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Association between frailty status and complications in patients undergoing surgical excision of malignant esophageal neoplasms. 食管恶性肿瘤手术切除患者虚弱状态与并发症的关系。
IF 2.2 Q2 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0825
Shane Shahrestani, Sammy Sayed, Tania Nasrollahi, Tasha Nasrollahi, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi

Background: Research within the last decade highlights the patients' frailty status as an important predictor of esophageal cancer outcomes, but the literature evaluating frailty's role in these patients remains limited. We evaluated the role of frailty in patients undergoing resection of malignant esophageal neoplasms.

Methods: We used the Nationwide Readmissions Database from 2016 and 2017 to identify patients who underwent excision of a malignant esophageal neoplasm. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Propensity score matching identified 289 frail patients and 281 non-frail patients. Mann-Whitney U testing was performed and receiver operating characteristic (ROC) curves were created, following the creation of logistic regression models for predicting discharge disposition. The area under the curve (AUC) served as a proxy for model performance.

Results: Frail patients had significantly more nonroutine discharges, longer inpatient lengths of stay, higher costs, more acute infections, posthemorrhagic anemia and deep vein thrombosis, and greater mortality (P<0.05). No significant differences were found between the 2 cohorts with respect to readmission rates, pulmonary embolism or dysphagia. Predictive models for patient discharge disposition demonstrated that frailty status in combination with age resulted in better ROC curves (AUC: 0.652) compared to models using age alone (AUC: 0.601).

Conclusions: Frailty was found to be significantly correlated with higher rates of inpatient medical complications following esophagectomy. The inclusion of patient frailty status in predictive models for discharge disposition resulted in a better predictive capacity compared to those using age alone.

背景:过去十年的研究强调,患者的虚弱状态是食管癌症预后的重要预测因素,但评估虚弱在这些患者中的作用的文献仍然有限。我们评估了虚弱在食管恶性肿瘤切除患者中的作用。方法:我们使用2016年和2017年的全国读者数据库来确定接受食管恶性肿瘤切除的患者。使用约翰斯·霍普金斯调整临床组虚弱定义诊断指标对患者虚弱进行询问。倾向评分匹配确定289名虚弱患者和281名非虚弱患者。在建立用于预测出院处置的逻辑回归模型后,进行了Mann-Whitney U测试,并创建了受试者操作特征(ROC)曲线。曲线下面积(AUC)是模型性能的代表。结果:虚弱患者的非常规出院次数明显增多,住院时间更长,费用更高,急性感染次数更多,出现出血性贫血和深静脉血栓形成,以及更高的死亡率(结论:发现虚弱与食管切除术后住院并发症的发生率较高显著相关。与单独使用年龄的预测模型相比,将患者虚弱状态纳入出院处置的预测模型具有更好的预测能力。
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引用次数: 0
Comparison of viscous budesonide and fluticasone in the treatment of patients with eosinophilic esophagitis: a systematic review and meta-analysis. 粘性布地奈德和氟替卡松治疗嗜酸性食管炎患者的比较:一项系统综述和荟萃分析。
IF 2.2 Q2 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.20524/aog.2023.0822
Laith Numan, Mohamad A Kalot, Tim Brotherton, Ahmad Tarakji, Shadi Hamdeh

Background: Steroids are an important pharmacologic treatment in patients with eosinophilic esophagitis (EoE). Fluticasone and budesonide are the 2 main steroid medications used in EOE treatment, but current United States (US) guidelines do not recommend one agent over the other. In this study, we conducted a meta-analysis to compare important patient outcomes when both agents are used.

Methods: A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed from each database's inception to March 29th, 2023. Two independent reviewers systematically identified trials that compared the effect of budesonide vs. fluticasone in the management of EoE. A meta-analysis was performed using a fixed-effects model. The primary outcome was the histologic response (defined as an eosinophil count <15 per high-power field) which reflects the response to treatment.

Results: Three studies met our inclusion criteria and were included in the analysis, with a total of 272 patients. All studies were carried out in the US and 1 was a randomized controlled trial. Our meta-analysis showed no statistically significant difference with the use of budesonide compared to fluticasone in achieving a histologic response (odds ratio 1.29, 95% confidence interval 0.77-2.14; P=0.34; I2=0%).

Conclusion: Our systematic review and meta-analysis indicated no difference between budesonide and fluticasone in achieving a histologic response in patients with EoE.

背景:类固醇是治疗嗜酸性食管炎(EoE)的重要药物。氟替卡松和布地奈德是EOE治疗中使用的两种主要类固醇药物,但目前美国的指南不建议使用一种药物而不是另一种。在这项研究中,我们进行了一项荟萃分析,以比较使用两种药物时的重要患者结果。方法:从数据库成立到2023年3月29日,对MEDLINE、EMBASE、Cochrane对照试验中央登记册、Cochran系统评价数据库和Scopus进行全面检索。两名独立评审员系统地确定了比较布地奈德和氟替卡松治疗EoE效果的试验。使用固定效应模型进行荟萃分析。主要结果是组织学反应(定义为嗜酸性粒细胞计数结果:三项研究符合我们的纳入标准并纳入分析,共272名患者。所有研究均在美国进行,其中一项是随机对照试验。我们的荟萃分析显示,与氟替卡松相比,布地奈德的使用在组织学反应方面没有统计学显著差异(优势比1.29,95%置信区间0.77-2.14;P=0.34;I2=0%)。结论:我们的系统综述和荟萃分析表明,布地奈德和氟替卡松在EoE患者中获得组织学反应方面没有差异。
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引用次数: 0
Prevalence of cirrhotic cardiomyopathy according to different diagnostic criteria: alterations in ultrasonographic parameters of both left and right ventricles before and after stress. 不同诊断标准下肝硬化心肌病的患病率:应激前后左心室和右心室超声参数的变化。
IF 2.2 Q2 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-20 DOI: 10.20524/aog.2023.0824
Dimitrios S Karagiannakis, Katerina Stefanaki, George Anastasiadis, Theodoros Voulgaris, Jiannis Vlachogiannakos

Background: We estimated the frequency of cirrhotic cardiomyopathy (CCM) using all of the proposed diagnostic criteria, to describe the whole spectrum of cardiac alterations, and to investigate the role of stress in unmasking latent cases of CCM.

Methods: Ninety consecutive patients were recruited. CCM was evaluated using the Montreal, the American Society of Echocardiography 2009 criteria, and the 2019 modified criteria of the CCM consortium. A dobutamine stress test was also performed.

Results: Left ventricular diastolic dysfunction (LVDD) was identified in 72 (80%), 36 (40%), and 10 (11.1%) patients based on the above criteria, respectively. None of the patients had right ventricular systolic dysfunction, either at rest or after stress. The dobutamine stress test revealed left systolic dysfunction in 4 (4.5%) patients. There was agreement among the 3 criteria that the presence of LVDD was not associated with the severity of liver disease, using Child-Pugh stage. However, patients with Child-B/C had longer QTc intervals (P=0.004), higher levels of brain natriuretic peptide (P=0.016), and greater echocardiographic E/e' ratio (P<0.001) and E/e'(s) (P=0.003), compared to Child-A patients, while a significant correlation was demonstrated between Child-Pugh score and E/e' (P<0.001), or E/e'(s) (P=0.002).

Conclusions: The prevalence of LVDD seems to be lower than previously considered. Right ventricular function seems to remain unimpaired. A dobutamine stress uncovered only a small percentage of patients with left systolic dysfunction. Nevertheless, the aggravation of several sonographic variables during stress, particularly in Child-B/C patients, potentially indicates a higher risk for clinical heart failure during stressful invasive interventions.

背景:我们使用所有提出的诊断标准来估计肝硬化心肌病(CCM)的发生频率,以描述心脏变化的全谱,并研究应激在揭示潜在CCM病例中的作用。方法:连续招募90名患者。CCM使用蒙特利尔、美国超声心动图学会2009年标准和CCM联合会2019年修订标准进行评估。还进行了多巴酚丁胺应激试验。结果:根据上述标准,分别有72例(80%)、36例(40%)和10例(11.1%)患者发现左心室舒张功能障碍(LVDD)。无论是在休息时还是在压力后,没有一名患者出现右心室收缩功能障碍。多巴酚丁胺负荷试验显示4名(4.5%)患者出现左收缩功能障碍。根据Child-Pugh分期,三项标准一致认为LVDD的存在与肝病的严重程度无关。然而,Child-B/C患者的QTc间期较长(P=0.004)、脑钠肽水平较高(P=0.016),以及更高的超声心动图E/E'比率(结论:LVDD的患病率似乎比以前考虑的要低。右心室功能似乎没有受到损害。多巴酚丁胺压力只发现了一小部分左收缩功能障碍的患者。然而,压力期间几个超声变量的加重,特别是儿童B/C患者,可能表明临床上更高的风险压力性侵入性干预期间的心力衰竭。
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引用次数: 0
Radiofrequency ablation for pancreatobiliary disease: an updated review. 射频消融治疗胰胆管疾病:最新综述。
IF 2.2 Q2 Medicine Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0828
Andrew Canakis, Reem Z Sharaiha

Endoscopic radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option in cases of malignant biliary obstruction, pancreatic cancer, and other pancreatic cystic neoplasms. Intraductal biliary RFA is safe, effective, and confers a survival advantage over stenting alone, where it should be used an adjunct to biliary stenting. Endoscopic ultrasound-guided RFA can also provide pancreatic cyst resolution in patients who are not ideal operative candidates. The aim of this review is to describe the endoscopic applications and associated outcomes of RFA.

内窥镜射频消融(RFA)已成为恶性胆道梗阻、胰腺癌症和其他胰腺囊性肿瘤的微创治疗选择。导管内胆道RFA是安全、有效的,与单独支架置入相比具有生存优势,应作为胆道支架置入的辅助手段。内镜超声引导下的RFA也可以为不理想的手术候选人提供胰腺囊肿的解决方案。这篇综述的目的是描述RFA的内镜应用和相关结果。
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引用次数: 0
The impact of a multidisciplinary team approach on the management of focal pancreatic lesions: a single tertiary center experience. 多学科团队方法对胰腺局灶性病变管理的影响:单一三级中心经验。
IF 2.1 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-25 DOI: 10.20524/aog.2023.0827
Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Martina Pezzullo, Patricia Loi, Julie Navez, Jean Closset, Maria Antonietta Bali, Morgane Van Wettere, Nicki D'Haene, Pieter Demetter, Laurine Verset, Christelle Bouchart, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis

Background: Multidisciplinary team (MDT) meetings aim to optimize patient management. We evaluated the impact of MDT discussions on the management and diagnosis of focal pancreatic lesions in a single tertiary center.

Methods: All patients with an initial diagnosis of solid or cystic pancreatic lesion discussed in our institution's MDT meeting on pancreatic diseases between January 1, 2020, and December 31, 2021, were included. The impact of MDT discussion on patient management, defined as a modification of the initially proposed therapeutic plan after MDT discussion, as well as the criteria leading to this modification, were the primary outcomes. Impact on diagnosis was the secondary outcome.

Results: A total of 522 patients were included. Of these, 185 (35.4%) and 337 (64.6%) had an initial diagnosis of cystic or solid lesion, respectively. The most common referral query was regarding the management plan (349/522; 66.9%). Endoscopy was the procedure most often proposed before MDT discussion (109/522; 20.9%). Overall, the MDT discussion led to modification of the management plan in 377/522 patients (72.2%), with a statistically significant difference between cystic and solid lesions (63.2% vs. 77.2%; P<0.001). Management modifications were mainly driven by revision of cross-sectional radiological images. MDT discussion led to modification of the diagnosis in 92/522 patients (17.6%), with a significant difference regarding cystic lesions (35.7% vs. 7.7%; P<0.001).

Conclusion: MDT discussion impacts the management of patients with cystic and solid pancreatic lesions, leading to a modification of the initially proposed management in two-thirds of them, mainly through revision of cross-sectional imaging.

背景:多学科团队会议旨在优化患者管理。我们评估了MDT讨论对单个三级中心胰腺局灶性病变的管理和诊断的影响。方法:纳入2020年1月1日至2021年12月31日期间在我们机构的胰腺疾病MDT会议上讨论的所有最初诊断为胰腺实性或囊性病变的患者。MDT讨论对患者管理的影响,定义为MDT讨论后对最初提出的治疗计划的修改,以及导致该修改的标准,是主要结果。次要结果是对诊断的影响。结果:共纳入522例患者。其中,185例(35.4%)和337例(64.6%)的初步诊断分别为囊性或实体性病变。最常见的转诊询问是关于管理计划(349/522;66.9%)。内窥镜检查是在MDT讨论之前最常提出的程序(109/522;20.9%)。总体而言,MDT讨论导致377/522名患者(72.2%)修改了管理计划,囊性和实体性病变之间存在统计学上的显著差异(63.2%对77.2%;P结论:MDT的讨论影响了囊性和实质性胰腺病变患者的管理,导致三分之二的患者修改了最初提出的管理方法,主要是通过修改横截面成像。
{"title":"The impact of a multidisciplinary team approach on the management of focal pancreatic lesions: a single tertiary center experience.","authors":"Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Martina Pezzullo, Patricia Loi, Julie Navez, Jean Closset, Maria Antonietta Bali, Morgane Van Wettere, Nicki D'Haene, Pieter Demetter, Laurine Verset, Christelle Bouchart, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis","doi":"10.20524/aog.2023.0827","DOIUrl":"10.20524/aog.2023.0827","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary team (MDT) meetings aim to optimize patient management. We evaluated the impact of MDT discussions on the management and diagnosis of focal pancreatic lesions in a single tertiary center.</p><p><strong>Methods: </strong>All patients with an initial diagnosis of solid or cystic pancreatic lesion discussed in our institution's MDT meeting on pancreatic diseases between January 1, 2020, and December 31, 2021, were included. The impact of MDT discussion on patient management, defined as a modification of the initially proposed therapeutic plan after MDT discussion, as well as the criteria leading to this modification, were the primary outcomes. Impact on diagnosis was the secondary outcome.</p><p><strong>Results: </strong>A total of 522 patients were included. Of these, 185 (35.4%) and 337 (64.6%) had an initial diagnosis of cystic or solid lesion, respectively. The most common referral query was regarding the management plan (349/522; 66.9%). Endoscopy was the procedure most often proposed before MDT discussion (109/522; 20.9%). Overall, the MDT discussion led to modification of the management plan in 377/522 patients (72.2%), with a statistically significant difference between cystic and solid lesions (63.2% vs. 77.2%; P<0.001). Management modifications were mainly driven by revision of cross-sectional radiological images. MDT discussion led to modification of the diagnosis in 92/522 patients (17.6%), with a significant difference regarding cystic lesions (35.7% vs. 7.7%; P<0.001).</p><p><strong>Conclusion: </strong>MDT discussion impacts the management of patients with cystic and solid pancreatic lesions, leading to a modification of the initially proposed management in two-thirds of them, mainly through revision of cross-sectional imaging.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/71/AnnGastroenterol-36-580.PMC10433261.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10506599","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
Endoscopic carbon dioxide insufflation tolerance test on the anal sphincter for anorectal hypofunction: a pilot and feasibility study. 肛门括约肌经内镜二氧化碳吹入耐受性试验治疗肛门直肠功能减退:一项初步和可行性研究。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0805
Akiko Toshimori, Mayo Tanabe, Yuto Shimamura, Daijiro Shiomi, Kei Ushikubo, Yumi Kishi, Hisaki Kato, Mai Fukuda, Yuki Shibata, Kosuke Kunita, Mary Raina Angeli Fujiyoshi, Yusuke Fujiyoshi, Yohei Nishikawa, Kazuya Sumi, Haruo Ikeda, Manabu Onimaru, Naoyuki Uragami, Noboru Yokoyama, Haruhiro Inoue

Background: Anorectal function deteriorates with age. The diagnostic performance of the endoscopic pressure study integrated system (EPSIS), an endoscopic carbon dioxide (CO2) insufflation stress test of the lower esophageal sphincter has been previously evaluated as a diagnostic tool for gastroesophageal reflux disease. We aimed to evaluate the applicability of EPSIS in improving anorectal function. We hypothesized that EPSIS can be applied to the diagnosis of lower gastrointestinal tract disorders.

Methods: This was a pilot, single-center, retrospective study using prospectively collected data between December 2021 and March 2022. It was designed to evaluate the differences in EPSIS rectal pressure measurements between older (≥80 years) and younger (<80 years) patients. At the end of the screening colonoscopy, the colonoscope was fixed in a retroflex position. When bowel movement was observed, CO2 was insufflated to the point where gas leakage occurred through the anus. The measured maximum pressure was defined as EPSIS-rectal pressure max (EPSIS-RP max) and compared between the groups.

Results: Overall, 30 patients were included and examined. The median ages of the <80 and ≥80 years' groups were 53 (range: 27-79) and 82 (range: 80-94) years, respectively, with corresponding median measured EPSIS-RP max of 18.7 (range: 8.5-30.2) and 9.8 (range: 5.4-22.3) mmHg (P<0.001).

Conclusions: Measurement of maximum rectal pressure illustrates the age-related decline in physiological anorectal function. Future studies should consider a loading test using EPSIS to quantify the decline in anorectal function and use it as a routine tool for screening and adjunctive diagnosis of anorectal hypofunction.

背景:肛门直肠功能随着年龄的增长而恶化。内镜压力研究集成系统(EPSIS)的诊断性能,即食管下括约肌的内镜二氧化碳(CO2)吹入压力测试,先前已被评估为胃食管反流疾病的诊断工具。我们旨在评估EPSIS在改善肛门直肠功能方面的适用性。我们假设EPSIS可以应用于下消化道疾病的诊断。方法:这是一项试点、单中心、回顾性研究,使用了2021年12月至2022年3月期间前瞻性收集的数据。旨在评估老年人(≥80岁)和年轻人(2人被吹入肛门至气体泄漏点)之间EPSIS直肠压力测量的差异。测量的最大压力被定义为EPSIS直肠最大压力(EPSIS-RP-max),并在两组之间进行比较。结果:总共纳入并检查了30名患者。结论的中位年龄:最大直肠压力的测量表明与年龄相关的肛门直肠生理功能下降。未来的研究应该考虑使用EPSIS进行负荷测试,以量化肛门直肠功能的下降,并将其作为筛查和辅助诊断肛门直肠功能低下的常规工具。
{"title":"Endoscopic carbon dioxide insufflation tolerance test on the anal sphincter for anorectal hypofunction: a pilot and feasibility study.","authors":"Akiko Toshimori,&nbsp;Mayo Tanabe,&nbsp;Yuto Shimamura,&nbsp;Daijiro Shiomi,&nbsp;Kei Ushikubo,&nbsp;Yumi Kishi,&nbsp;Hisaki Kato,&nbsp;Mai Fukuda,&nbsp;Yuki Shibata,&nbsp;Kosuke Kunita,&nbsp;Mary Raina Angeli Fujiyoshi,&nbsp;Yusuke Fujiyoshi,&nbsp;Yohei Nishikawa,&nbsp;Kazuya Sumi,&nbsp;Haruo Ikeda,&nbsp;Manabu Onimaru,&nbsp;Naoyuki Uragami,&nbsp;Noboru Yokoyama,&nbsp;Haruhiro Inoue","doi":"10.20524/aog.2023.0805","DOIUrl":"10.20524/aog.2023.0805","url":null,"abstract":"<p><strong>Background: </strong>Anorectal function deteriorates with age. The diagnostic performance of the endoscopic pressure study integrated system (EPSIS), an endoscopic carbon dioxide (CO<sub>2</sub>) insufflation stress test of the lower esophageal sphincter has been previously evaluated as a diagnostic tool for gastroesophageal reflux disease. We aimed to evaluate the applicability of EPSIS in improving anorectal function. We hypothesized that EPSIS can be applied to the diagnosis of lower gastrointestinal tract disorders.</p><p><strong>Methods: </strong>This was a pilot, single-center, retrospective study using prospectively collected data between December 2021 and March 2022. It was designed to evaluate the differences in EPSIS rectal pressure measurements between older (≥80 years) and younger (<80 years) patients. At the end of the screening colonoscopy, the colonoscope was fixed in a retroflex position. When bowel movement was observed, CO<sub>2</sub> was insufflated to the point where gas leakage occurred through the anus. The measured maximum pressure was defined as EPSIS-rectal pressure max (EPSIS-RP max) and compared between the groups.</p><p><strong>Results: </strong>Overall, 30 patients were included and examined. The median ages of the <80 and ≥80 years' groups were 53 (range: 27-79) and 82 (range: 80-94) years, respectively, with corresponding median measured EPSIS-RP max of 18.7 (range: 8.5-30.2) and 9.8 (range: 5.4-22.3) mmHg (P<0.001).</p><p><strong>Conclusions: </strong>Measurement of maximum rectal pressure illustrates the age-related decline in physiological anorectal function. Future studies should consider a loading test using EPSIS to quantify the decline in anorectal function and use it as a routine tool for screening and adjunctive diagnosis of anorectal hypofunction.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/0a/AnnGastroenterol-36-437.PMC10304521.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9745501","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
Mechanisms of sarcopenia in liver cirrhosis and the role of myokines. 肝硬化少肌症的机制及肌细胞因子的作用。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-29 DOI: 10.20524/aog.2023.0804
Eleni Geladari, Theodoros Alexopoulos, Meropi D Kontogianni, Larisa Vasilieva, Iliana Mani, Alexandra Alexopoulou

Sarcopenia is a syndrome characterized by a decline in skeletal muscle quantity and/or quality, strength and performance, leading to unfortunate events, such as injurious falls or even death. It is not identical to frailty and malnutrition, even though there is a significant overlap among these syndromes. In patients with liver cirrhosis (LC), sarcopenia is classified as secondary and has been associated with increased morbidity and mortality during the pre- and post-transplantation period. It can be a result of malnutrition, hyperammonemia, low physical activity, endocrine abnormalities, accelerated starvation, metabolic disturbances, altered gut function leading to chronic inflammation, and alcohol abuse. Myokines are peptides mainly synthesized by contracting muscle and adipose tissue cells and may play a key role in the pathophysiology of sarcopenia. More than a hundred myokines have been recognized, but only a few have been investigated. They can be classified as negative regulators, such as myostatin, tumor growth factor-β, activins, growth differentiation factor-11, and positive regulators of muscle growth including follistatin, bone morphogenic proteins, and irisin. So far, only myostatin, follistatin, irisin and decorin have been studied in LC-associated sarcopenia. In this review, we focused on the mechanisms of cirrhosis-related sarcopenia and the role of myokines that have already been studied in the literature, either as markers helping in the diagnostic evaluation of sarcopenia, or as prognostic factors of survival. Standard therapeutic options to prevent or treat sarcopenia in LC are also being reported, as well as the possible therapeutic implication of myokines.

Sarcopenia是一种以骨骼肌数量和/或质量、力量和表现下降为特征的综合征,导致不幸事件,如伤害性跌倒甚至死亡。它与虚弱和营养不良并不相同,尽管这些综合征之间有显著的重叠。在肝硬化(LC)患者中,少肌症被归类为继发性,并与移植前后发病率和死亡率的增加有关。它可能是营养不良、高氨血症、低体力活动、内分泌异常、饥饿加速、代谢紊乱、肠道功能改变导致慢性炎症和酗酒的结果。肌细胞因子是主要通过收缩肌肉和脂肪组织细胞合成的肽,可能在少肌症的病理生理学中发挥关键作用。已经识别了一百多种肌细胞因子,但只有少数被研究过。它们可分为负调节因子,如肌生长抑制素、肿瘤生长因子-β、激活素、生长分化因子-11,以及肌肉生长的正调节因子,包括卵泡抑制素、骨形态发生蛋白和鸢尾素。到目前为止,只有肌肉抑制素、卵泡抑制素、鸢尾素和花色苷被研究用于LC相关的少肌症。在这篇综述中,我们重点讨论了肝硬化相关少肌症的机制和肌细胞因子的作用,这些因子已经在文献中进行了研究,无论是作为有助于少肌症诊断评估的标志物,还是作为生存的预后因素。预防或治疗LC少肌症的标准治疗方案也在报道中,以及肌细胞因子可能的治疗意义。
{"title":"Mechanisms of sarcopenia in liver cirrhosis and the role of myokines.","authors":"Eleni Geladari,&nbsp;Theodoros Alexopoulos,&nbsp;Meropi D Kontogianni,&nbsp;Larisa Vasilieva,&nbsp;Iliana Mani,&nbsp;Alexandra Alexopoulou","doi":"10.20524/aog.2023.0804","DOIUrl":"10.20524/aog.2023.0804","url":null,"abstract":"<p><p>Sarcopenia is a syndrome characterized by a decline in skeletal muscle quantity and/or quality, strength and performance, leading to unfortunate events, such as injurious falls or even death. It is not identical to frailty and malnutrition, even though there is a significant overlap among these syndromes. In patients with liver cirrhosis (LC), sarcopenia is classified as secondary and has been associated with increased morbidity and mortality during the pre- and post-transplantation period. It can be a result of malnutrition, hyperammonemia, low physical activity, endocrine abnormalities, accelerated starvation, metabolic disturbances, altered gut function leading to chronic inflammation, and alcohol abuse. Myokines are peptides mainly synthesized by contracting muscle and adipose tissue cells and may play a key role in the pathophysiology of sarcopenia. More than a hundred myokines have been recognized, but only a few have been investigated. They can be classified as negative regulators, such as myostatin, tumor growth factor-β, activins, growth differentiation factor-11, and positive regulators of muscle growth including follistatin, bone morphogenic proteins, and irisin. So far, only myostatin, follistatin, irisin and decorin have been studied in LC-associated sarcopenia. In this review, we focused on the mechanisms of cirrhosis-related sarcopenia and the role of myokines that have already been studied in the literature, either as markers helping in the diagnostic evaluation of sarcopenia, or as prognostic factors of survival. Standard therapeutic options to prevent or treat sarcopenia in LC are also being reported, as well as the possible therapeutic implication of myokines.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5f/1b/AnnGastroenterol-36-392.PMC10304523.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10104065","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: 1
Alexithymic characteristics and interoceptive abilities are associated with disease severity and levels of C-reactive protein and cytokines in patients with inflammatory bowel disease. 炎症性肠病患者的Alexithymous特征和内感受能力与疾病严重程度以及C反应蛋白和细胞因子水平有关。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-06-14 DOI: 10.20524/aog.2023.0813
Eleni Vinni, Katerina Karaivazoglou, Evanthia Tourkochristou, Efthymios Tsounis, Maria Kalogeropoulou, Georgia Konstantopoulou, Theoni Lourida, Theodora Kafentzi, Efi Lampropoulou, Maria Rodi, Ioanna Aggeletopoulou, Georgia Diamantopoulou, Georgios Theocharis, Konstantinos Thomopoulos, Philippos Gourzis, Athanasia Mouzaki, Christos Triantos

Background: Alexithymia and atypical gut-brain signaling have been linked to the pathophysiology of inflammatory bowel disease (IBD). We herein assessed IBD patients' alexithymia levels and interoceptive abilities, and detected potential correlations with psychological distress, symptom severity and disease activity, and inflammation indices.

Methods: Adult IBD outpatients and healthy controls were recruited. Alexithymia was assessed using the Toronto Alexithymia Scale, interoceptive accuracy using the Heartbeat Counting Test (cardiac interoception) and the Water Load Test-II (gastric interoception), and interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA).

Results: Forty-one patients with Crohn's disease (CD), 16 with ulcerative colitis (UC), and 50 healthy controls were included. In CD patients, the level of externally oriented thinking and total alexithymia score were correlated with disease activity (P=0.027 and P=0.047, respectively), while in UC patients difficulties in identifying emotions were linked to disease activity (P=0.007). In CD patients, the Noticing, Not-Worrying and Emotional Awareness MAIA subscale score were correlated with C-reactive protein levels (P=0.005, P=0.048 and P=0.005), the Noticing subscale score with interleukin (IL)-1β levels (r=-0.350, P=0.039), the Not-Distracting subscale score with IL-6 levels (r=-0.402, P=0.017), and the Emotional Awareness subscale score with IL-1β (r=-0.367, P=0.030) and IL-6 (r=-0.379, P=0.025) levels. Finally, in UC patients, the Not-Worrying subscale score was significantly associated with IL-6 levels (r=-0.532, P=0.049), while difficulties in identifying emotions were linked to IL-8 levels (r=0.604, P=0.022).

Conclusion: Emotional and interoceptive processing is associated with IBD disease activity, suggesting a potential implication for IBD pathophysiology.

背景:述情障碍和非典型肠脑信号传导与炎症性肠病(IBD)的病理生理学有关。我们在此评估了IBD患者的述情障碍水平和内感受能力,并检测了与心理困扰、症状严重程度和疾病活动以及炎症指数的潜在相关性。方法:招募成年IBD门诊患者和健康对照者。使用Toronto Alexithymia量表评估Alexithyria,使用心跳计数测试(心脏内感受)和水负荷测试II(胃内感受)评估内感受准确性,使用内感受意识多维评估(MAIA)评估内感觉敏感性。结果:41名克罗恩病(CD)患者,16名溃疡性结肠炎(UC)患者,包括50名健康对照。在CD患者中,外向思维水平和述情障碍总分与疾病活动相关(分别为P=0.027和P=0.047),而在UC患者中,识别情绪的困难与疾病活动有关(P=0.007),不担心和情绪意识MAIA分量表得分与C反应蛋白水平相关(P=0.005,P=0.048和P=0.005),注意分量表得分和白细胞介素(IL)-1β水平相关(r=-0.350,P=0.039),不分心分量表评分和IL-6水平相关(r=-0.402,P=0.017),情绪意识分量表得分与IL-1β(r=-0.367,P=0.030)和IL-6(r=-0.379,P=0.025)水平有关。最后,在UC患者中,“不担心”分量表得分与IL-6水平显著相关(r=-0.532,P=0.049),而识别情绪的困难与IL-8水平相关(r=0.604,P=0.022)。
{"title":"Alexithymic characteristics and interoceptive abilities are associated with disease severity and levels of C-reactive protein and cytokines in patients with inflammatory bowel disease.","authors":"Eleni Vinni,&nbsp;Katerina Karaivazoglou,&nbsp;Evanthia Tourkochristou,&nbsp;Efthymios Tsounis,&nbsp;Maria Kalogeropoulou,&nbsp;Georgia Konstantopoulou,&nbsp;Theoni Lourida,&nbsp;Theodora Kafentzi,&nbsp;Efi Lampropoulou,&nbsp;Maria Rodi,&nbsp;Ioanna Aggeletopoulou,&nbsp;Georgia Diamantopoulou,&nbsp;Georgios Theocharis,&nbsp;Konstantinos Thomopoulos,&nbsp;Philippos Gourzis,&nbsp;Athanasia Mouzaki,&nbsp;Christos Triantos","doi":"10.20524/aog.2023.0813","DOIUrl":"10.20524/aog.2023.0813","url":null,"abstract":"<p><strong>Background: </strong>Alexithymia and atypical gut-brain signaling have been linked to the pathophysiology of inflammatory bowel disease (IBD). We herein assessed IBD patients' alexithymia levels and interoceptive abilities, and detected potential correlations with psychological distress, symptom severity and disease activity, and inflammation indices.</p><p><strong>Methods: </strong>Adult IBD outpatients and healthy controls were recruited. Alexithymia was assessed using the Toronto Alexithymia Scale, interoceptive accuracy using the Heartbeat Counting Test (cardiac interoception) and the Water Load Test-II (gastric interoception), and interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA).</p><p><strong>Results: </strong>Forty-one patients with Crohn's disease (CD), 16 with ulcerative colitis (UC), and 50 healthy controls were included. In CD patients, the level of externally oriented thinking and total alexithymia score were correlated with disease activity (P=0.027 and P=0.047, respectively), while in UC patients difficulties in identifying emotions were linked to disease activity (P=0.007). In CD patients, the Noticing, Not-Worrying and Emotional Awareness MAIA subscale score were correlated with C-reactive protein levels (P=0.005, P=0.048 and P=0.005), the Noticing subscale score with interleukin (IL)-1β levels (r=-0.350, P=0.039), the Not-Distracting subscale score with IL-6 levels (r=-0.402, P=0.017), and the Emotional Awareness subscale score with IL-1β (r=-0.367, P=0.030) and IL-6 (r=-0.379, P=0.025) levels. Finally, in UC patients, the Not-Worrying subscale score was significantly associated with IL-6 levels (r=-0.532, P=0.049), while difficulties in identifying emotions were linked to IL-8 levels (r=0.604, P=0.022).</p><p><strong>Conclusion: </strong>Emotional and interoceptive processing is associated with IBD disease activity, suggesting a potential implication for IBD pathophysiology.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/e1/AnnGastroenterol-36-412.PMC10304527.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800305","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
Cutaneous Crohn's disease after proctocolectomy for medically refractory colonic Crohn's disease: a case series and review of the literature. 医学难治性结肠克罗恩病顺产术后的皮肤克罗恩病:病例系列和文献综述。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-30 DOI: 10.20524/aog.2023.0811
Sandra Naffouj, Gabriel E Marrero-Rivera, Johan Nordenstam, Kyle T Amber, Itishree Trivedi

Background: Cutaneous Crohn's disease (CCD), also known as metastatic Crohn's disease (CD), is one of the rarest and most challenging cutaneous manifestations of CD. It is characterized by non-caseating granulomatous inflammation of the skin at sites that are non-contiguous with the gastrointestinal (GI) tract. Diagnosis of CCD needs a high clinical suspicion since morphological presentation varies widely and lacks an apparent correlation to the activity of the luminal CD. The onset of CCD in patients without active GI CD is a particularly understudied phenomenon.

Methods: We present a case series of a unique patient group who developed CCD while in remission from a luminal CD perspective, mainly after a proctocolectomy for Crohn's colitis. We also provide a literature review and summary of case reports of CCD after proctocolectomy.

Results: Our 4 adult patients diagnosed with CCD after proctocolectomy presented herein, were successfully treated with high-dose corticosteroids, followed by biologic therapy. Furthermore, a comprehensive review of CCD is provided regarding its pathogenesis, clinical presentation, differential diagnosis, and the evidence behind the available treatments.

Conclusions: CCD should be considered in any CD patient presenting with skin lesions regardless of their disease activity status and history of proctocolectomy. The treatment remains challenging; biologics remain the cornerstone and a multidisciplinary approach is recommended. Larger randomized clinical trials are essential to determine the optimal treatment protocol and to improve outcomes.

背景:皮肤性克罗恩病(CCD),也称为转移性克罗恩氏病(CD),是CD最罕见、最具挑战性的皮肤表现之一。其特征是在与胃肠道不相连的部位出现非干酪样肉芽肿性皮肤炎症。CCD的诊断需要高度的临床怀疑,因为形态学表现差异很大,并且与管腔CD的活性缺乏明显的相关性。在没有活动性胃肠道CD的患者中CCD的发作是一个特别缺乏研究的现象。方法:我们介绍了一个独特的患者组的一系列病例,从管腔CD的角度来看,他们在病情缓解时出现CCD,主要是在克罗恩结肠炎顺产切除术后。我们还提供了文献回顾和总结的CCD病例报告后顺产。结果:我们的4名成人患者在顺产结肠切除术后被诊断为CCD,他们成功地接受了高剂量皮质类固醇治疗,然后进行了生物治疗。此外,对CCD的发病机制、临床表现、鉴别诊断以及现有治疗方法背后的证据进行了全面的综述。结论:任何CD患者,无论其疾病活动状态和顺产切除史如何,都应考虑CCD。治疗仍然具有挑战性;生物制剂仍然是基石,建议采用多学科方法。更大规模的随机临床试验对于确定最佳治疗方案和改善结果至关重要。
{"title":"Cutaneous Crohn's disease after proctocolectomy for medically refractory colonic Crohn's disease: a case series and review of the literature.","authors":"Sandra Naffouj,&nbsp;Gabriel E Marrero-Rivera,&nbsp;Johan Nordenstam,&nbsp;Kyle T Amber,&nbsp;Itishree Trivedi","doi":"10.20524/aog.2023.0811","DOIUrl":"10.20524/aog.2023.0811","url":null,"abstract":"<p><strong>Background: </strong>Cutaneous Crohn's disease (CCD), also known as metastatic Crohn's disease (CD), is one of the rarest and most challenging cutaneous manifestations of CD. It is characterized by non-caseating granulomatous inflammation of the skin at sites that are non-contiguous with the gastrointestinal (GI) tract. Diagnosis of CCD needs a high clinical suspicion since morphological presentation varies widely and lacks an apparent correlation to the activity of the luminal CD. The onset of CCD in patients without active GI CD is a particularly understudied phenomenon.</p><p><strong>Methods: </strong>We present a case series of a unique patient group who developed CCD while in remission from a luminal CD perspective, mainly after a proctocolectomy for Crohn's colitis. We also provide a literature review and summary of case reports of CCD after proctocolectomy.</p><p><strong>Results: </strong>Our 4 adult patients diagnosed with CCD after proctocolectomy presented herein, were successfully treated with high-dose corticosteroids, followed by biologic therapy. Furthermore, a comprehensive review of CCD is provided regarding its pathogenesis, clinical presentation, differential diagnosis, and the evidence behind the available treatments.</p><p><strong>Conclusions: </strong>CCD should be considered in any CD patient presenting with skin lesions regardless of their disease activity status and history of proctocolectomy. The treatment remains challenging; biologics remain the cornerstone and a multidisciplinary approach is recommended. Larger randomized clinical trials are essential to determine the optimal treatment protocol and to improve outcomes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c5/ea/AnnGastroenterol-36-466.PMC10304526.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10104061","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
Safety and indications for endoscopic retrograde cholangiopancreatography in liver transplant patients: an analysis of the United States' National Inpatient Sample database. 肝移植患者内镜逆行胰胆管造影的安全性和适应症:对美国国家住院患者样本数据库的分析。
IF 2.2 Q2 Medicine Pub Date : 2023-07-01 Epub Date: 2023-05-25 DOI: 10.20524/aog.2023.0801
Zahid Ijaz Tarar, Umer Farooq, Mustafa Gandhi, Muhammad Usman Zafar, Saad Saleem, Faisal Kamal

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is performed to treat biliary complications after a liver transplantation; however, the previously available literature on the safety of ERCP in liver transplant patients is limited. We aimed to study the safety of ERCP in liver transplant patients.

Methods: We used a National Inpatient Sample database from 2016-2019 to identify patients who underwent ERCP and had a history of a liver transplantation, using the international classification of diseases, 10th revision. Multivariate logistic regression analysis was conducted to determine the odds of post-ERCP complications in liver transplant recipients.

Results: Liver transplant patients who underwent ERCP had a higher rate of post-ERCP pancreatitis and bleeding compared to the general adult population (11.39% vs. 9.19%, 0.83% vs. 0.53%, respectively). However, the adjusted odds of post-ERCP pancreatitis (adjusted odds ratio [aOR] 1.13, 95% confidence interval [CI] 0.86-1.49; P=0.36) and bleeding (aOR 1.41, 95%CI 0.58-3.46; P=0.45) were similar in both the liver transplant and no-transplant groups. There was no difference in the odds of post-ERCP cholangitis (aOR 1.26, 95%CI 0.80-2.01; P=0.32), and sepsis (aOR 0.94, 95%CI 0.66-1.34; P=0.76) between liver transplant and no transplant groups. Biliary stricture was the most common indication for ERCP in the liver transplant group, whereas choledocholithiasis was the main reason for ERCP in the general adult population.

Conclusions: ERCP is a safe procedure for treating biliary complications in liver transplant patients. The odds of post-ERCP complications (pancreatitis, bleeding, sepsis, cholangitis) in liver transplant patients are comparable to those in patients with no transplantation.

背景:内镜逆行胰胆管造影术(ERCP)用于治疗肝移植术后的胆道并发症;然而,以前关于肝移植患者ERCP安全性的文献是有限的。我们旨在研究肝移植患者ERCP的安全性。方法:我们使用2016-2019年的国家住院患者样本数据库,使用国际疾病分类第10次修订版,确定接受ERCP并有肝移植史的患者。采用多因素逻辑回归分析来确定肝移植受者ERCP术后并发症的发生率。结果:与普通成年人群相比,接受ERCP的肝移植患者发生ERCP后胰腺炎和出血的比率更高(分别为11.39%和9.19%,0.83%和0.53%)。然而,肝移植组和非肝移植组ERCP术后胰腺炎(调整后比值比[aOR]1.13,95%置信区间[CI]0.86-1.49;P=0.36)和出血(aOR1.41,95%CI0.58-3.46;P=0.45)的调整后比值相似。肝移植组和非肝移植组发生ERCP后胆管炎(aOR 1.26,95%CI 0.80-2.01;P=0.32)和败血症(aOR 0.94,95%CI 0.66-1.34;P=0.76)的几率没有差异。在肝移植组中,胆道狭窄是ERCP最常见的指征,而在普通成年人群中,胆总管结石是ERCP的主要原因。结论:ERCP是治疗肝移植患者胆道并发症的安全方法。肝移植患者发生ERCP术后并发症(胰腺炎、出血、败血症、胆管炎)的几率与未进行肝移植的患者相当。
{"title":"Safety and indications for endoscopic retrograde cholangiopancreatography in liver transplant patients: an analysis of the United States' National Inpatient Sample database.","authors":"Zahid Ijaz Tarar,&nbsp;Umer Farooq,&nbsp;Mustafa Gandhi,&nbsp;Muhammad Usman Zafar,&nbsp;Saad Saleem,&nbsp;Faisal Kamal","doi":"10.20524/aog.2023.0801","DOIUrl":"10.20524/aog.2023.0801","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is performed to treat biliary complications after a liver transplantation; however, the previously available literature on the safety of ERCP in liver transplant patients is limited. We aimed to study the safety of ERCP in liver transplant patients.</p><p><strong>Methods: </strong>We used a National Inpatient Sample database from 2016-2019 to identify patients who underwent ERCP and had a history of a liver transplantation, using the international classification of diseases, 10<sup>th</sup> revision. Multivariate logistic regression analysis was conducted to determine the odds of post-ERCP complications in liver transplant recipients.</p><p><strong>Results: </strong>Liver transplant patients who underwent ERCP had a higher rate of post-ERCP pancreatitis and bleeding compared to the general adult population (11.39% vs. 9.19%, 0.83% vs. 0.53%, respectively). However, the adjusted odds of post-ERCP pancreatitis (adjusted odds ratio [aOR] 1.13, 95% confidence interval [CI] 0.86-1.49; P=0.36) and bleeding (aOR 1.41, 95%CI 0.58-3.46; P=0.45) were similar in both the liver transplant and no-transplant groups. There was no difference in the odds of post-ERCP cholangitis (aOR 1.26, 95%CI 0.80-2.01; P=0.32), and sepsis (aOR 0.94, 95%CI 0.66-1.34; P=0.76) between liver transplant and no transplant groups. Biliary stricture was the most common indication for ERCP in the liver transplant group, whereas choledocholithiasis was the main reason for ERCP in the general adult population.</p><p><strong>Conclusions: </strong>ERCP is a safe procedure for treating biliary complications in liver transplant patients. The odds of post-ERCP complications (pancreatitis, bleeding, sepsis, cholangitis) in liver transplant patients are comparable to those in patients with no transplantation.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/d3/AnnGastroenterol-36-459.PMC10304520.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9747469","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
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Annals of Gastroenterology
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