The COLDWATER study found higher muscularis mucosa resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and en bloc resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than non-experts, while UCSP showed no significant difference in R0RR across endoscopist's experience levels.

Conclusions: UCSP achieves a more extensive excision of the muscularis mucosa compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher en bloc resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection.

背景:传统冷套扎息肉切除术(CCSP)的R0切除率(R0RR)和不全切除率(IRR)范围很广,这强调了改进技术的必要性。COLDWATER 研究旨在比较水下冷套扎息肉切除术(UCSP)与 CCSP 对 5-10 毫米结直肠息肉的治疗效果,重点关注组织病理学综合评估、有效性和安全性:这是一项随机、单盲、对照试验,比较了 UCSP 和 CCSP 对 5-10 毫米大小的非梗阻性结直肠息肉的治疗效果。主要结果是报告肌肉粘膜切除率的差异。次要结果侧重于切除深度、R0-RR、IRR、整块切除率、不良事件和复发率的差异:COLDWATER研究发现,UCSP的肌肉粘膜切除率更高(81.72±62.81% vs. CCSP:72.33±22.33%,P=0.003),粘膜下存在率相当(UCSP:16.6%,CCSP:12.5%,P=0.25)。UCSP在IRR(3.5% vs. 8.5%,P=0.05)和全灶切除(98% vs. 93.5%,P=0.04)方面的疗效更好。在CCSP中,专业内镜医师的R0RR高于非专业内镜医师,而UCSP显示不同内镜医师经验水平的R0RR无显著差异:结论:与CCSP相比,UCSP能更大范围地切除粘膜肌肉,但切除深度不够。此外,UCSP显示出更高的全切率,IRR率更低,是培训缺乏经验的内镜医师进行息肉切除术的一种有前途的技术,因为它在实现R0切除方面的成功与经验无关。
{"title":"Results of the COLDWATER randomized controlled trial: enhanced performance of underwater cold snare polypectomy for colorectal polyps 5-10 mm, independent of endoscopist experience.","authors":"Maria Zachou, Martha Nifora, Theodoros Androutsakos, Georgios Katsaras, Konstantinos Varytimiadis, Christina Zoumpouli, Panayiotis Karantanos, Efthimia Lalla, Georgios Mpetsios, Maria Panoutsakou, Roxana Stoica, Dionisia Thermou, Georgios Mavrogenis, Evangelia Ntikoudi, Nikolaos Nikiteas, Stavros Sougioultzis, Evangelos Kalaitzakis, Stilianos Kykalos","doi":"10.20524/aog.2024.0889","DOIUrl":"10.20524/aog.2024.0889","url":null,"abstract":"<p><strong>Background: </strong>The wide range of R0 resection rates (R0RR) and incomplete resection rates (IRR) observed with conventional cold snare polypectomy (CCSP) emphasizes the necessity for technique enhancement. The COLDWATER study aimed to compare underwater cold snare polypectomy (UCSP) to CCSP for 5-10-mm colorectal polyps, focusing on comprehensive histopathological evaluation, efficacy, and safety.</p><p><strong>Methods: </strong>This was a randomized, single-blind, controlled trial comparing UCSP to CCSP for non-pedunculated colorectal polyps of size 5-10 mm. The primary outcome was to report differences in the <i>muscularis mucosa</i> resection ratio. The secondary outcomes focused on differences in depth of excision, R0-RR, IRR, <i>en bloc</i> resection rate, adverse events, and recurrence rate.</p><p><strong>Results: </strong>The COLDWATER study found higher <i>muscularis mucosa</i> resection in UCSP (81.72±62.81% vs. CCSP: 72.33±22.33%, P=0.003) with comparable submucosa presence (UCSP: 16.6%, CCSP: 12.5%, P=0.25). UCSP showed better outcomes regarding IRR (3.5% vs. 8.5%, P=0.05) and <i>en bloc</i> resection (98% vs. 93.5%, P=0.04). In CCSP, expert endoscopists achieved higher R0RR than non-experts, while UCSP showed no significant difference in R0RR across endoscopist's experience levels.</p><p><strong>Conclusions: </strong>UCSP achieves a more extensive excision of the <i>muscularis mucosa</i> compared to CCSP, even though it does not attain a deeper excision. Additionally, UCSP shows a higher <i>en bloc</i> resection rate, with lower rates of IRR, and emerges as a promising technique for training inexperienced endoscopists in polypectomy, given its experience-independent success in achieving R0 resection.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"466-475"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554088","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}
引用次数: 0
The growing trend of vascular intestinal disorder in young individuals: a 20-year analysis. 年轻人血管性肠道疾病的增长趋势:20 年分析。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-14 DOI: 10.20524/aog.2024.0891
Pojsakorn Danpanichkul, Yatawee Kanjanakot, Siwanart Kongarin, Phuuwadith Wattanachayakul, Chawin Lopimpisuth, Sakditad Saowapa, Nattanicha Chaisrimaneepan, Priyata Dutta, Yanfang Pang, Kwanjit Duangsonk

Background: Vascular intestinal disorder (VID) is a condition with a low incidence, but a high mortality risk. The increasing prevalence of substance abuse and metabolic syndrome among young individuals could impact the burden of VID. This study aimed to evaluate the impact of VID on young individuals.

Methods: Our study harnessed data from the Global Burden of Disease study, spanning 2000 to 2019. With this extensive dataset, we conducted a comprehensive analysis of the prevalence, mortality rates, and impact on disability-adjusted life years (DALYs) related to VID among young individuals aged 15 to 49 years.

Results: Globally, there were an estimated 32,628 cases, 3869 deaths, and 201,099 million DALYs attributed to VID in young individuals. Geographically, the regions of America had the highest burden of VID in young individuals. From 2000-2019, there was an increasing prevalence in all areas, with the most pronounced change observed in Southeast Asia (annual percentage change [APC] +2.17%, P<0.001). Over the study period, there was a more rapid increase in prevalence in males (APC +0.82%, P<0.001) than in females (APC +0.59%, P<0.001). Rates of death and DALYs declined in most regions, except for the Eastern Mediterranean region, where there was a slight increase (APC +0.85%, P<0.001 and 0.88%, P<0.001, respectively).

Conclusion: Over the past decade, the burden of VID in young individuals has been increasing, particularly in Southeast Asia and the Eastern Mediterranean region, necessitating immediate and inclusive measures to tackle the rising burden.

背景:血管性肠道疾病(VID)是一种发病率低但死亡率高的疾病。药物滥用和代谢综合征在年轻人中越来越普遍,这可能会影响血管性肠病的负担。本研究旨在评估 VID 对年轻人的影响:我们的研究利用了 2000 年至 2019 年全球疾病负担研究的数据。利用这一广泛的数据集,我们对 15 至 49 岁年轻人中 VID 的患病率、死亡率以及对残疾调整生命年(DALYs)的影响进行了全面分析:在全球范围内,估计有 32628 例病例、3869 例死亡和 201,099 百万残疾调整生命年。从地域上看,美洲地区的年轻人患 VID 的比例最高。从 2000 年到 2019 年,所有地区的发病率都在上升,东南亚的变化最为明显(年百分比变化[APC]+2.17%,PConclusion):在过去十年中,年轻个体的 VID 负担一直在增加,尤其是在东南亚和地中海东部地区,因此有必要立即采取包容性措施来应对不断增加的负担。
{"title":"The growing trend of vascular intestinal disorder in young individuals: a 20-year analysis.","authors":"Pojsakorn Danpanichkul, Yatawee Kanjanakot, Siwanart Kongarin, Phuuwadith Wattanachayakul, Chawin Lopimpisuth, Sakditad Saowapa, Nattanicha Chaisrimaneepan, Priyata Dutta, Yanfang Pang, Kwanjit Duangsonk","doi":"10.20524/aog.2024.0891","DOIUrl":"10.20524/aog.2024.0891","url":null,"abstract":"<p><strong>Background: </strong>Vascular intestinal disorder (VID) is a condition with a low incidence, but a high mortality risk. The increasing prevalence of substance abuse and metabolic syndrome among young individuals could impact the burden of VID. This study aimed to evaluate the impact of VID on young individuals.</p><p><strong>Methods: </strong>Our study harnessed data from the Global Burden of Disease study, spanning 2000 to 2019. With this extensive dataset, we conducted a comprehensive analysis of the prevalence, mortality rates, and impact on disability-adjusted life years (DALYs) related to VID among young individuals aged 15 to 49 years.</p><p><strong>Results: </strong>Globally, there were an estimated 32,628 cases, 3869 deaths, and 201,099 million DALYs attributed to VID in young individuals. Geographically, the regions of America had the highest burden of VID in young individuals. From 2000-2019, there was an increasing prevalence in all areas, with the most pronounced change observed in Southeast Asia (annual percentage change [APC] +2.17%, P<0.001). Over the study period, there was a more rapid increase in prevalence in males (APC +0.82%, P<0.001) than in females (APC +0.59%, P<0.001). Rates of death and DALYs declined in most regions, except for the Eastern Mediterranean region, where there was a slight increase (APC +0.85%, P<0.001 and 0.88%, P<0.001, respectively).</p><p><strong>Conclusion: </strong>Over the past decade, the burden of VID in young individuals has been increasing, particularly in Southeast Asia and the Eastern Mediterranean region, necessitating immediate and inclusive measures to tackle the rising burden.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"458-465"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554089","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}
引用次数: 0
The national burden of inflammatory bowel disease in the United States from 1990-2019: results from the Global Burden of Disease study database. 1990-2019 年美国全国炎症性肠病负担:全球疾病负担研究数据库的结果。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-14 DOI: 10.20524/aog.2024.0894
Saqr Alsakarneh, Kamal Hassan, Fouad Jaber, Micheal Mintz, Mir Zulqarnian, Ayah Obeid, Hassan Ghoz, Jana G Hashash, Francis A Farraye

Background: Inflammatory bowel disease (IBD) epidemiology has changed rapidly in recent years. We aimed to provide a systematic report of the burden of IBD at a state level in the United States (US), and to study the age- and sex-specific trends of incidence, prevalence and mortality rates for the past 3 decades.

Methods: Using the Global Burden of Disease (GBD) 2019 Study Database, we examined the incidence, prevalence and mortality rate, and the disability-adjusted life-years from GBD 2019 at national and state level from 1990-2019.

Results: There was an overall decrease in incidence and prevalence rates of IBD in the US from 1990-2019, while a simultaneous increase in the overall mortality rates was identified. However, a distinct trend of increasing incidence and prevalence rates emerged starting in 2000, with incidence rates rising from 21 cases per 100,000 persons in 2000 to 23 cases per 100,000 persons in 2019. From 1990-2019, incidence and prevalence decreased in males at a higher rate than in females. However, mortality rates increased more in females than males. Incidence rates were highest in Midwestern and Eastern states, and were lowest across the northern Great Plains and Western states, with the highest incidence noted in Michigan (31 cases per 100,000 persons). California had the greatest decrease in incidence rates from 1990-2019 (-63.3%).

Conclusion: Our results concerning recent trends and geographic variations in IBD offer policymakers crucial insights for informed decision-making in policy, research, and investment, facilitating more effective strategies and allocation of resources.

背景:近年来,炎症性肠病(IBD)的流行病学发生了迅速变化。我们旨在系统报告美国州一级的 IBD 负担,并研究过去 30 年间发病率、患病率和死亡率的年龄和性别特异性趋势:利用全球疾病负担(GBD)2019研究数据库,我们研究了1990-2019年期间全国和各州的发病率、流行率和死亡率,以及GBD 2019中的残疾调整生命年:结果:1990-2019年期间,美国IBD的发病率和患病率总体下降,而总体死亡率同时上升。然而,从2000年开始,发病率和患病率出现了明显的上升趋势,发病率从2000年的每10万人21例上升到2019年的每10万人23例。从 1990 年到 2019 年,男性发病率和流行率的下降率高于女性。然而,女性死亡率的上升幅度高于男性。中西部和东部各州的发病率最高,大平原北部和西部各州的发病率最低,其中密歇根州的发病率最高(每 10 万人 31 例)。1990-2019 年间,加利福尼亚州的发病率降幅最大(-63.3%):我们关于 IBD 最新趋势和地域差异的研究结果为政策制定者在政策、研究和投资方面做出明智决策提供了重要启示,有助于制定更有效的战略和分配资源。
{"title":"The national burden of inflammatory bowel disease in the United States from 1990-2019: results from the Global Burden of Disease study database.","authors":"Saqr Alsakarneh, Kamal Hassan, Fouad Jaber, Micheal Mintz, Mir Zulqarnian, Ayah Obeid, Hassan Ghoz, Jana G Hashash, Francis A Farraye","doi":"10.20524/aog.2024.0894","DOIUrl":"10.20524/aog.2024.0894","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) epidemiology has changed rapidly in recent years. We aimed to provide a systematic report of the burden of IBD at a state level in the United States (US), and to study the age- and sex-specific trends of incidence, prevalence and mortality rates for the past 3 decades.</p><p><strong>Methods: </strong>Using the Global Burden of Disease (GBD) 2019 Study Database, we examined the incidence, prevalence and mortality rate, and the disability-adjusted life-years from GBD 2019 at national and state level from 1990-2019.</p><p><strong>Results: </strong>There was an overall decrease in incidence and prevalence rates of IBD in the US from 1990-2019, while a simultaneous increase in the overall mortality rates was identified. However, a distinct trend of increasing incidence and prevalence rates emerged starting in 2000, with incidence rates rising from 21 cases per 100,000 persons in 2000 to 23 cases per 100,000 persons in 2019. From 1990-2019, incidence and prevalence decreased in males at a higher rate than in females. However, mortality rates increased more in females than males. Incidence rates were highest in Midwestern and Eastern states, and were lowest across the northern Great Plains and Western states, with the highest incidence noted in Michigan (31 cases per 100,000 persons). California had the greatest decrease in incidence rates from 1990-2019 (-63.3%).</p><p><strong>Conclusion: </strong>Our results concerning recent trends and geographic variations in IBD offer policymakers crucial insights for informed decision-making in policy, research, and investment, facilitating more effective strategies and allocation of resources.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"427-435"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554090","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}
引用次数: 0
Hemospray® (hemostatic powder TC-325) as monotherapy for acute gastrointestinal bleeding: a multicenter prospective study. Hemospray®(止血粉 TC-325)作为急性消化道出血的单一疗法:一项多中心前瞻性研究。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-20 DOI: 10.20524/aog.2024.0897
Apostolis Papaefthymiou, Nasar Aslam, Mohamed Hussein, Durayd Alzoubaidi, Seth A Gross, Alvaro De La Serna, Ioannis Varbobitis, Tricia A Hengehold, Miguel Fraile López, Jacobo Ortiz Fernández-Sordo, Johannes W Rey, Bu Hayee, Edward J Despott, Alberto Murino, Sulleman Moreea, Phil Boger, Jason M Dunn, Inder Mainie, Daniel Mullady, Dayna Early, Melissa Latorre, Krish Ragunath, John T Anderson, Pradeep Bhandari, Martin Goetz, Ralf Kiesslich, Emmanuel Coron, Enrique Rodríguez De Santiago, Tamas A Gonda, Michael O'Donnell, Benjamin Norton, Andrea Telese, Roberto Simons-Linares, Rehan Haidry

Background: Hemostatic powders are used as second-line treatment in acute gastrointestinal (GI) bleeding (AGIB). Increasing evidence supports the use of TC-325 as monotherapy in specific scenarios. This prospective, multicenter study evaluated the performance of TC-325 as monotherapy for AGIB.

Methods: Eighteen centers across Europe and USA contributed to a registry between 2016 and 2022. Adults with AGIB were eligible, unless TC-325 was part of combined hemostasis. The primary endpoint was immediate hemostasis. Secondary outcomes were rebleeding and mortality. Associations with risk factors were investigated (statistical significance at P≤0.05).

Results: One hundred ninety patients were included (age 51-81 years, male: female 2:1), with peptic ulcer (n=48), upper GI malignancy (n=79), post-endoscopic treatment hemorrhage (n=37), and lower GI lesions (n=26). The primary outcome was recorded in 96.3% (95% confidence interval [CI]: 92.6-98.5) with rebleeding in 17.4% (95%CI 11.9-24.1); 9.9% (95%CI 5.8-15.6) died within 7 days, and 21.7% (95%CI 15.6-28.9) within 30 days. Regarding peptic ulcer, immediate hemostasis was achieved in 88% (95%CI 75-95), while 26% (95%CI 13-43) rebled. Higher ASA score was associated with mortality (OR 23.5, 95%CI 1.60-345; P=0.02). Immediate hemostasis was achieved in 100% of cases with malignancy and post-intervention bleeding, with rebleeding in 17% and 3.1%, respectively. Twenty-six patients received TC-325 for lower GI bleeding, and in all but one the primary outcome was achieved.

Conclusions: TC-325 monotherapy is safe and effective, especially in malignancy or post-endoscopic intervention bleeding. In patients with peptic ulcer, it could be helpful when the primary treatment is unfeasible, as bridge to definite therapy.

背景:止血粉被用作急性胃肠道(GI)出血(AGIB)的二线治疗。越来越多的证据支持在特定情况下使用 TC-325 作为单一疗法。这项前瞻性多中心研究评估了 TC-325 作为单药治疗 AGIB 的效果:2016年至2022年期间,欧洲和美国的18个中心参与了一项登记。除非 TC-325 是联合止血的一部分,否则成人 AGIB 患者均符合条件。主要终点是立即止血。次要结果为再出血和死亡率。研究了与风险因素的相关性(P≤0.05时具有统计学意义):共纳入了 190 名患者(年龄 51-81 岁,男女比例 2:1),分别患有消化性溃疡(48 人)、上消化道恶性肿瘤(79 人)、内镜治疗后出血(37 人)和下消化道病变(26 人)。96.3%(95% 置信区间[CI]:92.6-98.5)的患者获得了主要结果,17.4%(95% 置信区间 11.9-24.1)的患者再次出血;9.9%(95% 置信区间 5.8-15.6)的患者在 7 天内死亡,21.7%(95% 置信区间 15.6-28.9)的患者在 30 天内死亡。在消化性溃疡方面,88%(95%CI 75-95)的患者能立即止血,26%(95%CI 13-43)的患者则出现反弹。ASA 评分越高,死亡率越高(OR 23.5,95%CI 1.60-345;P=0.02)。100%的恶性肿瘤和干预后出血病例都能立即止血,再次出血的比例分别为 17% 和 3.1%。26名患者接受了TC-325治疗下消化道出血,除一名患者外,其他患者均达到了主要治疗效果:结论:TC-325 单药治疗安全有效,尤其适用于恶性肿瘤或内镜手术后出血。结论:TC-325 单药治疗安全有效,尤其适用于恶性肿瘤或内镜介入治疗后出血,对于消化性溃疡患者,当主要治疗方法不可行时,TC-325 可作为明确治疗的过渡药物。
{"title":"Hemospray® (hemostatic powder TC-325) as monotherapy for acute gastrointestinal bleeding: a multicenter prospective study.","authors":"Apostolis Papaefthymiou, Nasar Aslam, Mohamed Hussein, Durayd Alzoubaidi, Seth A Gross, Alvaro De La Serna, Ioannis Varbobitis, Tricia A Hengehold, Miguel Fraile López, Jacobo Ortiz Fernández-Sordo, Johannes W Rey, Bu Hayee, Edward J Despott, Alberto Murino, Sulleman Moreea, Phil Boger, Jason M Dunn, Inder Mainie, Daniel Mullady, Dayna Early, Melissa Latorre, Krish Ragunath, John T Anderson, Pradeep Bhandari, Martin Goetz, Ralf Kiesslich, Emmanuel Coron, Enrique Rodríguez De Santiago, Tamas A Gonda, Michael O'Donnell, Benjamin Norton, Andrea Telese, Roberto Simons-Linares, Rehan Haidry","doi":"10.20524/aog.2024.0897","DOIUrl":"10.20524/aog.2024.0897","url":null,"abstract":"<p><strong>Background: </strong>Hemostatic powders are used as second-line treatment in acute gastrointestinal (GI) bleeding (AGIB). Increasing evidence supports the use of TC-325 as monotherapy in specific scenarios. This prospective, multicenter study evaluated the performance of TC-325 as monotherapy for AGIB.</p><p><strong>Methods: </strong>Eighteen centers across Europe and USA contributed to a registry between 2016 and 2022. Adults with AGIB were eligible, unless TC-325 was part of combined hemostasis. The primary endpoint was immediate hemostasis. Secondary outcomes were rebleeding and mortality. Associations with risk factors were investigated (statistical significance at P≤0.05).</p><p><strong>Results: </strong>One hundred ninety patients were included (age 51-81 years, male: female 2:1), with peptic ulcer (n=48), upper GI malignancy (n=79), post-endoscopic treatment hemorrhage (n=37), and lower GI lesions (n=26). The primary outcome was recorded in 96.3% (95% confidence interval [CI]: 92.6-98.5) with rebleeding in 17.4% (95%CI 11.9-24.1); 9.9% (95%CI 5.8-15.6) died within 7 days, and 21.7% (95%CI 15.6-28.9) within 30 days. Regarding peptic ulcer, immediate hemostasis was achieved in 88% (95%CI 75-95), while 26% (95%CI 13-43) rebled. Higher ASA score was associated with mortality (OR 23.5, 95%CI 1.60-345; P=0.02). Immediate hemostasis was achieved in 100% of cases with malignancy and post-intervention bleeding, with rebleeding in 17% and 3.1%, respectively. Twenty-six patients received TC-325 for lower GI bleeding, and in all but one the primary outcome was achieved.</p><p><strong>Conclusions: </strong>TC-325 monotherapy is safe and effective, especially in malignancy or post-endoscopic intervention bleeding. In patients with peptic ulcer, it could be helpful when the primary treatment is unfeasible, as bridge to definite therapy.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"418-426"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554085","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}
引用次数: 0
Feasibility and safety of peroral endoscopic myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis. 贲门失弛缓症患者口腔内窥镜肌切开术加胃底折叠术的可行性和安全性:系统回顾和荟萃分析。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-14 DOI: 10.20524/aog.2024.0890
Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Ashu Acharya, Umer Farooq, Zahid Ejaz, Muhammad Aziz, Manesh Kumar Gangwani, Umar Hayat, Anand Kumar, Alexander Schlachterman, David Loren, Thomas Kowalski

Background: Achalasia can cause disabling symptoms that may substantially impair the quality of life. Peroral endoscopic myotomy (POEM) has shown promising results in the management of achalasia. In this meta-analysis we have evaluated the feasibility and safety of single-session POEM with fundoplication (POEM+F) in patients with achalasia.

Methods: We reviewed several databases from inception to July 08, 2022, to identify studies evaluating the feasibility and/or safety of single-session POEM+F for patients with achalasia. Our outcomes of interest included the technical success of POEM+F, adverse events, esophagitis and wrap integrity on follow-up upper endoscopy, total procedure time, and fundoplication time. Pooled rates with 95% confidence intervals (CI) for outcomes were calculated using a random effect model. Heterogeneity was assessed using the I 2 statistic.

Results: We included 4 studies with 90 patients. Pooled rates (95%CI) of technical success and adverse events were 92% (83-96%) and 5% (2-11%), respectively. Pooled rates (95%CI) of esophagitis and wrap integrity on follow-up upper endoscopy were 18% (11-30%) and 85% (43-98%) respectively. Pooled mean procedure time and fundoplication time were 113.2 (98.7-127.6) and 55.3 (43.7-66.8) min, respectively.

Conclusions: This meta-analysis demonstrates the feasibility and safety of POEM+F in patients with achalasia. More studies with long-term follow up are required to further validate these findings.

背景:贲门失弛缓症可引起致残性症状,严重影响生活质量。口周内镜下肌切开术(POEM)在治疗贲门失弛缓症方面取得了良好的效果。在这项荟萃分析中,我们评估了贲门失弛缓症患者单次口腔内镜肌切开术联合胃底折叠术(POEM+F)的可行性和安全性:我们查阅了从开始到2022年7月8日的多个数据库,以确定评估单次POEM+F治疗贲门失弛缓症患者的可行性和/或安全性的研究。我们关注的结果包括 POEM+F 的技术成功率、不良事件、随访上内镜检查中的食管炎和包裹完整性、总手术时间和胃底折叠术时间。采用随机效应模型计算了结果的汇总率和 95% 置信区间 (CI)。使用I 2统计量评估异质性:我们纳入了 4 项研究,共 90 名患者。技术成功率和不良事件的汇总率(95%CI)分别为 92% (83-96%) 和 5% (2-11%)。后续上内镜检查中食管炎和包裹完整性的汇总率(95%CI)分别为18%(11%-30%)和85%(43%-98%)。汇总的平均手术时间和胃底折叠术时间分别为113.2(98.7-127.6)分钟和55.3(43.7-66.8)分钟:这项荟萃分析证明了 POEM+F 在贲门失弛缓症患者中的可行性和安全性。要进一步验证这些研究结果,还需要更多的长期随访研究。
{"title":"Feasibility and safety of peroral endoscopic myotomy with fundoplication in patients with achalasia: a systematic review and meta-analysis.","authors":"Faisal Kamal, Muhammad Ali Khan, Wade Lee-Smith, Sachit Sharma, Ashu Acharya, Umer Farooq, Zahid Ejaz, Muhammad Aziz, Manesh Kumar Gangwani, Umar Hayat, Anand Kumar, Alexander Schlachterman, David Loren, Thomas Kowalski","doi":"10.20524/aog.2024.0890","DOIUrl":"10.20524/aog.2024.0890","url":null,"abstract":"<p><strong>Background: </strong>Achalasia can cause disabling symptoms that may substantially impair the quality of life. Peroral endoscopic myotomy (POEM) has shown promising results in the management of achalasia. In this meta-analysis we have evaluated the feasibility and safety of single-session POEM with fundoplication (POEM+F) in patients with achalasia.</p><p><strong>Methods: </strong>We reviewed several databases from inception to July 08, 2022, to identify studies evaluating the feasibility and/or safety of single-session POEM+F for patients with achalasia. Our outcomes of interest included the technical success of POEM+F, adverse events, esophagitis and wrap integrity on follow-up upper endoscopy, total procedure time, and fundoplication time. Pooled rates with 95% confidence intervals (CI) for outcomes were calculated using a random effect model. Heterogeneity was assessed using the <i>I</i> <sup>2</sup> statistic.</p><p><strong>Results: </strong>We included 4 studies with 90 patients. Pooled rates (95%CI) of technical success and adverse events were 92% (83-96%) and 5% (2-11%), respectively. Pooled rates (95%CI) of esophagitis and wrap integrity on follow-up upper endoscopy were 18% (11-30%) and 85% (43-98%) respectively. Pooled mean procedure time and fundoplication time were 113.2 (98.7-127.6) and 55.3 (43.7-66.8) min, respectively.</p><p><strong>Conclusions: </strong>This meta-analysis demonstrates the feasibility and safety of POEM+F in patients with achalasia. More studies with long-term follow up are required to further validate these findings.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"403-409"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554083","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}
引用次数: 0
Use of N-acetylcysteine plus simethicone to improve mucosal visibility in upper digestive endoscopy via systematic alphanumeric-coded endoscopy: a randomized, double-blind controlled trial. 通过系统字母数字编码内窥镜检查,使用 N-乙酰半胱氨酸加西甲硅油改善上消化道内窥镜检查中的粘膜可见度:随机双盲对照试验。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-14 DOI: 10.20524/aog.2024.0895
Sergio Sobrino-Cossío, Fabian Emura, Oscar Teramoto-Matsubara, Raúl Araya, Adolfo Parra-Blanco, Jonathan Richard White, Vitor Arantes, Josué Aliaga Ramos, Elymir Soraya Galvis-García, Francisco de-la-Vega-González, Gonzalo Rodríguez-Vanegas, Carlos Alberto Donneys, Arturo Reding-Bernal, Estrella Martínez-López, Juan Carlos López-Alvarenga, Noriya Uedo

Background: The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method.

Methods: This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects.

Results: A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group.

Conclusion: The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.

背景:上消化道(GI)内窥镜检查前使用消泡剂和粘液溶解剂并进行全面系统的复查对于优化病变检测至关重要。本研究采用创新的系统方法,评估了西甲硅油和 N-乙酰半胱氨酸对上消化道粘膜充分可见性(AMV)的影响:这项随机双盲对照试验纳入了在2019年8月至2019年12月期间接受诊断性上消化道内镜检查以筛查早期肿瘤的连续患者。通过系统的字母数字编码内镜对上消化道进行了系统评估。患者被分为4组:1)水组;2)仅西甲硅油组;3)N-乙酰半胱氨酸+西甲硅油组;4)仅N-乙酰半胱氨酸组。对每组的以下参数进行了评估:年龄、性别、体重指数、粘膜可见度和副作用:结果:共获取了 4564 张上消化道部位的图像进行评估。4 组的平均 AMV 为 93.98±7.36%。与其他组相比,N-乙酰半胱氨酸+西甲硅酮组的清洁率更高(P=0.001)。其余各组之间没有明显差异,但在单独使用粘液溶解剂或消泡剂时,有几个部位的清洁效果更好。各组均未发现副作用:结论:N-乙酰半胱氨酸和西甲硅油的组合可优化上消化道粘膜的可见度,从而有可能提高诊断率。
{"title":"Use of N-acetylcysteine plus simethicone to improve mucosal visibility in upper digestive endoscopy via systematic alphanumeric-coded endoscopy: a randomized, double-blind controlled trial.","authors":"Sergio Sobrino-Cossío, Fabian Emura, Oscar Teramoto-Matsubara, Raúl Araya, Adolfo Parra-Blanco, Jonathan Richard White, Vitor Arantes, Josué Aliaga Ramos, Elymir Soraya Galvis-García, Francisco de-la-Vega-González, Gonzalo Rodríguez-Vanegas, Carlos Alberto Donneys, Arturo Reding-Bernal, Estrella Martínez-López, Juan Carlos López-Alvarenga, Noriya Uedo","doi":"10.20524/aog.2024.0895","DOIUrl":"10.20524/aog.2024.0895","url":null,"abstract":"<p><strong>Background: </strong>The use of antifoaming and mucolytic agents prior to upper gastrointestinal (GI) endoscopy and a thorough systematic review are essential to optimize lesion detection. This study evaluated the effect of simethicone and N-acetylcysteine on the adequate mucosal visibility (AMV) of the upper GI tract by an innovative systematic method.</p><p><strong>Methods: </strong>This randomized, double-blind controlled trial included consecutive patients who underwent diagnostic upper GI endoscopy for screening for early neoplasms between August 2019 and December 2019. The upper GI tract was systematically assessed by systematic alphanumeric-coded endoscopy. Patients were divided into 4 groups: 1) water; 2) only simethicone; 3) N-acetylcysteine + simethicone; and 4) only N-acetylcysteine. The following parameters were assessed in each group: age, sex, body mass index, level of adequate mucosal visibility, and side-effects.</p><p><strong>Results: </strong>A total of 4564 images from upper GI areas were obtained for evaluation. The mean AMV in the 4 groups was 93.98±7.36%. The N-acetylcysteine + simethicone group had a higher cleaning percentage compared with the other groups (P=0.001). There was no significant difference among the remaining groups, but several areas had better cleaning when a mucolytic or antifoam alone was used. No side-effects were found in any group.</p><p><strong>Conclusion: </strong>The combination of N-acetylcysteine plus simethicone optimizes the visibility of the mucosa of the upper GI tract, which could potentially increase diagnostic yield.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"410-417"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554092","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}
引用次数: 0
Frailty is a predictor for worse outcomes in patients hospitalized with Clostridioides difficile infection. 虚弱是艰难梭菌感染住院患者病情恶化的预测因素。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-07-01 Epub Date: 2024-06-20 DOI: 10.20524/aog.2024.0898
Abdelkader Chaar, Jin Woo Yoo, Ahmad Nawaz, Rabia Rizwan, Osama Qasim Agha, Paul Feuerstadt

Background: Frailty has major health implications for affected patients and is widely used in the perioperative risk assessment. The Hospital Frailty Risk Score (HFRS) is a validated score that utilizes administrative billing data to identify patients at higher risk because of frailty. We investigated the utility of the HFRS in patients with Clostridioides difficile infection (CDI) to determine whether they were at risk for worse outcomes and higher healthcare resource utilization.

Methods: Using the 2017 National Inpatient Sample, we identified all adults with a primary diagnosis of CDI. We classified patients into 2 groups: those who had an HFRS <5 (NonFrailCDI) and those with a score ≥5 (FrailCDI). We assessed differences in hospital outcomes and healthcare resource utilization based on frailty status.

Results: We identified 93,810 hospitalizations, of which 54,300 (57.88%) were FrailCDI. FrailCDI patients were at higher risk for fulminant CDI (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.6-2.3), requiring colectomy (OR 4.1, 95%CI 1.5-11.2), and inpatient mortality (OR 4.5, 95%CI 2.8-7.1). Furthermore, FrailCDI patients had higher odds of requiring Intensive Care Unit admission (OR 13.7, 95%CI 6.3-29.9) or transfer to another facility on discharge (OR 2.2, 95%CI 2.0-2.4), and had longer hospital stays and higher total charges when compared with NonFrailCDI.

Conclusions: Frailty as defined by the HFRS is an independent factor for worse outcomes and higher healthcare utilization in adults admitted for CDI. Risk stratifying patients by frailty may improve outcomes.

背景:虚弱对患者的健康有重大影响,被广泛用于围手术期风险评估。医院虚弱风险评分(Hospital Frailty Risk Score,HFRS)是一种经过验证的评分方法,它利用管理账单数据来识别因虚弱而面临较高风险的患者。我们研究了 HFRS 在艰难梭菌感染(CDI)患者中的实用性,以确定他们是否有恶化预后和提高医疗资源利用率的风险:利用 2017 年全国住院患者样本,我们确定了所有初诊为 CDI 的成年人。我们将患者分为两组:一组是有 HFRS 结果的患者,另一组是没有 HFRS 结果的患者:我们确定了 93810 例住院患者,其中 54300 例(57.88%)为 FrailCDI。FrailCDI 患者发生暴发性 CDI(几率比 [OR] 1.9,95% 置信区间 [CI] 1.6-2.3)、需要结肠切除术(OR 4.1,95%CI 1.5-11.2)和住院死亡率(OR 4.5,95%CI 2.8-7.1)的风险较高。此外,与非FrailCDI相比,FrailCDI患者需要入住重症监护病房(OR 13.7,95%CI 6.3-29.9)或出院时转院(OR 2.2,95%CI 2.0-2.4)的几率更高,住院时间更长,总费用更高:结论:根据 HFRS 定义的体弱是导致因 CDI 入院的成人患者预后更差、医疗费用更高的一个独立因素。根据体弱程度对患者进行风险分层可改善预后。
{"title":"Frailty is a predictor for worse outcomes in patients hospitalized with <i>Clostridioides difficile</i> infection.","authors":"Abdelkader Chaar, Jin Woo Yoo, Ahmad Nawaz, Rabia Rizwan, Osama Qasim Agha, Paul Feuerstadt","doi":"10.20524/aog.2024.0898","DOIUrl":"10.20524/aog.2024.0898","url":null,"abstract":"<p><strong>Background: </strong>Frailty has major health implications for affected patients and is widely used in the perioperative risk assessment. The Hospital Frailty Risk Score (HFRS) is a validated score that utilizes administrative billing data to identify patients at higher risk because of frailty. We investigated the utility of the HFRS in patients with <i>Clostridioides difficile</i> infection (CDI) to determine whether they were at risk for worse outcomes and higher healthcare resource utilization.</p><p><strong>Methods: </strong>Using the 2017 National Inpatient Sample, we identified all adults with a primary diagnosis of CDI. We classified patients into 2 groups: those who had an HFRS <5 (NonFrailCDI) and those with a score ≥5 (FrailCDI). We assessed differences in hospital outcomes and healthcare resource utilization based on frailty status.</p><p><strong>Results: </strong>We identified 93,810 hospitalizations, of which 54,300 (57.88%) were FrailCDI. FrailCDI patients were at higher risk for fulminant CDI (odds ratio [OR] 1.9, 95% confidence interval [CI] 1.6-2.3), requiring colectomy (OR 4.1, 95%CI 1.5-11.2), and inpatient mortality (OR 4.5, 95%CI 2.8-7.1). Furthermore, FrailCDI patients had higher odds of requiring Intensive Care Unit admission (OR 13.7, 95%CI 6.3-29.9) or transfer to another facility on discharge (OR 2.2, 95%CI 2.0-2.4), and had longer hospital stays and higher total charges when compared with NonFrailCDI.</p><p><strong>Conclusions: </strong>Frailty as defined by the HFRS is an independent factor for worse outcomes and higher healthcare utilization in adults admitted for CDI. Risk stratifying patients by frailty may improve outcomes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 4","pages":"442-448"},"PeriodicalIF":2.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11226747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554084","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}
引用次数: 0
Clinical characteristics of symptomatic young patients with colonic adenomas. 有症状的年轻结肠腺瘤患者的临床特征。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-20 DOI: 10.20524/aog.2024.0872
Mario El Hayek, Fadi F Francis, Fadi H Mourad, Martine Elbejjani, Kassem Barada, Jana G Hashash

Background: The incidence of colonic adenomas and colorectal cancer has been on the rise among young patients. In this study, we aimed to describe the characteristics of young patients (<50 years) with adenomatous polyps and to characterize those polyps. We also aimed to determine appropriate surveillance intervals for young patients.

Methods: We performed a retrospective chart review of patients <50 years of age who had polypectomy of 1 or more adenomatous polyps on colonoscopy between 2008 and 2021. Patient demographics, colonoscopy indication and polyp characteristics were obtained from the chart. Timing and findings on surveillance colonoscopies were recorded.

Results: A total of 610 patients were included: mean age 42.9±5.9 years, 61% males, body mass index 27.5±4.7 kg/m2, and over 50% smokers. The most common indications were abdominal pain (23.3%), rectal bleeding (22.3%), and change in bowel habits (17.6%). Almost half of the patients who had adenomas (299) were younger than 45 years. Tubular adenoma was the most frequently encountered type of polyp (571; 93.6%). Mean polyp size was 1.1±0.9 cm. The most common location of adenomas was the sigmoid colon (41%). Of patients with adenomas, 156 (26%) had surveillance colonoscopy within 2.9±2.3 years; 74 patients (47.4%) were found to have new adenomas.

Conclusions: Patients aged <50 years with colonic adenomas were mostly males, overweight, and smokers. Further adenomas were found in 47% of surveillance colonoscopies, and most were encountered within 5 years. High rates of recurrent adenomas in people <50 years of age may warrant frequent surveillance.

背景:结肠腺瘤和结肠直肠癌的发病率在年轻患者中呈上升趋势。在这项研究中,我们旨在描述年轻患者的特征(方法:我们对患者进行了回顾性病历审查:我们对患者进行了回顾性病历审查:共纳入 610 名患者:平均年龄(42.9±5.9)岁,61% 为男性,体重指数(27.5±4.7)kg/m2,50% 以上为吸烟者。最常见的适应症是腹痛(23.3%)、直肠出血(22.3%)和排便习惯改变(17.6%)。近一半的腺瘤患者(299 人)年龄在 45 岁以下。管状腺瘤是最常见的息肉类型(571;93.6%)。息肉的平均大小为 1.1±0.9 厘米。腺瘤最常见的位置是乙状结肠(41%)。在患有腺瘤的患者中,有 156 人(26%)在 2.9±2.3 年内接受了结肠镜检查,其中 74 人(47.4%)发现了新的腺瘤:结论
{"title":"Clinical characteristics of symptomatic young patients with colonic adenomas.","authors":"Mario El Hayek, Fadi F Francis, Fadi H Mourad, Martine Elbejjani, Kassem Barada, Jana G Hashash","doi":"10.20524/aog.2024.0872","DOIUrl":"10.20524/aog.2024.0872","url":null,"abstract":"<p><strong>Background: </strong>The incidence of colonic adenomas and colorectal cancer has been on the rise among young patients. In this study, we aimed to describe the characteristics of young patients (<50 years) with adenomatous polyps and to characterize those polyps. We also aimed to determine appropriate surveillance intervals for young patients.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients <50 years of age who had polypectomy of 1 or more adenomatous polyps on colonoscopy between 2008 and 2021. Patient demographics, colonoscopy indication and polyp characteristics were obtained from the chart. Timing and findings on surveillance colonoscopies were recorded.</p><p><strong>Results: </strong>A total of 610 patients were included: mean age 42.9±5.9 years, 61% males, body mass index 27.5±4.7 kg/m<sup>2</sup>, and over 50% smokers. The most common indications were abdominal pain (23.3%), rectal bleeding (22.3%), and change in bowel habits (17.6%). Almost half of the patients who had adenomas (299) were younger than 45 years. Tubular adenoma was the most frequently encountered type of polyp (571; 93.6%). Mean polyp size was 1.1±0.9 cm. The most common location of adenomas was the sigmoid colon (41%). Of patients with adenomas, 156 (26%) had surveillance colonoscopy within 2.9±2.3 years; 74 patients (47.4%) were found to have new adenomas.</p><p><strong>Conclusions: </strong>Patients aged <50 years with colonic adenomas were mostly males, overweight, and smokers. Further adenomas were found in 47% of surveillance colonoscopies, and most were encountered within 5 years. High rates of recurrent adenomas in people <50 years of age may warrant frequent surveillance.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 3","pages":"341-347"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11107410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080529","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}
引用次数: 0
Pre-left ventricular assist device endoscopic evaluation does not reduce the risk of later gastrointestinal bleeding: a multicenter study. 左心室辅助装置前内窥镜评估不会降低日后消化道出血的风险:一项多中心研究。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-04-10 DOI: 10.20524/aog.2024.0878
Jiahao Peng, Samanthika Devalaraju, Mohamed Azab, William T Cates, Molly Stone, Jonathan Reichstein, Sneha Shaha, Subhasis Chatterjee, Andrew B Civitello, Mourad H Senussi, B Joseph Elmunzer, Michael Volk, Wasseem Skef

Background: Gastrointestinal bleeding (GIB) is a common complication after placement of a left ventricular assist device (LVAD). Some institutions attempt to mitigate post-LVAD GIB using preoperative endoscopy. Our study evaluated whether preoperative endoscopy was associated with a lower risk of post-LVAD GIB.

Methods: This was a multicenter cohort study of patients who underwent LVAD insertion from 2010-2019 at 3 academic sites. A total of 398 study participants were categorized based on whether they underwent preoperative endoscopy or not. The follow-up period was 1 year and the primary outcome was GIB. Secondary outcomes were severe bleeding and intraprocedural complications.

Results: A total of 114 patients experienced GIB within 1 year, with a higher rate in the endoscopy cohort (36.4% vs. 24.8%, P=0.015). After adjusting for covariables, the endoscopy cohort remained at increased risk of GIB (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.976; P=0.032). Severe bleeding was common (47.4%). Arteriovenous malformations (48 cases) and peptic ulcer disease (17 cases) were the most identified sources of GIB. Only 1 minor adverse event occurred during preoperative endoscopy.

Conclusions: Our study suggests that pre-LVAD endoscopy is associated with a higher risk of GIB post LVAD, despite controlling for confounders. While this was an observational study and may not have captured all confounders, it appears that endoscopic screening may not be warranted.

背景:胃肠道出血(GIB)是放置左心室辅助装置(LVAD)后常见的并发症。一些机构试图通过术前内镜检查来减轻左心室辅助装置术后胃肠道出血。我们的研究评估了术前内镜检查是否与降低 LVAD 术后 GIB 风险有关:这是一项多中心队列研究,研究对象是 2010-2019 年期间在 3 个学术机构接受 LVAD 植入术的患者。共有398名研究参与者根据是否接受术前内镜检查进行了分类。随访期为 1 年,主要结果为 GIB。次要结果为严重出血和术中并发症:共有114名患者在1年内发生了GIB,其中内镜检查组的发生率更高(36.4%对24.8%,P=0.015)。调整协变量后,内镜组发生 GIB 的风险仍然较高(调整后的几率比 1.77,95% 置信区间 1.05-2.976;P=0.032)。严重出血很常见(47.4%)。动静脉畸形(48 例)和消化性溃疡病(17 例)是最常见的 GIB 来源。只有 1 例轻微不良事件发生在术前内镜检查期间:我们的研究表明,尽管控制了混杂因素,但 LVAD 术前内镜检查与 LVAD 术后发生 GIB 的较高风险有关。虽然这是一项观察性研究,可能没有考虑到所有的混杂因素,但内镜筛查似乎没有必要。
{"title":"Pre-left ventricular assist device endoscopic evaluation does not reduce the risk of later gastrointestinal bleeding: a multicenter study.","authors":"Jiahao Peng, Samanthika Devalaraju, Mohamed Azab, William T Cates, Molly Stone, Jonathan Reichstein, Sneha Shaha, Subhasis Chatterjee, Andrew B Civitello, Mourad H Senussi, B Joseph Elmunzer, Michael Volk, Wasseem Skef","doi":"10.20524/aog.2024.0878","DOIUrl":"10.20524/aog.2024.0878","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal bleeding (GIB) is a common complication after placement of a left ventricular assist device (LVAD). Some institutions attempt to mitigate post-LVAD GIB using preoperative endoscopy. Our study evaluated whether preoperative endoscopy was associated with a lower risk of post-LVAD GIB.</p><p><strong>Methods: </strong>This was a multicenter cohort study of patients who underwent LVAD insertion from 2010-2019 at 3 academic sites. A total of 398 study participants were categorized based on whether they underwent preoperative endoscopy or not. The follow-up period was 1 year and the primary outcome was GIB. Secondary outcomes were severe bleeding and intraprocedural complications.</p><p><strong>Results: </strong>A total of 114 patients experienced GIB within 1 year, with a higher rate in the endoscopy cohort (36.4% vs. 24.8%, P=0.015). After adjusting for covariables, the endoscopy cohort remained at increased risk of GIB (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.976; P=0.032). Severe bleeding was common (47.4%). Arteriovenous malformations (48 cases) and peptic ulcer disease (17 cases) were the most identified sources of GIB. Only 1 minor adverse event occurred during preoperative endoscopy.</p><p><strong>Conclusions: </strong>Our study suggests that pre-LVAD endoscopy is associated with a higher risk of GIB post LVAD, despite controlling for confounders. While this was an observational study and may not have captured all confounders, it appears that endoscopic screening may not be warranted.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 3","pages":"313-320"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11107400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080556","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}
引用次数: 0
Update in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis. 预防内镜逆行胰胆管造影术后胰腺炎的最新进展。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-05-01 Epub Date: 2024-03-14 DOI: 10.20524/aog.2024.0870
Bálint Gellért, Árpád V Patai, István Hritz

Of all the possible complications associated with endoscopic retrograde cholangiopancreatography (ERCP), acute pancreatitis undoubtedly represents the heaviest burden for patients and healthcare professionals. The overall incidence, ranging from 3.5% to around 10%, and annual estimated costs exceeding $150 million in the USA should signal caution for everyone carrying out ERCP. In-depth knowledge of the risk factors and the pharmacological and endoscopic treatment options is required to avoid this adverse event. In this review, we evaluate the relevant data published in the literature since the appearance of the latest recommendations of the leading gastroenterological societies. Thus, we intend to provide a comprehensive and up-to-date overview of the factors to consider and possible interventions applicable before and after the intervention to prevent the development of post-ERCP pancreatitis.

在与内镜逆行胰胆管造影术(ERCP)相关的所有可能并发症中,急性胰腺炎无疑给患者和医护人员带来了最沉重的负担。在美国,急性胰腺炎的总发病率从 3.5% 到 10% 左右不等,每年的估计费用超过 1.5 亿美元,这表明每一个进行 ERCP 的人都应该小心谨慎。要避免这一不良事件,就必须深入了解风险因素以及药物和内镜治疗方案。在这篇综述中,我们评估了自主要胃肠病学会提出最新建议以来发表在文献中的相关数据。因此,我们希望提供一个全面、最新的概览,介绍为预防ERCP术后胰腺炎的发生而需要考虑的因素以及在手术前后可能采取的干预措施。
{"title":"Update in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis.","authors":"Bálint Gellért, Árpád V Patai, István Hritz","doi":"10.20524/aog.2024.0870","DOIUrl":"10.20524/aog.2024.0870","url":null,"abstract":"<p><p>Of all the possible complications associated with endoscopic retrograde cholangiopancreatography (ERCP), acute pancreatitis undoubtedly represents the heaviest burden for patients and healthcare professionals. The overall incidence, ranging from 3.5% to around 10%, and annual estimated costs exceeding $150 million in the USA should signal caution for everyone carrying out ERCP. In-depth knowledge of the risk factors and the pharmacological and endoscopic treatment options is required to avoid this adverse event. In this review, we evaluate the relevant data published in the literature since the appearance of the latest recommendations of the leading gastroenterological societies. Thus, we intend to provide a comprehensive and up-to-date overview of the factors to consider and possible interventions applicable before and after the intervention to prevent the development of post-ERCP pancreatitis.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 3","pages":"266-279"},"PeriodicalIF":2.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11107403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080557","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}
引用次数: 0
期刊
Annals of Gastroenterology
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1