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Helicobacter pylori infection diagnosis and management: current practices of Greek gastroenterologists. 幽门螺杆菌感染的诊断和管理:希腊消化科医生的当前做法。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0844
Adonis A Protopapas, Ioanna Papagiouvanni, Andreas N Protopapas, Ioannis Goulis

Background: The diagnosis and management of Helicobacter pylori (H. pylori) infection vary significantly, depending on country, area, and specialty. The aim of this study was to record the current practices of Greek gastroenterologists in the screening and treatment of H. pylori infection.

Method: An anonymous questionnaire consisting of 19 questions about the management of H. pylori infection was sent with the aid of the Hellenic Society of Gastroenterology to all members of the Society.

Results: The questionnaire was completed by 180 gastroenterologists, with a response rate of 31.4%. Diagnostic tests to confirm H. pylori infection are ordered by >90% of the gastroenterologists for patients with current peptic ulcer disease, gastric lymphoma, family history of gastric cancer, and an endoscopic appearance suggestive of gastritis. Most gastroenterologists (55.8%) also tested for H. pylori in patients with gastroesophageal reflux disease (GERD). Histopathology was the most preferred (60.6%) method when testing was decided during endoscopy, while urea breath test was the most preferred method (67.8%) regardless of endoscopy. Most gastroenterologists use quadruple eradication regimens supported by international guidelines (90%), while 65.6% of the physicians answered that they systematically recommend the addition of probiotics to standard therapy. Most physicians (82.8%) answered that they always confirm the eradication of the pathogen.

Conclusions: The majority of Greek gastroenterologists conform to the recommendations of international guidelines regarding the diagnosis and management of H. pylori infection, except for the screening of patients with GERD. A considerable number of doctors use probiotics in addition to standard therapy.

背景:幽门螺杆菌(H. pylori)感染的诊断和治疗因国家、地区和专业的不同而存在很大差异。本研究旨在记录希腊消化内科医生目前在幽门螺杆菌感染筛查和治疗方面的做法:方法:在希腊胃肠病学会的协助下,向该学会的所有会员发送了一份匿名调查问卷,其中包含 19 个有关幽门螺杆菌感染管理的问题:结果:180 名消化内科医生填写了问卷,回复率为 31.4%。对于患有消化性溃疡病、胃淋巴瘤、胃癌家族史以及内镜检查提示胃炎的患者,90%以上的消化内科医生都会要求进行诊断性检查以确认幽门螺杆菌感染。大多数胃肠病专家(55.8%)还会对胃食管反流病(GERD)患者进行幽门螺杆菌检测。在内镜检查期间决定检测时,组织病理学是最受欢迎的方法(60.6%),而无论是否进行内镜检查,尿素呼气试验都是最受欢迎的方法(67.8%)。大多数胃肠病医生使用国际指南支持的四联根除方案(90%),而 65.6% 的医生回答说,他们系统地建议在标准疗法中添加益生菌。大多数医生(82.8%)回答说,他们总是确认病原体已被根除:结论:除了对胃食管反流病患者进行筛查外,大多数希腊胃肠病医生都遵守国际指南中关于幽门螺杆菌感染诊断和管理的建议。相当多的医生在标准疗法之外还使用益生菌。
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引用次数: 0
Effectiveness and safety of darvadstrocel in patients with complex perianal fistulizing Crohn's disease: a systematic review. darvadstrocel 对复杂性肛周瘘克罗恩病患者的有效性和安全性:系统性综述。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.20524/aog.2023.0850
Fotios S Fousekis, Konstantinos Mpakogiannis, Georgios D Lianos, Anastasios Koukoudis, Dimitrios K Christodoulou, Ioannis Papaconstantinou, Konstantinos H Katsanos

Background: Managing complex perianal fistulizing Crohn's disease (CD) remains challenging, despite current medical and surgical treatment approaches. Darvadstrocel, a therapy utilizing adipose-derived stem cells, shows promise in promoting tissue regeneration and healing, offering a novel and effective treatment for fistula management.

Method: A systematic literature search was conducted on PubMed and Scopus to identify studies involving patients with complex perianal fistulizing CD treated with darvadstrocel.

Results: In total, 2 randomized controlled trials (RCT), 5 observational studies with retrospective data collection and 2 observational studies with prospective design were included in the final review. Data from the European ADMIRE-CD RCT demonstrated that darvadstrocel is superior to placebo in terms of clinical and imaging improvement over both the short and long term. These findings align with the prospective studies analyzed in this systematic review. The rate of treatment-emergent adverse events in the ADMIRE-CD trial's RCTs was similar in both the darvadstrocel and control groups, with perianal abscess being the most common adverse event up to 52 weeks after drug administration. Retrospective studies indicated no side-effects beyond 52 weeks.

Conclusions: Darvadstrocel appears to be a new, potentially effective and safe treatment option for the management of complex perianal fistulas. However, more randomized clinical trials are needed to evaluate the efficacy and safety profile of the drug.

背景:尽管目前采用了药物和手术治疗方法,但治疗复杂的肛周克罗恩病(CD)瘘管仍具有挑战性。Darvadstrocel是一种利用脂肪来源干细胞的疗法,有望促进组织再生和愈合,为瘘管管理提供了一种新颖有效的治疗方法:方法:在PubMed和Scopus上进行了系统性文献检索,以确定涉及使用darvadstrocel治疗复杂肛周瘘患者的研究:结果:共有 2 项随机对照试验 (RCT)、5 项采用回顾性数据收集的观察性研究和 2 项采用前瞻性设计的观察性研究被纳入最终综述。欧洲ADMIRE-CD随机对照试验的数据显示,在短期和长期临床和影像学改善方面,达伐司曲塞均优于安慰剂。这些研究结果与本系统综述分析的前瞻性研究结果一致。在ADMIRE-CD试验的RCT中,darvadstrocel组和对照组的治疗突发不良事件发生率相似,其中肛周脓肿是用药后52周内最常见的不良事件。回顾性研究表明,用药52周后没有出现副作用:结论:Darvadstrocel似乎是治疗复杂性肛周瘘的一种新的、潜在有效且安全的治疗方案。然而,还需要更多的随机临床试验来评估该药物的疗效和安全性。
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引用次数: 0
Pathology results of endoscopic ultrasound-guided tissue acquisition in retroperitoneal masses: a multicenter study. 内窥镜超声引导下腹膜后肿块组织采集的病理结果:一项多中心研究。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0846
Mariana Quintanar-Martínez, Maria Del Carmen Manzano-Robleda, Enrique Murcio-Pérez, Gustavo López-Arce, Isaac Bartnicki-Navarrete, Luis Uscanga, Angélica Hernández-Guerrero, Jorge López-Cossio, Alvaro Villalobos-Garita, Jorge Perales-Oliva, José Vargas-Jimenez, Félix Téllez-Ávila

Background: Malignant etiologies are found in 70-80% of symptomatic retroperitoneal masses. Histology is required for diagnosis and treatment. Information about endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-GTA) is scant for retroperitoneal masses. This study aimed to assess the pathology results of EUS-GTA for diagnosing retroperitoneal masses.

Methods: This retrospective, multicenter study involved patients from 5 care centers. All patients with retroperitoneal masses who underwent EUS evaluation were enrolled. We recorded demographic and clinical characteristics, location and size of the mass, type of needle (FNA/FNB), and complications related to the procedure.

Results: A total of 43 patients were included. The median age was 50.5 (range: 23-83) years, and 22 (51.2%) were female. The initial symptom was abdominal pain in 23 (52.3%) cases and weight loss in 11 (25%). Initial imaging was by computed tomography in 33 (75%) patients. Diagnosis with EUS-GTA was reached in 67.5% (29/43) cases. The most frequent histological diagnosis was carcinoma, in 25.5% (11/43). A malignant etiology was found in 31 (72%): 20 were primary tumors from the retroperitoneum, and 11 were metastases. In patients with metastasis, surgery was avoided and medical treatment was indicated. No adverse events were reported.

Conclusion: EUS and EUS-GTA can frequently provide accurate tissue diagnosis and significantly impact the subsequent management.

背景:有症状的腹膜后肿块中有 70-80% 是恶性病因。诊断和治疗需要进行组织学检查。有关腹膜后肿块的内窥镜超声(EUS)引导下组织采集(EUS-GTA)的信息很少。本研究旨在评估 EUS-GTA 诊断腹膜后肿块的病理结果:这项多中心回顾性研究涉及 5 个医疗中心的患者。所有接受 EUS 评估的腹膜后肿块患者均被纳入研究。我们记录了人口统计学和临床特征、肿块的位置和大小、穿刺针类型(FNA/FNB)以及与手术相关的并发症:结果:共纳入 43 名患者。中位年龄为 50.5 岁(23-83 岁),女性 22 人(51.2%)。23例(52.3%)患者的最初症状是腹痛,11例(25%)患者体重减轻。33例(75%)患者的最初影像学检查为计算机断层扫描。67.5%的患者(29/43)通过 EUS-GTA 确诊。最常见的组织学诊断是癌,占 25.5%(11/43)。31例(72%)发现恶性病因:20例为腹膜后原发肿瘤,11例为转移瘤。有转移瘤的患者应避免手术,改用药物治疗。无不良反应报告:结论:EUS 和 EUS-GTA 经常能提供准确的组织诊断,并对后续治疗产生重大影响。
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引用次数: 0
Diagnostic accuracy of bowel ultrasonography in patients with inflammatory bowel disease: a systematic review and meta-analysis. 炎症性肠病患者肠道超声波检查的诊断准确性:系统回顾和荟萃分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2024-01-01 Epub Date: 2023-12-20 DOI: 10.20524/aog.2024.0842
Sheza Malik, Sruthi Venugopalan, Bettina Gabrielle Tenorio, Shahab R Khan, Priyadarshini Loganathan, Udayakumar Navaneethan, Babu P Mohan

Background: Bowel ultrasonography (BUS) is emerging as a promising noninvasive tool for assessing disease activity in inflammatory bowel disease (IBD) patients. We evaluated the diagnostic accuracy of BUS in IBD patients against the gold standard diagnostic method, standard colonoscopy.

Methods: Major databases were searched from inception to May 2023 for studies on BUS diagnostic accuracy in IBD. Outcomes of interest were pooled sensitivity, specificity, positive (PPV), and negative (NPV) predictive values. Endoscopic confirmation served as ground truth. Standard meta-analysis methods with a random-effects model and I2 statistics were applied. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Results: Twenty studies (1094 patients) were included in the final analysis. The majority (75%) of studies considered bowel wall thickness >3 mm as abnormal. Endoscopic evaluation was performed between days 3 and 180. The pooled diagnostic accuracy of BUS in IBD was 66% (95% confidence interval [CI] 58-72%; I2=78%), sensitivity was 88.6% (95%CI 85-91%; I2=77%), and specificity 86% (95%CI 81-90%; I2=95%). PPV and NPV were 94% (95%CI 93-96%; I2=25%) and 74% (95%CI 66-80%; I2=95%), respectively. On subgroup analysis, small-intestine contrast-enhanced ultrasonography (SICUS) demonstrated high sensitivity (97%, 95%CI 91-99%; I2=83%), whereas BUS exhibited high specificity (94%, 95%CI 92-96%; I2=0%) and NPV (76%, 95%CI 68-83%; I2=80.9%). Meta-regression revealed a significant relation between side-to-side anastomosis and BUS specificity (P=0.02) and NPV (P=0.004).

Conclusion: The high diagnostic accuracy of BUS in detecting bowel wall inflammation suggests utilizing regular BUS as the primary modality, with subsequent consideration of SICUS if clinically warranted.

背景:肠道超声波检查(BUS)正在成为评估炎症性肠病(IBD)患者疾病活动性的一种很有前途的无创工具。我们对照金标准诊断方法--标准结肠镜检查,评估了 BUS 对 IBD 患者的诊断准确性:方法:检索了从开始到 2023 年 5 月有关 IBD BUS 诊断准确性的主要数据库。感兴趣的结果是汇总的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)。内镜确认为基本事实。采用随机效应模型和I2统计的标准荟萃分析方法。使用诊断准确性研究质量评估-2工具评估偏倚风险:最终分析纳入了 20 项研究(1094 名患者)。大多数研究(75%)认为肠壁厚度大于 3 毫米为异常。内镜评估在第 3 天和 180 天之间进行。BUS对IBD的汇总诊断准确率为66%(95%置信区间[CI] 58-72%;I2=78%),敏感性为88.6%(95%CI 85-91%;I2=77%),特异性为86%(95%CI 81-90%;I2=95%)。PPV和NPV分别为94%(95%CI 93-96%;I2=25%)和74%(95%CI 66-80%;I2=95%)。在亚组分析中,小肠造影剂增强超声检查(SICUS)显示出较高的灵敏度(97%,95%CI 91-99%;I2=83%),而BUS显示出较高的特异性(94%,95%CI 92-96%;I2=0%)和NPV(76%,95%CI 68-83%;I2=80.9%)。元回归显示,侧对侧吻合与 BUS 特异性(P=0.02)和 NPV(P=0.004)之间存在显著关系:结论:BUS 在检测肠壁炎症方面具有很高的诊断准确性,建议将常规 BUS 作为主要方式,如果临床需要,再考虑 SICUS。
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引用次数: 0
Safety and efficacy of transitioning inflammatory bowel disease patients from intravenous to subcutaneous infliximab: a single-center real-world experience. 炎症性肠病患者从静脉注射英夫利昔单抗过渡到皮下注射的安全性和有效性:单中心真实世界经验。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0816
Angus W Jeffrey, Reeham Abu-Rgeef, Sherman Picardo, Shankar Menon, Kenji So, Kannan Venugopal

Background: A new subcutaneous (SC) formulation exists for infliximab (CT-P13 SC). The aim of this study was to assess the durability of clinical and endoscopic responses after a switch from intravenous (IV) to SC infliximab.

Methods: Patients were transitioned on maintenance infliximab, including those with dose-optimized therapy. The primary outcome was clinical, biochemical and overall remission at 6 months, as defined by a Harvey-Bradshaw Index <5 for Crohn's disease or a partial Mayo score <3 for ulcerative colitis, C-reactive protein less than 10 mg/L, and fecal calprotectin less than 100 μg/g.

Results: Forty patients were switched from IV to SC infliximab. Twenty-seven (68%) had a diagnosis of Crohn's disease and 13 (33%) had ulcerative colitis. Twenty-three (58%) were on 5 mg/kg of IV infliximab every 8 weeks and 15 (38%) 5 mg/kg every 6 weeks. There were 2 patients (4%) on 10 mg/kg every 6 weeks. At the time of their switch, 37 (93%) patients were in clinical remission, 25 (76%) were in biochemical remission, and 25 (76%) were in both biochemical and clinical remission. At 6 months the proportion of patients in clinical remission decreased from 93% to 82%, with an overall relapse rate of 11%. Treatment persistence at 6 months was 77.5%.

Conclusion: Switching patients from IV infliximab to 120 mg fortnightly SC injections is a safe and effective option for the treatment of inflammatory bowel disease, including for those patients on dose-escalated infliximab or with active disease at the time of switch.

背景:英夫利昔单抗(CT-P13 SC)存在一种新的皮下(SC)制剂。本研究的目的是评估从静脉注射(IV)转为SC英夫利昔单抗后临床和内镜反应的持久性。方法:患者接受英夫利昔单抗维持治疗,包括接受剂量优化治疗的患者。根据Harvey-Bradshaw指数的定义,主要结果是6个月时的临床、生化和总体缓解。结果:40名患者从静脉注射转为SC英夫利昔单抗。27人(68%)被诊断为克罗恩病,13人(33%)患有溃疡性结肠炎。23人(58%)每8周静脉注射5 mg/kg英夫利昔单抗,15人(38%)每6周注射5 mg/kg。有2名患者(4%)每6周服用10mg/kg。在他们转换时,37名(93%)患者处于临床缓解期,25名(76%)患者处于生化缓解期,还有25名(76%)患者同时处于生化和临床缓解期。在6个月时,临床缓解的患者比例从93%下降到82%,总体复发率为11%。6个月时的持续治疗率为77.5%。结论:将患者从静脉注射英夫利昔单抗转为每两周注射120 mg SC是治疗炎症性肠病的安全有效的选择,包括那些服用剂量递增的英夫利单抗或在转诊时患有活动性疾病的患者。
{"title":"Safety and efficacy of transitioning inflammatory bowel disease patients from intravenous to subcutaneous infliximab: a single-center real-world experience.","authors":"Angus W Jeffrey,&nbsp;Reeham Abu-Rgeef,&nbsp;Sherman Picardo,&nbsp;Shankar Menon,&nbsp;Kenji So,&nbsp;Kannan Venugopal","doi":"10.20524/aog.2023.0816","DOIUrl":"10.20524/aog.2023.0816","url":null,"abstract":"<p><strong>Background: </strong>A new subcutaneous (SC) formulation exists for infliximab (CT-P13 SC). The aim of this study was to assess the durability of clinical and endoscopic responses after a switch from intravenous (IV) to SC infliximab.</p><p><strong>Methods: </strong>Patients were transitioned on maintenance infliximab, including those with dose-optimized therapy. The primary outcome was clinical, biochemical and overall remission at 6 months, as defined by a Harvey-Bradshaw Index <5 for Crohn's disease or a partial Mayo score <3 for ulcerative colitis, C-reactive protein less than 10 mg/L, and fecal calprotectin less than 100 μg/g.</p><p><strong>Results: </strong>Forty patients were switched from IV to SC infliximab. Twenty-seven (68%) had a diagnosis of Crohn's disease and 13 (33%) had ulcerative colitis. Twenty-three (58%) were on 5 mg/kg of IV infliximab every 8 weeks and 15 (38%) 5 mg/kg every 6 weeks. There were 2 patients (4%) on 10 mg/kg every 6 weeks. At the time of their switch, 37 (93%) patients were in clinical remission, 25 (76%) were in biochemical remission, and 25 (76%) were in both biochemical and clinical remission. At 6 months the proportion of patients in clinical remission decreased from 93% to 82%, with an overall relapse rate of 11%. Treatment persistence at 6 months was 77.5%.</p><p><strong>Conclusion: </strong>Switching patients from IV infliximab to 120 mg fortnightly SC injections is a safe and effective option for the treatment of inflammatory bowel disease, including for those patients on dose-escalated infliximab or with active disease at the time of switch.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"36 5","pages":"549-554"},"PeriodicalIF":2.2,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/64/AnnGastroenterol-36-549.PMC10433247.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10506600","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
Association between smoking status and inpatient outcomes of acute cholangitis in the United States: a propensity matched analysis. 吸烟状况与美国急性胆管炎住院结局的相关性:一项倾向匹配分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.20524/aog.2023.0821
Waqas Rasheed, Anass Dweik, Gnanashree Dharmarpandi, Muhammad Anees, Ola Aljobory, Yasir Al-Hilli

Background: Acute cholangitis (AC) is an infection of the biliary tract superimposed on stasis. This study aimed to investigate the effects of smoking on inpatient outcomes of AC.

Methods: We identified primary AC hospitalizations using the National Inpatient Sample database (2017-2020). Using a 1:1 matching method, we created a matched comparison cohort of AC patients who were non-smokers, based on demographics, hospital characteristics and comorbidities.

Results: We matched 3960 smoker patients with 3960 non-smoker patients within the AC population. Non-smokers were older than smokers (70 vs. 59 years, P<0.001). Smokers had a stronger association with bile duct calculi (74.37% vs. 69.29%, P<0.001) and other bile duct disorders (clots, parasites, extrinsic compression and other rare disorders) (6.82% vs. 5.05%, P=0.011). No significant difference in inpatient mortality, median length of stay (LOS), or median inpatient cost (MIC) was found between the matched cohorts (P>0.05). However, smoking was associated with higher odds of complications, including sepsis without shock (0.88% vs. 0.51%, P=0.042), sepsis with shock (1.26% vs. 0.51%, P<0.001), biliary pancreatitis (6.57% vs. 4.42%, P<0.001) and myocardial infarction (6.19% vs. 3.54%, P<0.001), as well as a greater need for inpatient endoscopic retrograde cholangiopancreatography (ERCP) (72.85% vs. 63.76%, P<0.001) and early ERCP (50.76% vs. 42.32%, P<0.001) compared to non-smokers.

Conclusions: This study found no difference in mortality, LOS, or MIC in acute cholangitis-related hospitalizations associated with smoking. However, smoking was associated with a higher risk of complications and a greater need for ERCP and early ERCP.

背景:急性胆管炎(AC)是一种胆道感染加上胆汁淤积。本研究旨在调查吸烟对AC住院结果的影响。方法:我们使用国家住院患者样本数据库(2017-2020)确定了原发性AC住院患者。使用1:1匹配的方法,我们根据人口统计、医院特征和合并症,创建了一个非吸烟者AC患者的匹配比较队列。结果:我们匹配了AC人群中3960名吸烟者和3960名非吸烟者。不吸烟者的年龄大于吸烟者(70岁vs.59岁,P0.05)。然而,吸烟与并发症的发生率较高相关,包括无休克的败血症(0.88%vs.0.51%,P=0.042),败血症伴休克(1.26%对0.51%,P结论:本研究发现,与吸烟相关的急性胆管炎相关住院患者的死亡率、LOS或MIC没有差异。然而,吸烟与更高的并发症风险以及更大的ERCP和早期ERCP需求相关。
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引用次数: 0
Dual metformin and glucagon-like peptide-1 receptor agonist therapy reduces mortality and hepatic complications in cirrhotic patients with diabetes mellitus. 二甲双胍和胰高血糖素样肽-1受体激动剂双重治疗可降低糖尿病肝硬化患者的死亡率和肝脏并发症。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0814
Daniel J Huynh, Benjamin D Renelus, Daniel S Jamorabo

Background: Type 2 diabetes (T2DM) can accelerate the progression of cirrhosis. The potential for oral diabetes medications to counteract the mortality and morbidity of chronic liver diseases is unclear.

Methods: We compared the effectiveness of dual metformin and glucagon-like peptide-1 receptor agonists (GLP1-RA) vs. metformin treatment alone in reducing mortality and hepatic complications in cirrhotic patients with T2DM. We evaluated propensity score-matched cohorts of T2DM and cirrhosis patients treated with metformin or dual metformin and GLP1-RA therapy. Data were obtained from the TriNetX Research Network. Our outcomes were all-cause mortality, composite risk of hepatic decompensation, and hepatocellular carcinoma (HCC).

Results: Compared to patients on metformin alone, dual metformin and GLP1-RA therapy users had a lower risk for both death (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.42-0.89; P=0.011) and hepatic decompensation (HR 0.65, 95%CI 0.46-0.93; P=0.02) over 5 years. Patients on dual therapy had a lower risk for HCC (HR 0.44, 95%CI 0.26-0.74; P=0.001) compared to mono-metformin therapy patients.

Conclusion: In our multicenter retrospective study, dual therapy was associated with better mortality and morbidity in cirrhosis patients with T2DM compared to those on metformin alone.

背景:2型糖尿病(T2DM)可加速肝硬化的进展。口服糖尿病药物对抗慢性肝病死亡率和发病率的潜力尚不清楚。方法:我们比较了二甲双胍和胰高血糖素样肽-1受体激动剂(GLP1-RA)与二甲双胍单独治疗在降低肝硬化T2DM患者死亡率和肝脏并发症方面的有效性。我们评估了接受二甲双胍或二甲双胍和GLP1-RA双重治疗的T2DM和肝硬化患者的倾向评分匹配队列。数据来自TriNetX研究网络。我们的结果是全因死亡率、肝失代偿和肝细胞癌(HCC)的复合风险。结果:与单独使用二甲双胍的患者相比,二甲双胍和GLP1-RA双重治疗的患者在5年内死亡(危险比[HR]0.61,95%置信区间[CI]0.42-0.89;P=0.011)和肝失代偿(HR 0.65,95%CI 0.46-0.93;P=0.02)的风险较低。与单二甲双胍治疗患者相比,接受双重治疗的患者患HCC的风险较低(HR 0.44,95%CI 0.26-0.74;P=0.001)。结论:在我们的多中心回顾性研究中,与单独使用二甲双胍的患者相比,双重治疗与肝硬化T2DM患者更好的死亡率和发病率相关。
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引用次数: 0
Effect of add-on devices with projections on screening colonoscopy: a systematic review and meta-analysis. 带投影的附加装置对结肠镜筛查的影响:一项系统综述和荟萃分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0820
Magdalini Manti, Georgios Tziatzios, Antonio Facciorusso, Apostolis Papaefthymiou, Daryl Ramai, Ioannis Papanikolaou, Cesare Hassan, Konstantinos Triantafyllou, Konstantina Paraskeva, Paraskevas Gkolfakis

Background: Add-on devices with projections, e.g., Endocuff, Endocuff Vision, EndoRings, and Wingcap, placed on the distal tip of the colonoscope promise to improve the detection of precancerous lesions. We performed a meta-analysis to evaluate the performance of these devices exclusively among individuals undergoing colonoscopy for screening purpose.

Methods: A computerized literature search was performed across MEDLINE and Cochrane Library databases for randomized controlled trials that compared standard colonoscopy (SC) to procedures using add-on devices. The primary outcome was adenoma detection rate (ADR), while secondary outcomes included polyp detection rate (PDR), advanced ADR (AADR), and sessile serrated lesion detection rate (SSLDR). The effect size on study outcomes was calculated using a random-effects model and presented as the risk ratio (RR) and 95% confidence interval (CI).

Results: Seven studies enrolling a total of 5785 patients were included. The use of add-on-devices with projections was associated with a higher ADR compared to SC: 45.9% vs. 41.1%; RR 1.18, 95%CI 1.02-1.37; P=0.03; I2=79%. Although PDR was higher in screening colonoscopies assisted by add-on devices as compared to SC, the difference failed to reach significance: 55.1% vs. 50.8%; RR 1.10, 95%CI 0.96-1.26; P=0.17; I2=75%. No difference was found between procedures assisted by add-on devices with projections and SC colonoscopies in terms of AADR (18.5% vs. 17.6%; RR 1.00, 95%CI 0.79-1.27; P=0.98; I2=56%) or SSLDR (6.8% vs. 5.8%; RR 1.17, 95%CI 0.95-1.44; P=0.15; I2=0%).

Conclusion: Colonoscopy assisted by add-on devices with projections achieves a better ADR compared to SC among individuals undergoing screening for bowel cancer.

背景:在结肠镜远端放置带有投影的附加设备,如Endouff、Endouff Vision、EndoRings和Wingcap,有望提高对癌前病变的检测。我们进行了一项荟萃分析,专门在接受结肠镜检查进行筛查的个体中评估这些设备的性能。方法:在MEDLINE和Cochrane Library数据库中进行计算机化文献检索,以进行随机对照试验,将标准结肠镜检查(SC)与使用附加设备的程序进行比较。主要结果是腺瘤检出率(ADR),次要结果包括息肉检出率(PDR)、晚期ADR(AADR)和无柄锯齿状病变检出率(SSLDR)。使用随机效应模型计算对研究结果的影响大小,并以风险比(RR)和95%置信区间(CI)表示。结果:包括7项研究,共纳入5785名患者。与SC相比,使用带投影的附加装置与更高的ADR相关:45.9%对41.1%;rr1.18,95%CI1.02-1.37;P=0.03;I2=79%。尽管与SC相比,PDR在附加设备辅助的结肠镜筛查中更高,但差异未达到显著性:55.1%对50.8%;rr1.10,95%CI 0.96-1.26;P=0.17;I2=75%。在AADR(18.5%对17.6%;RR 1.00,95%CI 0.79-1.27;P=0.98;I2=56%)或SSLDR(6.8%对5.8%;RR 1.17,95%CI 0.95-1.44;P=0.15;I2=0%)方面,由带投影的附加装置辅助的程序和SC结肠镜检查之间没有发现差异癌症。
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引用次数: 0
The perfect biliary plastic stent: the search goes on. 完美的胆道塑料支架:搜索仍在继续。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0826
Bianca Dinescu, Theodor Voiosu, Andreea Benguş, Radu Bogdan Mateescu, Mihail-Radu Voiosu, Andrei Voiosu

The introduction of biliary plastic stents has been a landmark achievement in the field of endoscopic retrograde cholangiopancreatography, ensuring minimally invasive and highly effective relief of the obstructed biliary system. Attempts to improve the patency and avoid complications after biliary plastic stenting have led to several innovations, but complications due to stent occlusion are still frequent. Because these complications are clinically relevant, and may guide stent choice and patient management, efforts have been made to elucidate the causes of and ways to prevent occlusion of indwelling stents. In this narrative review we focus on biliary plastic stents and discuss the mechanisms of stent occlusion, existing evidence on salient outcomes, as well as options to overcome existing limitations and prolong plastic stent patency.

胆道塑料支架的引入是内窥镜逆行胰胆管造影领域的一项里程碑式成就,确保了胆道系统梗阻的微创高效缓解。为了改善胆道整形支架术后的通畅性和避免并发症,已经有了一些创新,但由于支架闭塞引起的并发症仍然很常见。由于这些并发症具有临床相关性,并可能指导支架的选择和患者管理,因此已努力阐明留置支架堵塞的原因和预防方法。在这篇叙述性综述中,我们重点讨论了胆道塑料支架,并讨论了支架闭塞的机制、显著结果的现有证据,以及克服现有限制和延长塑料支架通畅性的选择。
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引用次数: 0
Efficacy of lumen-apposing metal stents for the management of benign gastrointestinal stricture: a systematic review and meta-analysis. 管腔贴壁金属支架治疗良性胃肠道狭窄的疗效:一项系统综述和荟萃分析。
IF 2.2 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.20524/aog.2023.0819
Suprabhat Giri, Arun Vaidya, Aditya Kale, Vaneet Jearth, Sridhar Sundaram

Background: Lumen-apposing metal stents (LAMS) are an evolving option for the management of benign gastrointestinal (GI) strictures. Multiple studies have reported on the efficacy and safety of LAMS for benign GI strictures, but were limited by their small sample size. Hence, we conducted this meta-analysis to assess the critical role of LAMS for the management of benign GI strictures.

Methods: A literature search of various databases from inception until October 2022 was conducted for studies evaluating the outcome of LAMS in patients with benign GI strictures. The outcomes assessed included technical and clinical success, adverse events including stent migration, and reintervention. Pooled event rates across studies were expressed with summative statistics.

Results: A total of 18 studies (527 patients) were included in the present analysis. The pooled event rates for technical, short-term and long-term clinical success were 99.9% (95% confidence interval [CI] 99.1-100.0), 93.9% (95%CI 90.7-100.0), and 72.8% (95%CI 55.7-90.0), respectively. The pooled incidence of adverse events and stent migration with LAMS for benign GI strictures was 13.5% (95%CI 8.6-18.5) and 10.6% (95%CI 6.0-15.2), respectively. The pooled event rate for reintervention with LAMS for GI strictures was 23.0% (95%CI 15.7-30.3). In a subgroup analysis focusing only on anastomotic strictures there was no significant difference in the pooled event rates for various outcomes.

Conclusions: LAMS have a high technical and short-term clinical success rate, with an acceptable safety profile for the management of benign GI strictures. Further studies are needed to determine the appropriate duration of stent therapy and long-term outcomes.

背景:管腔贴壁金属支架(LAMS)是治疗良性胃肠道(GI)狭窄的一种不断发展的选择。多项研究报道了LAMS治疗良性胃肠道狭窄的有效性和安全性,但受样本量小的限制。因此,我们进行了这项荟萃分析,以评估LAMS在良性胃肠道狭窄管理中的关键作用。方法:从成立到2022年10月,对各种数据库进行文献检索,以评估LAMS在良性胃肠道狭窄患者中的疗效。评估的结果包括技术和临床成功、不良事件(包括支架移位)和再干预。各研究的汇总事件率用总结性统计数据表示。结果:本分析共纳入18项研究(527名患者)。技术、短期和长期临床成功的合并事件发生率分别为99.9%(95%置信区间[CI]99.1-100.0)、93.9%(95%CI 90.7-100.0)和72.8%(95%CI 55.7-90.0)。对于良性胃肠道狭窄,LAMS的不良事件和支架移位的合并发生率分别为13.5%(95%CI 8.6-18.5)和10.6%(95%CI 6.0-15.2)。LAMS再干预胃肠道狭窄的合并事件发生率为23.0%(95%CI 15.7-30.3)。在仅关注吻合口狭窄的亚组分析中,各种结果的合并事件率没有显著差异。结论:LAMS具有较高的技术和短期临床成功率,在治疗良性胃肠道狭窄方面具有可接受的安全性。需要进一步的研究来确定支架治疗的适当持续时间和长期结果。
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引用次数: 0
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Annals of Gastroenterology
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