BMC Gastroenterology最新文献

Purpose: This study aimed to investigate the efficacy of measuring lymph node size on preoperative CT imaging to predict pathological lymph node metastasis in patients with colon cancer to enhance diagnostic accuracy and improve treatment planning by establishing more reliable assessment methods for lymph node metastasis.

Methods: We retrospectively analyzed 1,056 patients who underwent colorectal resection at our institution between January 2004 and March 2020. From this cohort, 694 patients with resectable colon cancer were included in the study. We analyzed the relationship between lymph node size on preoperative CT imaging and lymph node metastasis identified on postoperative pathological examination.

Results: The optimal cutoff values for the maximum long diameter and short diameter of regional lymph nodes on preoperative CT were identified as 6.5 mm and 5.5 mm, respectively, with an AUC of 0.7794 and 0.7755, respectively. Notably, the predictive accuracy varied by tumor location. Higher cutoff values were observed in the right-sided colon (maximum long diameter: 7.7 mm, maximum short diameter: 5.9 mm) compared to the left-sided colon (maximum long diameter: 5.8 mm, maximum short diameter: 5.2 mm).

Conclusion: Lymph node size on preoperative CT is a significant predictor of pathological lymph node metastasis in colon cancer. Notably, the optimal cutoff values for predicting lymph node metastasis vary depending on the specific region within the colon.

Background: Neutropenic enterocolitis is a serious gastrointestinal complication that can develop in patients undergoing chemotherapy or other immunosuppressive treatments. It is characterized by inflammation and necrosis of the bowel, and most commonly affects the cecum and ascending colon. Although individual case reports have described the features of NE, a comprehensive synthesis of all the published cases is required.

Methods: A systematic search of the literature databases was conducted to identify all NE case reports. Data on patient demographics, clinical presentation, diagnostic findings, treatment approaches, and outcomes were independently extracted by the five reviewers. Generalized estimating equations were used to examine the associations between variables.

Results: In total, 227 cases from 159 publications met the inclusion criteria. Most cases occur in patients with hematological cancers undergoing chemotherapy. Common presentations include abdominal pain, fever, and diarrhea. Imaging typically shows a thickening of the bowel wall. Broad-spectrum antibiotics and bowel rest were the primary initial treatment. The overall mortality rate was 33.5%. While statistical analyses did not find significant associations, factors showing clinically significant increased odds for mortality included sepsis, multiorgan failure, and isolated ileocecal valve involvement, potentially representing important prognostic indicators.

Conclusion: This systematic review and meta-analysis provides the largest consolidated analysis of NE cases. It identifies typical clinical features and helps characterize risk factors and prognostic indicators to aid in the early diagnosis and management of this potentially lethal complication.

Objective: Summaries of the relationships between the microbiota and liver cirrhosis and their conclusions are not consistent. This study describes microbial differences in patients with liver cirrhosis by performing a meta-analysis.

Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library and collected related articles published before March 10, 2024. Ratio of autochthonous to non-autochthonous taxa was calculated as the cirrhosis dysbiosis ratio (CDR). Using a random-effects model, the standard mean deviation (SMD) and 95% confidence interval (CI) were calculated. We subsequently performed subgroup, sensitivity, and publication bias analyses. cirrhosis dysbiosis ratio.

Results: A total of 53 eligible papers including 5076 participants were included. The pooled estimates revealed a moderately significant reduction in gut microbiome richness in patients with liver cirrhosis compared with controls, including the Shannon, Chao1, observed species, ACE, and PD indices, but no significant difference was observed for the Simpson index. Over 80% of the studies reported significant differences in β diversity. Families Enterobacteriaceae and Pasteurellaceae, belonging to the phylum Proteobacteria, along with the family Streptococcaceae and the genera Haemophilus, Streptococcus, and Veillonella, were significantly associated with liver cirrhosis compared to the control group. In contrast, the healthy group exhibited a higher abundance of the class Clostridia, particularly the families Lachnospiraceae and Ruminococcaceae, which are known for their diversity and role as common gut commensals. Furthermore, the class Bacilli, predominantly represented by the genus Streptococcus, was markedly enriched in the cirrhosis group.

Conclusions: The microbiota richness of liver cirrhosis patients was lower than that of healthy controls. Alterations in gut microbiota linked to liver cirrhosis were characterized by a decrease in Lachnospiraceae, Ruminococcaceae, and Clostridia and an enrichment of Enterobacteriaceae, Pasteurellaceae, Streptococcaceae, Bacilli, and Streptococcus.

Background: Small-bowel angioectasia is commonly diagnosed and managed using double-balloon enteroscopy; however, rebleeding rates can vary significantly. This study aimed to identify and evaluate the clinical predictors of rebleeding in patients with small-bowel angioectasia.

Methods: This retrospective study focused on adult patients who underwent endoscopic management for small bowel vascular lesions (SBVLs). A total of 67 patients were included in the study, all of whom were retrospectively analyzed. The SBVLs were classified using the Yano et al. classification system. Among these, 62 patients with angioectasia who received endoscopic treatment were specifically analyzed. To further investigate the clinical outcomes, the angioectasia group that required endoscopic treatment was divided into two subgroups based on the number of double-balloon enteroscopy (DBE) procedures performed. Univariate and multivariate binary logistic regression analyses were used to establish which predictor variables were significantly related to the recurrence.

Results: A total of 67 patients (mean age 68.1 ± 8.9 years; 44 males) with SBVL, angioectasia was diagnosed in 62 (92.5%) patients, dieulafoy lesion in 1 (1.5%) patient, and arteriovenous malformation in 4 (6%) patients. Similarly, the prevalence of chronic renal failure and diabetes mellitus were significantly higher in the multiple DBE endotherapy group compared to the single DBE endotherapy group (p < 0.001; p = 0.032, respectively). In multivariate logistic regression analysis, anticoagulant use (OR = 9.648, 95% CI: 1.729-53.817, p = 0.010), chronic renal failure (OR = 15.683, 95% CI: 2.727-90.203, p = 0.002), localization of duodenum (OR = 13.509, 95% CI: 1.598-114.168, p = 0.017), and localization of the ileum (OR = 17.100, 95% CI: 1.477-197.905, p = 0.023) were all independently associated with a higher risk of angioectasia recurrence.

Conclusions: The findings of this study demonstrates a high success rate of endoscopic treatment, with a rebleeding rate of 27%, highlighting the significance of this approach. Chronic renal failure, use of anticoagulant, and lesion localization in the duodenum or ileum were identified as independent risk factors for rebleeding, underscoring the need for careful patient monitoring and targeted intervention in these cases.

Background: Early identification of the risk of early cancer-related death (within one year, ECRD) due to recurrence after liver resection for hepatocellular carcinoma (HCC) patients with Barcelona Clinic Liver Cancer (BCLC) stage B/C is important for surgeons to make clinical decisions. Our study aimed to establish a nomogram to predict the ECRD due to recurrence for HCC patients with BCLC stage B/C.

Methods: A total of 672 HCC patients with BCLC stages B/C from four medical centers between January 2012 and December 2018 were included in our study. The patients were randomly divided into a training cohort (n = 404) and a validation cohort (n = 268) at a ratio of 6:4. The least absolute shrinkage and selection operator (LASSO) logistic regression model was used to establish a nomogram model.

Results: In our LASSO-logistic regression model, three variables were independently associated with the ECRD due to recurrence: the alpha-fetoprotein-tumor burden score (ATS score, Odd Ratio [OR]: 1.12, p = 0.001), BCLC stage (OR: 4.39, p < 0.001) and the aspartate transaminase (AST) to alanine transaminase (ALT) ratio (AAR, OR: 1.49, p = 0.027) and we established the nomogram model based on these three variables. The nomogram model showed superior predictive ability in the training cohort (Area under the curve [AUC]: 0.754, 95%CI: 0.703-0.804) and the validation cohort (AUC: 0.741, 95%CI: 0.660-0.823). Compared with the ATS score, BCLC stage and AAR, the nomogram both had better predictive ability in both the training cohort (ATS score, AUC: 0.699, 95%CI: 0.646-0.752, p = 0.010; BCLC stage, AUC: AUC: 0.684, 95%CI: 0.637-0.732, p < 0.001; AAR, AUC: 0.593, 95%CI: 0.522-0.663, p < 0.001) and the validation cohort (ATS score, AUC: 0.659, 95%CI: 0.577-0.740, p = 0.002; BCLC stage, AUC: 0.688, 95%CI: 0.622-0.753, p = 0.009; AAR, AUC: 0.540, 95%CI: 0.436-0.645, p < 0.001).

Conclusions: We established a nomogram that had excellent predictive power for predicting the ECRD due to recurrence in HCC patients with BCLC stage B/C, which might help surgeons to avoid futile liver resection.

Background: Previous studies have suggested an association between inflammatory bowel disease (IBD), and pancreatitis, including acute pancreatitis (AP) and chronic pancreatitis (CP). We aimed to examine the potential causal relationship between IBD and pancreatitis using the Mendelian randomization (MR) method.

Methods: We obtained data from genome-wide association studies (GWASs) in European individuals for IBD and its main subtypes, Crohn's disease (CD) and ulcerative colitis (UC) (31,665 IBD cases, 13,768 UC cases, 17,897 CD cases and 33,977 controls). Four independent summary statistics of pancreatitis from the the European Bioinformatics Institute (EMBL-EBI, 10,630 AP cases and 844,679 controls, 1,424 CP cases and 476,104 controls) and FinnGen Consortium (8,446 AP cases, 4,820 CP cases and 437,418 controls) were used for bidirectional MR analyses and sensitivity analysis. Finally, further meta-analysis was conducted on the MR results.

Results: Generally, IBD is associated with an increased risk of pancreatitis (IBD-AP, OR = 1.050, 95% CI 1.020-1.080, P = 7.20 × 10^-5; IBD-CP, OR = 1.050, 95% CI 1.010-1.090, P = 0.019). In addition, UC increased the risk of pancreatitis (UC-AP, OR = 1.050, 95% CI 1.020-1.070, P = 9.10 × 10^-5; UC-CP, OR = 1.090, 95% CI 1.040-1.140, P = 1.44 × 10^-4) and CD increased the risk of acute pancreatitis (OR = 1.040, 95% CI 1.020-1.060, P = 9.61 × 10^-5). However, no causal association was found between CD and the risk of chronic pancreatitis (P > 0.05). The reverse MR results showed that AP may be associated with a reduced risk of IBD and CD (AP-IBD, OR = 0.880, 95% CI 0.810-0.960, P = 0.003; AP-CD, OR = 0.830, 95% CI 0.730-0.940, P = 0.003). However, there is no causal relationship between AP and the risk of UC, and there is no causal relationship between CP and the risk of IBD and its subtypes(P > 0.05).

Conclusion: In conclusion, based on MR analysis and meta-analysis, our results showed a positive causal effect of IBD on pancreatitis, and subgroup analyses showed that UC and CD may promote the development of acute pancreatitis, whereas UC may promote the development of chronic pancreatitis. Reverse MR analysis suggests that AP may have a potential protective effect on IBD and CD.

Background: Despite the widespread use of percutaneous endoscopic gastrostomy (PEG) in pediatric populations, there is a paucity of data on the indications and outcomes of this procedure in Switzerland. This manuscript presents our experience with PEG indication, outcomes, and related complications in children.

Methods: This single-center retrospective study included patients < 18 years old who underwent PEG placement between 2007 and 2016. We retrieved demographics, PEG indications, associated comorbidities, pre-placement workup, growth parameters up to 12 months, and associated complications.

Results: Eighty-one patients were included, with a median age of 7 years. Common indications included inadequate caloric intake (85%), failure to thrive, and feeding difficulties. Neurological conditions (46%) were the most commonly associated comorbidity. Thirty-six patients (44%) underwent a pH study before PEG placement. There were significant increases in z-scores for weight (p < 0.002) and body mass index (p < 0.001) 12 months after PEG placement. Minor complications were relatively frequent (n = 55, 68%), mainly granulation tissue or local erythema. Two patients had major complications.

Conclusion: PEG is a safe technique for providing long-term enteral nutrition in children, with neurological disease being the most common clinical indication. Our experience demonstrated significant weight gain in children after one year of PEG, with frequent but well-controlled complications.

Background: Endoscopic gallbladder-preserving cholecystolithotomy (EGPC) has become an alternative option for treating cholecystolithiasis. However, developing a new method of EGPC in which the gallbladder wall is not damaged remains a challenge. This study introduced a new EGPC method called endoscopic retrograde cholangiopancreatography (ERCP) combined with extracorporeal shock wave lithotripsy (ESWL), which preserves the integrity of the gallbladder wall in the treatment of cholecystolithiasis complicated with choledocholithiasis.

Methods: In total, six patients (aged 23-72 years, 3 males and 3 females, Han ethnicity) who had large gallbladder stones (diameter ≥ 1 cm) complicated with common bile duct (CBD) stones and who underwent ERCP combined with ESWL at the First Affiliated Hospital of Nanchang University from July 2022 to December 2022 were enrolled. The patients' clinical characteristics, endoscopic treatment and follow-up data were analyzed. A paired t test was performed to compare the differences in the main serological indicators before and after EGPC.

Results: Of the six patients, five completed EGPC, and one failed due to intolerable abdominal pain during ESWL and was subsequently transferred to surgery. With respect to post-EGPC adverse events, one patient developed mild post-ERCP pancreatitis, and no other adverse events occurred. Both the technical success rate and clinical success rate of ERCP combined with ESWL were 83.3% and the incidence of adverse events was 16.7%. The six patients were followed up for an average of 24 months, during which only one patient experienced a recurrence of gallbladder stones at the 3-month follow-up, but no gallbladder stones were found at the 6-month follow-up after oral administration of ursodeoxycholic acid.

Conclusions: ERCP combined with ESWL is a potentially safe and effective treatment for large gallbladder stones.

Trial registration: This study was registered at the Chinese Clinical Trial Registry site. [Registration number: ChiCTR2200060927 ( http://www.chictr.org.cn/ ); registration date: June 14, 2022].

Purpose: The survival benefits of neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC) patients are inconsistent. This study aims to investigate how different tumor regression grades (TRG) influence the survival gains associated with NAC treatment.

Methods: This study compared the treatment outcomes of patients who underwent CSC (neoadjuvant chemotherapy - surgery - adjuvant chemotherapy) with those receiving traditional SC (surgery - adjuvant chemotherapy) treatment. Propensity score matching (PSM) was employed to minimize potential biases arising from differences in baseline characteristics and intervention factors between the treatment groups. After PSM, the CSC cohort was stratified according to TRGs, and their survival outcomes were compared to assess the impact of TRGs on survival gains associated with NAC.

Results: Before PSM, a total of 506 patients were enrolled: 291 in the CSC cohort and 215 in the SC cohort. The CSC cohort had a lower 3-year survival rate (3Y-SR) than the SC cohort (64.6% vs. 76%). In the CSC cohort, patients who achieved pathological complete response (pCR, 12.1%, 26/215) demonstrated significantly improved 3Y-SR (95.5%). After PSM, 110 patients were matched in each cohort. The 3Y-SR was similar between the CSC cohort (68.3%) and the SC cohort (63.6%). In the CSC cohort, 12.7% (14/110) of patients achieved pCR. Subgroup analysis revealed that the pCR subgroup (3Y-SR 100%) was the only subgroup within the CSC cohort that maintained significantly improved survival compared to the SC cohort. Better tumor differentiation was the only pre-treatment factor significantly associated with achieving pCR (p < 0.001).

Conclusion: In this retrospective study, LAGC patients who achieved pCR after NAC demonstrated significantly better survival outcomes compared to other response groups. The study found tumor differentiation was a potential predictor of pCR.

Background: Endoscopic ultrasound-guided transmural drainage (EUS-TD) is widely performed to treat postoperative peripancreatic fluid collection (POPFC). Recent reports on EUS-TD lack a consensus on stent selection. This study aimed to assess the efficacy of EUS-TD for POPFC using an external drainage-based approach.

Methods: We retrospectively examined the medical records of patients with POPFC treated with EUS-TD using external drainage from October 2016 to July 2024. Technical success was defined as successful placement of the external drainage. Clinical success was defined as the reduction in fluid collection, as evidenced by follow-up computed tomography 1 week post-procedure.

Results: This study included 14 patients. The median duration from surgery to endoscopic treatment was 13 (range: 11-26) days. The median procedural time was 26 (range: 13-35) min. The technical success rate was 100%, and 6 Fr endoscopic nasocystic drainage was performed in all patients. The clinical success rate was 100%, and no adverse events were observed. One patient experienced self-removal and required repuncture.

Conclusions: EUS-TD for POPFC with an external drainage-based approach is safe and effective, with a short procedure time. However, this was a retrospective study with a small sample size, suggesting that future prospective studies are warranted.