Translational gastroenterology and hepatology最新文献

Iatrogenic bile duct injury (BDI) is a serious complication that affects patients' quality of life and survival. Surgical resection of the hepatic segment affected has been reported. We describe a case of anatomical resection of segment 5 (S5) using multiple applications of indocyanine green (ICG) fluorescence imaging. A 46-year-old female with BDI during laparoscopic cholecystectomy performed in 2010 was referred to Osaka Metropolitan University Hospital due to recurrent cholangitis. Abdominal computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) identified stumps on bile duct draining segment 5 (B5s), significantly dilated, suggestive of sclerosing cholangitis. Drainage of B5s was not feasible via endoscopic approach and surgical resection of S5 was indicated. ICG (0.5 mg/kg) was administered 3 days prior to surgery [indocyanine green retention rate at 15 minutes (ICGR15): 3.6%]. After an inverted L-shaped incision, atrophic regions of S5 were identified by naked-eye examination and more clearly by near-infrared imaging. Intraoperative ultrasound also identified biliary dilatations in non-fluorescing regions of S5, which suggested abnormal biliary drainage surrounding the atrophic area. In order to remove whole responsible legions causing cholangitis, we decided to indicate anatomic resection of S5 with the use of positive staining technique. The medial and the cranial branch of S5 portal vein (P5) were punctured and stained (0.25 mg ICG mixed with indigo-carmine). Fluorescence imaging delineated S5, including the atrophic area. Hepatic parenchyma was transected using the clamp-crash method under Pringle maneuver. The two major branches of P5 stained previously were identified and ligated. Finally, the root of the dilated hepatic ducts with complete obstruction were identified and divided, 1 cm distal to metal clips. Fluorescence imaging was used to confirm the removal of all stained regions. Then, ICG (1.25 mg) was administered to confirm blood perfusion of the remaining hepatic parenchyma. No bile leaks were identified by naked-eye examination or fluorescence imaging. Postoperative course was uneventful and patient was discharged on day 8. This technique underscores the multifaceted applications of indocyanine green in liver surgery, from preoperative planning and intraoperative guidance to postoperative assessment, thereby enhancing the safety and efficacy of hepatic resections.

Background: Compared to patients with chronic hepatitis B (CHB) in the immune tolerance phase, those in the indeterminate phase (IP) tend to have a higher proportion of liver inflammation and fibrosis, and they usually progress more rapidly to hepatocellular carcinoma (HCC). However, no definitive conclusion has been reached regarding the necessity of antiviral therapy (AVT) for patients in the IP. The present study aims to evaluate the cost-effectiveness of oral antiviral treatment in CHB patients who are in the IP [indeterminate phase-chronic hepatitis B (IP-CHB)] from a healthcare system perspective.

Methods: Cost and effectiveness, measured in quality-adjusted life years (QALYs), were compared in a virtual cohort of 100,000 CHB patients in the IP receiving AVT (scenario I) vs. no treatment (scenario II). A Markov model was used to simulate seven health states related to CHB progression. Transition probabilities and cost data were primarily sourced from published studies. One-way deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the model.

Results: Over 50 years, AVT provided an additional 1.4541 QALYs per patient, with an incremental cost-effectiveness ratio (ICER) of $253.51 per QALY. In a cohort of 100,000 patients, scenario I reduced the incidence of compensated cirrhosis by 11,581 cases, decompensated cirrhosis by 15,436 cases, orthotopic liver transplantation by 718 cases, and HCC by 15,112 cases, while preventing 28,923 deaths, saving over 30% more lives compared to scenario II. Sensitivity analyses confirmed the robustness of our findings, with progression to decompensated cirrhosis being the most influential factor. Probabilistic sensitivity analysis indicated a 100% probability of cost-effectiveness at a willingness-to-pay threshold of one time China's per capita gross domestic product (GDP) in 2023 ($12,690.1).

Conclusions: Oral AVT for IP-CHB is highly cost-effective and significantly reduces the global burden of hepatitis B virus (HBV)-related diseases and mortality.

Background: Pancreatic cancer (PC) has a low chance of resection, and a consistent burden of disease, with pain greatly impacting the quality of life (QoL). We aim to find the most efficient method to treat pain in patients with unresectable PC.

Methods: Our study was registered on PROSPERO (CRD42023477094). On the 29^th of October 2023, a systematic search was performed, including only randomised controlled trials (RCTs) reporting on patients with unresectable PC-associated pain, QoL, survival, analgesics use, and adverse events (AEs). Different random-effects meta-analyses were performed on the Visual Analog Scale (VAS) and AEs. Survival curves of treatments were estimated based on individual patients' data from the reported Kaplan-Meier curves.

Results: Twenty-one RCTs were eligible. At 4 weeks from a moderate to severe baseline pain level, the VAS score decreased to 2.27 [95% confidence interval (CI): 1.63-2.91] with percutaneous celiac plexus neurolysis (P-CPN), and 2.80 (95% CI: 2.17-3.42) with opioids, while in individual studies to 1.30 (95% CI: 0.68-1.92) with endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN), and 1.45 (95% CI: 1.37-1.53) with high-intensity focused ultrasound (HIFU). At 8 and 12 weeks, there was an increase in pain scores for all treatment groups. AEs associated with interventional techniques were transient, the most common being diarrhoea, haemodynamic changes, and procedure-related pain. The median survival time in days was 126.22 (95% CI: 87.21-165.31) for opioids and 86.71 (95% CI: 62.45-136.88) for P-CPN.

Conclusions: Interventional techniques reduce pain and opioid use with few adverse effects; they should be considered more often and earlier in the management of patients with unresectable PC.

Background: Non-alcoholic fatty liver disease (NAFLD) significantly threatens public health. Early diagnosis of NAFLD can prevent adverse outcomes, but the current diagnosis system is still imperfect. Serum markers and their combinations are valuable for detecting diseases, including NAFLD. The advanced lung cancer inflammatory index (ALI) is a comprehensive indicator that reflects the inflammation and nutritional status. Gamma-glutamyl transpeptidase (GGT) is an evaluation index for liver function. This study aims to construct a novel indicator based on ALI and GGT to evaluate NAFLD.

Methods: A cross-sectional survey was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. Binary logistic regression model and multivariate logistic regression model were utilized to examine the associations. Stratified and receiver operating characteristic (ROC) curve analyses were applied to confirm whether the dependent and independent variables had stable associations in the population.

Results: This population-based study included 3,905 American adults. According to binary logistic regression analysis, an increase in ALI × GGT was significantly correlated with an increased risk of liver fibrosis, and multivariate logistic regression analysis confirmed that ALI × GGT was an independent risk factor for liver fibrosis. After grouping adjustment, we found that the diagnostic value of ALI × GGT was greater among participants under 50 years of age, women, those with diabetes mellitus or borderline diabetes, those without hypertension, and those without non-alcoholic fatty liver.

Conclusions: Our study revealed a new indicator, ALI × GGT, which could serve as a potential biomarker for early liver fibrosis in specific populations.

Background: Inflammatory bowel disease (IBD) is a complex chronic disease of the gastrointestinal tract. This systematic review aimed at highlighting the latest findings on the use of machine learning (ML) in the IBD subtypes, ulcerative colitis and Crohn's disease (CD), with a view to obtaining a basis for the clinical application of ML to differentiate between these subtypes.

Methods: We conducted an extensive search of six major databases, including PubMed, Web of Science, Embase, Cochrane Library, Scopus, and Ovid, for entries made between 1 January 2000 and 28 November 2024. The search was focused on identifying studies that used ML to construct diagnostic models for ulcerative colitis and CD. Quality Assessment of Diagnostic Accuracy Studies was used to assess the risk of bias and concerns about the applicability of these studies. The protocol for this review was registered in PROSPERO (CRD42024543036).

Results: After a rigorous screening and assessment process, 31 papers were found to be suitable for inclusion in the review, with a total sample size of 15,140. Most of the included studies were retrospective (n=27, 87%), with the vast majority of studies (n=20, 65%) published between 2021 and 2023. Random forest (RF) was identified as the most commonly used (n=10, 32%), followed by support vector machines (n=9, 29%), and the majority of the studies were focused on model evaluation metrics of ML.

Conclusions: Our findings indicate that ML holds the potential to enhance diagnostic accuracy in distinguishing between ulcerative colitis and CD, particularly through the utilization of models developed from endoscopic and fecal biomarker data based on deep learning and RF.

Background: Graft steatosis and fibrosis detection is a challenge to avoid graft loss. The role of liver biopsy (LB) after liver transplantation (LT) is changing with the emergence of non-invasive tests. Our aim is to evaluate the accuracy of transient elastography (TE) in predicting steatosis and fibrosis post-LT.

Methods: This prospective study was performed on 158 LT patients. Controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) were carried out prior to LB. We built receiver operating characteristic (ROC) curves to evaluate the predictive performance of TE.

Results: Using CAP, the area under the curve (AUC) were 0.872 [95% confidence interval (CI): 0.791-0.953, P=0.01] and 0.708 (95% CI: 0.614-0.801, P<0.001) for the diagnosis of steatosis ≥ S2 and ≥ S1, respectively. Using LSM, the AUC were 0.588 (95% CI: 0.486-0.691, P=0.10) and 0.651 (95% CI: 0.480-0.822, P=0.10) for the diagnosis of fibrosis ≥ F2 and F3-F4, respectively. Cut-offs for CAP were 246.5 dB/m for S1 and 275.5 dB/m for S2. Cut-offs for LSM were 7.65 kPa for ≥ F2 and 9.25 kPa for ≥ F3.

Conclusions: TE may be useful for screening advanced fibrosis and, interestingly, steatosis after LT. TE might gain relevance to track graft metabolic dysfunction and to propose lifestyle interventions.