Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Common bile duct stones (CBDs) can typically be treated by endoscopic retrograde cholangiopancreatography (ERCP) in 85-90% of cases. However, in the remaining 10-15% of patients, bile duct stones cannot be extracted. In such cases, the placement of a temporary biliary plastic stent is recommended.

Methods: We conducted a systematic review and meta-analysis (PROSPERO registration number: CRD42023459712; October 2023). An electronic search was carried out using the following databases: PubMed/MEDLINE, Scopus, and CENTRAL (last search: October 20, 2023). All published studies (both randomized clinical trials and non-randomized interventional studies) involving patients who had undergone ERCP for CBDs with incomplete biliary clearance were included. The risk of bias was assessed using the RoB 2.0 and ROBINS-I tools. The confidence in network meta-analysis tool was employed to estimate each study's contribution matrix within the network estimate.

Results: Twenty papers (comprising 902 patients) were selected for qualitative and quantitative synthesis and were included in the standard meta-analysis, while only five studies (254 patients) were used for the network meta-analysis. The pooled success rate of stenting intervention in difficult choledocholithiasis was 79% (95% CI:71-87%). In the network meta-analysis model, ursodeoxycholic acid and single or double stenting resulted in a higher probability of being the most effective treatments.

Conclusions: In cases of incomplete CBD clearance, the insertion of a temporary plastic stent achieves complete clearance in 79% of patients. Although not significantly superior in indirect comparison with stent alone, the adjunctive treatment with ursodeoxycholic acid appears to be the most likely to succeed.

Background and aims: Fecal microbiota transplantation is an effective treatment method for recurrent Clostridioides difficile infection. Widely used enteric tube and colonoscopy methods demonstrate excellent efficacy and safety results. Recent data suggest that new fecal microbiota transplantation methods using oral capsules may provide a less invasive approach. In this study, we aimed to compare primary fecal microbiota transplantation efficacy as well as short- and long-term safety of two different administration routes: oral capsules and enteric tube.

Methods: This retrospective study included 60 consecutive patients who underwent fecal microbiota transplantation for recurrent Clostridioides difficile infection. Thirty participants received 50 oral capsules containing frozen material for a single day and 30 patients received fecal microbiota transplantation via nasoenteric tube. All patients received standard treatment with oral vancomycin 500 mg q.i.d. for at least five days before the procedure. After intervention, patients were followed up for at least six months. Data on Clostridioides difficile infection recurrences and health status were collected and analyzed.

Results: The oral capsules group consisted of 30 patients. Among them, 22 (73.3%) participants experienced resolution of symptoms after a single fecal microbiota transplantation, while eight (26.7%) patients developed recurrent diarrhea within eight weeks. The other 30 patients received treatment via nasoenteric tube. Among them, 24 (80%) patients were cured after a single fecal microbiota transplantation, while six (20%) experienced recurrent disease within eight weeks. The primary efficacy did not show significant differences between the two groups (p=0.85). Throughout the follow-up period, no serious adverse events or fecal microbiota transplantation related deaths were reported in both groups.

Conclusions: Fecal microbiota transplantation with frozen oral capsules is a safe, less invasive method with comparable efficacy to nasoenteric administration route.

Background: Helicobacter pylori (H. pylori) infection remains a significant burden in gastroduodenal diseases. However, contemporary data on the prevalence of H. pylori infection in Germany are limited.

Aim: This study aimed to evaluate the current seroprevalence of H. pylori infection in the East Bavarian region by analyzing antibody levels in patients presenting to a German university hospital.

Methods: Serum samples were collected from both inpatients and outpatients of a German university hospital. H. pylori antibody concentrations were measured using a commercially available assay.

Results: The overall prevalence of H. pylori infection was 24.8% (78/314), with the highest infection rates observed in individuals aged over 60 years. A significant association was found between H. pylori infection and liver cirrhosis, with a prevalence of 36.4% (36/99) in patients with liver cirrhosis compared to 19.5% (42/215) in those without liver cirrhosis (p = 0.002). No significant associations were observed between H. pylori infection and type 2 diabetes or coronary artery disease.

Conclusion: This study highlights a low prevalence in H. pylori seropositivity in the eastern part of Bavaria. In patients with liver cirrhosis, we still see a considerable high prevelance of H. pylori. The findings underscore the importance of continued surveillance to monitor trends in H. pylori prevalence and its associations with extragastric diseases.

Background and aims: Cannabis is a commonly used recreational and medicinal substance and has been shown to have anti-inflammatory and analgesic effects. Previous studies have shown that cannabis may reduce disease severity of pancreatitis. We aim to use nationally available data to further investigate the impact of cannabis on outcomes among patients with chronic pancreatitis (CP).

Methods: Nationwide Inpatient Sample (NIS) 2016-2020 was used to identify patients with CP. Patients were stratified based on the presence of cannabis use. Data was collected regarding patient demographics, comorbidities, and Charlson Comorbidity Index (CCI). The outcomes assessed were sepsis, acute kidney injury (AKI), deep vein thrombosis (DVT), pulmonary embolism (PE), intensive care unit (ICU) admission, acute pancreatitis (AP), pancreatic cancer, total charges, and length of stay. The relationships were analyzed using multivariate logistic regression.

Results: Out of 907,790 hospitalized patients in this study; 52,360 (5.8%) were cannabis users. After adjusting for confounding factors, cannabis use was associated with decreased odds of mortality (aOR=0.47, p<0.001), DVT (aOR=0.71, p<0.001), PE (aOR=0.622, p=0.002), ICU admission (aOR=0.705, p<0.001), pancreatic cancer (aOR=0.730, p=0.021). There was no difference in odds of AKI, sepsis or AP between the two groups.

Conclusions: Our study found that cannabis use is associated with reduced disease severity and better outcomes among patients hospitalized with CP. Further studies are needed to confirm our findings and explore the role of cannabinoids in pancreatitis.

Background and aims: Visualization of lesions on small bowel capsule endoscopy (SBCE) depends on capsule motility. The aim of this study was to assess the delineation of the ampulla of Vater (AoV) across different levels of expertise and reading speeds.

Methods: This was a study whereby de-identified SBCE videos were reviewed by scrolling with mouse wheel and then at a speed of 10 frames per second (10 fps). Data regarding delineation of the AoV and bile was collected.

Results: Thirty patients (63.3% males, 63.5 years +/- SD 7.164) were included. The mean detection rate of AoV was higher when the mouse wheel was used than when compared to 10 fps for trainees (35% vs. 21.7%) and experts (33.8% vs 20.5%). The rate of concordance in the delineation of the AoV amongst experts declined with higher reviewing speeds (κ 0.493, p=0.98 mouse wheel vs κ 0.482, p=0.2 10 fps). Experts had a better agreement in detecting AoV than trainees (κ 0.493, p=0.98 vs 0.482, p=0.2 for mouse wheel and 10 fps respectively for experts: κ 0.135, p=0.75 for mouse wheel and 0.109, p=0.2 at 10 fps).

Conclusions: This study demonstrates that visualization of the AoV is dependent on the level of expertise and capsule speed.