BMC Gastroenterology最新文献

Background & aims: Portal vein thrombosis (PVT) is a prevalent cirrhosis complication linked to gastrointestinal bleeding. This study aims to assess correlations between PVT classification and the risk of bleeding in patients with cirrhotic PVT.

Methods: This retrospective study included 380 hospitalized cirrhotic patients complicated by PVT, categorized into bleeding and non-bleeding groups based on history of gastrointestinal bleeding. Patients were followed for 12 months to calculate bleeding and recurrence rates. PVT was classified as non-extending or extending, based on the anatomical location and extent. Multivariate logistic regression analyses and propensity score matching (PSM) were used to evaluate the impact of superior mesenteric vein thrombosis (SMVT) extension on bleeding outcomes.

Results: Of 380 patients, 223 (58.7%) were in the bleeding group and 157 (41.3%) in the non-bleeding group; 267 (70.3%) had non-extending PVT and 113 (29.7%) extending PVT (89 involving SMV). During follow-up, 201 (55.5%) experienced bleeding, with a 63.7% recurrence rate in the initial bleeding group. Extended PVT and SMVT-positive patients were significantly more likely to have higher baseline bleeding rates, 12-month bleeding rates, and recurrence rates compared with non-extended and SMVT-negative patients (all P < 0.05). Multivariate analysis identified SMVT extension as an independent risk factor associated with baseline (OR = 2.194; P = 0.010) and 12-month bleeding (OR = 1.962; P = 0.018). PSM confirmed significant associations between SMVT extension and gastrointestinal bleeding at baseline (P = 0.035) and 12 months (P = 0.033).

Conclusions: In patients with cirrhosis and PVT, the extension into the SMV is significantly associated with an increased risk of gastrointestinal bleeding.

Background: Intrapancreatic fat deposition (IPFD) is associated with pancreatic diseases, such as pancreatitis, type 2 diabetes mellitus, and pancreatic cancer, and so on. Although non-invasive imaging has been used to quantify IPFD in clinical settings, this approach does not fully reflect the incidence and prevalence of IPFD, especially its occurrence in a cohort of elderly individuals, which is difficult to determine from routine medical visits. This study aims to systematically evaluate IPFD in elderly individuals, classify its subtypes, and assess their relationship with other pancreatic lesions.

Methods: In the present study, 85 cadaveric pancreatic specimens (median age 88.0 years) without any known pancreatic diseases or prior abdominal surgery were subjected to histopathological and immunohistochemical analyses as needed.

Results: IPFD was classified into three predominant types: fatty infiltration of the pancreas (FIP), fatty replacement of the pancreas (FRP), and irregular intralobular fatty degeneration (IIFD), with 81% of the cases occurring in the dorsal pancreatic anlage (body and tail, and superior aspect of the head). In a univariate analysis, IIFD showed significant age dependence (p = 0.035), with the prevalence increasing with age (p = 0.088 for trend). FIP was strongly associated with inflammatory cell infiltration (p = 0.001), acinar-to-ductal metaplasia (ADM) (p = 0.003), and pancreatic intraepithelial neoplasia (PanIN) (p < 0.001). In the multivariate analyses, the association between age and IIFD was attenuated and no longer statistically significant (OR 1.044, 95% CI 0.991-1.099; p = 0.106). The association with FIP was also nonsignificant. For PanIN, there was a trend toward higher odds (OR 5.136; p = 0.080), but this did not reach statistical significance.

Conclusion: Our study demonstrated at least three distinct pathological subtypes of IPFD: FIP, FRP, and IIFD. Each has unique histopathological features, developmental mechanisms, and potential pathological significance. In the multivariate analysis, although it did not reach statistical significance, a trend was observed for FIP with PanIN, suggesting its potential role in early pancreatic pathology. Similarly, IIFD showed a non-significant trend toward age dependence, highlighting its possible relevance to age-related pancreatic changes. These findings underscore the need for the pathological distinction of IPFD subtypes in future research on pancreatic aging and disease. Furthermore, the embryological preference of IIFD for the dorsal pancreas and its mechanism deserve further exploration.

Background: Despite considerable advancements in recent decades, mortality and complications following liver resection remain high. The volume-outcome relationship has been the subject of extensive research and offers relevant potential for improvement of surgical outcomes. This review aims to examine the impact of hospital and surgeon volume on patient-relevant outcomes in liver resections and synthesize the available evidence.

Methods: A rapid systematic literature review was conducted, searching CENTRAL, Embase, PubMed, and study registries for articles published from 2000 to 2023. Eligible studies investigated the association between hospital or surgeon volume and patient-relevant outcomes in anatomical and non-anatomical liver resections. Study quality was assessed using the ISPOR and ROBINS-E checklists and reported alongside the results. The review protocol registered with PROSPERO (CRD42023398566).

Results: The search yielded 3287 records, of which 38 publications met the inclusion criteria. All included studies were retrospective observational studies. A higher surgical volume was associated with improved patient-relevant outcomes, such as reduced mortality following both anatomical and non-anatomical liver resections and lower rates of postoperative complications. However, the results indicate that the impact of hospital or surgeon volume is limited and likely depends on the respective outcome parameter. A considerable gap remains with respect to long-term outcomes and quality of life, and studies investigating surgeon volume are scarce.

Conclusion: The findings provide evidence supporting a positive association between higher hospital volume and improved patient-relevant outcomes in liver resection. However, surgeon volume remains underexplored and the evidence from subgroups indicates that the impact of hospital or surgeon volume likely depends on study quality, procedure type, volume thresholds, and respective outcome parameters. Patient care could benefit from further research on long-term outcomes as well as quality of life, for which the current evidence is scarce.