Clinical and Experimental Gastroenterology最新文献

{"title":"Alkaline Phosphatase Pathophysiology with Emphasis on the Seldom-Discussed Role of Defective Elimination in Unexplained Elevations of Serum ALP - A Case Report and Literature Review.","authors":"Michael D Levitt,&nbsp;Sophie M Hapak,&nbsp;David G Levitt","doi":"10.2147/CEG.S345531","DOIUrl":"https://doi.org/10.2147/CEG.S345531","url":null,"abstract":"<p><p>While serum alkaline phosphatase activity has become a routine clinical measurement, we have found that physicians' knowledge of the pathophysiology of this enzyme is almost solely limited to the concept that an elevated serum alkaline phosphatase suggests disease of liver or bone. For example, physicians at all levels of training had no understanding of such basic physiological information as the function of alkaline phosphatase in the liver or how this enzyme is eliminated from the serum. Based on a patient with an enormously elevated alkaline phosphatase, this report provides a review of existing clinically relevant information concerning the pathophysiology of alkaline phosphatase with emphasis on the mechanisms involved in the homeostasis of this enzyme. A novel aspect of this paper is the discussion of the previously neglected concept that defective enzyme elimination could play a major role in the pathogenesis of serum alkaline phosphatase elevations.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"41-49"},"PeriodicalIF":2.4,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/63/ceg-15-41.PMC8934114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40310524","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}

{"title":"A Novel MRI and Clinical-Based Scoring System to Assess Post-Surgery Healing and to Predict Long-Term Healing in Cryptoglandular Anal Fistulas.","authors":"Pankaj Garg,&nbsp;Vipul D Yagnik,&nbsp;Sushil Dawka,&nbsp;Baljit Kaur,&nbsp;Geetha R Menon","doi":"10.2147/CEG.S343254","DOIUrl":"https://doi.org/10.2147/CEG.S343254","url":null,"abstract":"<p><strong>Background: </strong>Anal fistulas cause great uncertainty and anxiety in patients and surgeons alike. This is largely because of the inability to accurately confirm postoperative fistula healing, especially long-term healing. There is no scoring system available that can objectively assess cryptoglandular anal fistulas for postoperative healing and can also accurately predict long-term healing.</p><p><strong>Methods: </strong>Several parameters that could indicate anal fistula healing were assessed. Out of these, six parameters (four MRI-based and two clinical) were finalized, and a weighted score was given to each parameter. A novel scoring system (NSS) was developed. A minimum possible score (zero) indicated complete healing whereas the maximum weighted score (n = 20) indicated confirmed non-healing. Scoring was done with postoperative MRI (at least 3 months post-surgery), then compared with the actual healing status, and subsequently correlated with the final long-term clinical outcome.</p><p><strong>Results: </strong>The NSS was validated in 183 operated cryptoglandular fistula-in-ano patients over a 3-year period in whom 283 MRIs (preoperative plus postoperative) were performed. The postoperative follow-up was 12-48 months (median-30 months). The NSS was found to have a very high positive predictive value (98.2%) and moderately high negative predictive value (83.7%) for long-term fistula healing. Additionally, its sensitivity and specificity in predicting healing were 93.9% and 94.7%, respectively.</p><p><strong>Conclusion: </strong>Thus, this new scoring system is highly accurate and would be a useful tool for surgeons and radiologists managing anal fistulas. By objectivizing the assessment of postoperative healing, it can both ease and streamline management. Moreover, reliable prediction of recurrence-free long-term healing will greatly allay the apprehensions associated with this dreaded disease.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"27-40"},"PeriodicalIF":2.4,"publicationDate":"2022-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/e6/ceg-15-27.PMC8860728.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39670343","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}

{"title":"Mucosal Gene Transcript Signatures in Treatment Naïve Inflammatory Bowel Disease: A Comparative Analysis of Disease to Symptomatic and Healthy Controls in the European IBD-Character Cohort.","authors":"Simen Svendsen Vatn,&nbsp;Jonas Christoffer Lindstrøm,&nbsp;Aina E F Moen,&nbsp;Stephan Brackmann,&nbsp;Tone M Tannæs,&nbsp;Christine Olbjørn,&nbsp;Daniel Bergemalm,&nbsp;Åsa V Keita,&nbsp;Fernando Gomollon,&nbsp;Trond Espen Detlie,&nbsp;Torben Lüders,&nbsp;Rahul Kalla,&nbsp;Alex Adams,&nbsp;Jack Satsangi,&nbsp;Jørgen Jahnsen,&nbsp;Morten H Vatn,&nbsp;Jonas Halfvarson,&nbsp;Petr Ricanek,&nbsp;Hilde Nilsen","doi":"10.2147/CEG.S343468","DOIUrl":"https://doi.org/10.2147/CEG.S343468","url":null,"abstract":"<p><strong>Background: </strong>Studies of the mucosal transcriptomic landscape have given new insight into the pathogenesis of inflammatory bowel disease (IBD). Recently, the predictive biomarker potential of gene expression signatures has been explored. To further investigate the mucosal gene expression in IBD, we recruited a cohort of treatment naïve patients and compared them to both symptomatic and healthy controls.</p><p><strong>Methods: </strong>Altogether, 323 subjects were included: Crohn's disease (N = 75), ulcerative colitis (N = 87) and IBD unclassified (N = 3). Additionally, there were two control groups: symptomatic controls (N = 131) and healthy controls (N = 27). Mucosal biopsies were collected during ileocolonoscopy and gene expression in inflamed and non-inflamed mucosa was explored. Gene expression profiling was performed using Agilent G3 Human Gene Expression 860K v3 One-Color microarray. We recorded information about treatment escalation to anti-TNF agents or surgery, and anti-TNF response, to explore predictive opportunities of the mucosal transcriptome.</p><p><strong>Results: </strong>Gene expression profiles in symptomatic controls in whom IBD had been excluded resembled that of IBD patients and diverged from that of healthy controls. In non-inflamed Crohn's disease and ulcerative colitis, gene set enrichment analysis revealed dysregulation of pathways involved in basic cellular biological processes. Mitochondria-associated pathways were dysregulated both in non-inflamed and inflamed Crohn's disease and ulcerative colitis (>2.6 normalized enrichment scores <-1.8). Gene expression signatures of Crohn's disease and ulcerative colitis did not predict time for treatment escalation (p = 0.175). No significant association was found between gene expression signatures and anti-TNF response.</p><p><strong>Conclusion: </strong>Non-inflamed samples are probably superior to inflamed samples when exploring gene expression signatures in IBD and might reveal underlying mechanisms central for disease initiation. The gene expression signatures of the control groups were related to if they were symptomatic or not, which may have important implications for future study designs.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"5-25"},"PeriodicalIF":2.4,"publicationDate":"2022-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/54/ceg-15-5.PMC8848803.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39648006","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}

{"title":"Non-Invasive Risk Stratification in NAFLD/NASH Patients for Screening EGD.","authors":"John Romano,&nbsp;Thaer Abdelfattah,&nbsp;Paul P Manka,&nbsp;Michael Fuchs,&nbsp;Wing-Kin Syn","doi":"10.2147/CEG.S339850","DOIUrl":"https://doi.org/10.2147/CEG.S339850","url":null,"abstract":"1Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA; 2Division of Gastroenterology and Hepatology, Central Virginia VA Health Care System, Richmond, VA, USA; 3Department of Internal Medicine, University Hospital, Knappschaftskrankenhaus, RuhrUniversity Bochum, Bochum, Germany; 4Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, VA, USA; 5Section of Gastroenterology, Ralph H Johnson VAMC, Charleston, SC, USA; 6Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Universidad del Pa S Vasco/Euskal Herriko Univertsitatea (UPV/EHU), Leioa, Spain Portal hypertension is a major complication of cirrhosis, as it predisposes patients to manifestations of hepatic decompensation, including the development of esophageal variceal bleeding, hepatic encephalopathy, and ascites. Esophageal varices are present in approximately 50% of patients with cirrhosis. The mortality during a variceal bleeding event is high, with estimates ranging from 15% to 20%, being largely dependent upon whether patients have received the standard of care with endoscopic band ligation, vasoactive drugs, and antibiotics. The hepatic venous pressure gradient (HVPG) is considered the gold standard in ascertaining the presence of portal hypertension (PH). Clinically significant portal hypertension (CSPH), which is associated with the development of the aforementioned manifestations of decompensation, has been defined as an HVPG greater than or equal to 10 mmHg. After a diagnosis of cirrhosis, current guidelines recommend screening for esophageal varices with esophagogastroduodenoscopy (EGD). This procedure is carried out to identify patients who are at risk for variceal hemorrhage and would benefit from starting prophylactic therapy with beta blockade. This procedure carries risks, which include any type of respiratory or cardiac suppression from anesthesia, infection, bleeding, and perforation. In addition, a significant majority of patients with varices who are indeed at high risk for bleeding do not have any symptoms from the varices themselves, making EGD a non-ideal screening test. Previous studies suggest that non-invasive blood-based markers are useful to identify patients with liver damage (fibrosis or cirrhosis) and may identify those who will develop complications such as liver cancer. Examples of these markers include the Fibrosis-4 Index (FIB-4), which is a non-invasive estimate of liver scarring in HCV and HBV patients; the NAFLD (Non-Alcoholic Fatty Liver Disease) Fibrosis Score (NFS), which is used to estimate the amount of scarring in the liver based on several laboratory tests; the BARD score, based upon BMI, AST/ALT ratio, and the presence or absence of diabetes; and the AST to Platelet Ratio Index (APRI). We evaluated whether these non-invasive markers and/or any other clinical parameters may be used to identify patients with liver cirrhosis who","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":" ","pages":"1-3"},"PeriodicalIF":2.4,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ca/93/ceg-15-1.PMC8759994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39833530","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}

{"title":"Decreased Rate of Presentation, but Worsened Racial-Ethnic Disparity in Acute Gastrointestinal Bleeding During Coronavirus 2019 Shutdown: A Retrospective Cohort Study.","authors":"Sumana Reddy,&nbsp;Beyla Patel,&nbsp;Luke Baldelli,&nbsp;Rajiv T Majithia,&nbsp;Michael K Dougherty","doi":"10.2147/CEG.S348574","DOIUrl":"https://doi.org/10.2147/CEG.S348574","url":null,"abstract":"<p><strong>Purpose: </strong>In spring 2020, Coronavirus Disease 2019 (COVID-19) \"stay-at-home\" orders may have led to later, more acute disease presentations of emergent conditions such as gastrointestinal bleeding (GIB). In this retrospective cohort study, we compared incidence and severity of GIB during the strictest COVID shutdown to pre-COVID periods.</p><p><strong>Patients and methods: </strong>We compared weekly counts of emergency department (ED) visits for GIB between March 27 and May 7, 2020 (COVID period) and pre-COVID periods in 2019 and 2020 in a US statewide network of hospitals. We compared the severity of GIB presentations using incident rate ratios (IRR) of \"severe\" GIB (requiring ≥4 units of blood, endoscopic therapy, interventional radiology or surgical procedure), intensive care (ICU) admission and shock. We also looked for effect modification of demographic covariates on associations between year and GIB outcomes.</p><p><strong>Results: </strong>Fewer patients presented to ED for GIB during COVID than during the same dates in 2019 (534 versus 904; IRR 0.59, 95% CI 0.53-0.66). A greater proportion of COVID-period ED visits required inpatient admission (73.6% vs 67.8%, p = 0.02) and had severe GIB (19.3% vs 14.9%, p = 0.03). Proportion of patients requiring transfusion (p < 0.001), with shock (p < 0.01), or with critical hemoglobin (p = 0.003) or lactate (p = 0.02) were worse during COVID. Non-white patients experienced disproportionately worse outcomes during COVID than in 2019, with greater absolute counts of shock (65 vs 62, p = 0.01 for interaction) or ICU admission (40 vs 35, p = 0.01 for interaction).</p><p><strong>Conclusion: </strong>Fewer acute GIB presented during the pandemic period compared to the year prior. The severity of pandemic presentations was greater, driven by disproportionately worse outcomes in minorities.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"15 ","pages":"67-77"},"PeriodicalIF":2.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/28/ceg-15-67.PMC9112516.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169705","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}

{"title":"Sexual Dysfunction in Female Patients with Inflammatory Bowel Disease: An Overview.","authors":"Taylor Boyd,&nbsp;Punyanganie S de Silva,&nbsp;Sonia Friedman","doi":"10.2147/CEG.S359367","DOIUrl":"https://doi.org/10.2147/CEG.S359367","url":null,"abstract":"<p><p>Sexual dysfunction is common among females with inflammatory bowel disease and may result in issues involving intimacy, sexual activity, and satisfaction, as well both the formation and preservation of personal relationships. Risk factors for sexual dysfunction include select surgical interventions, medications, mental illnesses, and IBD-related intestinal and extraintestinal comorbidities. In addition, certain demographic factors such as age, disease type and activity may influence the severity of sexual dysfunction. Evaluation of sexual dysfunction may include the use of validated sexual functioning questionnaires, a brief mental health assessment, initial inquiry into vulvovaginal or perineal symptoms, and a gynecologic and GI-focused physical exam. An interdisciplinary care team involving IBD specialists, obstetrician-gynecologists, pelvic floor physical therapists, and primary care physicians may be best suited to provide optimal care and treatment recommendations for patients with sexual dysfunction. Options for management often include pelvic floor physical therapy, biofeedback, and mental health support. Further research is necessary to delineate the impact of IBD activity on sexual dysfunction, to determine if health outcome differences exist depending on surgical approaches utilized during J-pouch operations, and finally to evaluate the care and perceptions of patients with IBD who identify as sexual and gender minorities.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"15 ","pages":"213-224"},"PeriodicalIF":2.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/c4/ceg-15-213.PMC9759977.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10415336","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}

{"title":"Ethnicity Associated Microbial and Metabonomic Profiling in Newly Diagnosed Ulcerative Colitis.","authors":"Ravi Misra,&nbsp;Magali Sarafian,&nbsp;Alexandros Pechlivanis,&nbsp;Nik Ding,&nbsp;Jesus Miguens-Blanco,&nbsp;Julie McDonald,&nbsp;Elaine Holmes,&nbsp;Julian Marchesi,&nbsp;Naila Arebi","doi":"10.2147/CEG.S371965","DOIUrl":"https://doi.org/10.2147/CEG.S371965","url":null,"abstract":"Introduction Ulcerative colitis (UC) differs across geography and ethnic groups. Gut microbial diversity plays a pivotal role in disease pathogenesis and differs across ethnic groups. The functional diversity in microbial-driven metabolites may have a pathophysiologic role and offer new therapeutic avenues. Methods Demographics and clinical data were recorded from newly diagnosed UC patients. Blood, urine and faecal samples were collected at three time points over one year. Bacterial content was analysed by 16S rRNA sequencing. Bile acid profiles and polar molecules in three biofluids were measured using liquid-chromatography mass spectrometry (HILIC) and nuclear magnetic resonance spectroscopy. Results We studied 42 patients with a new diagnosis of UC (27 South Asians; 15 Caucasians) with 261 biosamples. There were significant differences in relative abundance of bacteria at the phylum, genus and species level. Relative concentrations of urinary metabolites in South Asians were significantly lower for hippurate (positive correlation for Ruminococcus) and 4-cresol sulfate (Clostridia) (p<0.001) with higher concentrations of lactate (negative correlation for Bifidobacteriaceae). Faecal conjugated and primary conjugated bile acids concentrations were significantly higher in South Asians (p=0.02 and p=0.03 respectively). Results were unaffected by diet, phenotype, disease severity and ongoing therapy. Comparison of time points at diagnosis and at 1 year did not reveal changes in microbial and metabolic profile. Conclusion Ethnic-related microbial metabolite associations were observed in South Asians with UC. This suggests a predisposition to UC may be influenced by environmental factors reflected in a distinct gene-environment interaction. The variations may serve as markers to identify risk factors for UC and modified to enhance therapeutic response.","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"15 ","pages":"199-212"},"PeriodicalIF":2.4,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/1d/ceg-15-199.PMC9733448.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10324508","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}

{"title":"Exclusive Enteral Nutrition in Adult Crohn's Disease: an Overview of Clinical Practice and Perceived Barriers.","authors":"Roberto de Sire, Olga Maria Nardone, Anna Testa, Giulio Calabrese, Anna Caiazzo, Fabiana Castiglione","doi":"10.2147/CEG.S267172","DOIUrl":"10.2147/CEG.S267172","url":null,"abstract":"<p><p>Recently, the role of nutrition in the management of Crohn's disease (CD) is of increasing interest and the exploration of novel nutritional interventions to improve long-term management of the disease is challenging. So far, the majority of the studies on the role of exclusive enteral nutrition (EEN) in CD are conducted in the pediatric population and have highlighted the efficacy of EEN for achieving mucosal healing. This implicates that a similar approach would be beneficial in adult patients. However, the evidence for EEN in adults is heterogeneous, with meta-analyses reporting it as inferior to steroids while growing data demonstrate improvement in complicated CD. Currently, EEN is less used in adult patients with IBD. Indeed, the lack of palatability of enteral formula leads to difficulties in acceptance and compliance. The search for more tolerable and still effective diets has become an intense area of research aiming to explore the potential role of diet to control inflammation in patients with CD. Thus, this narrative review provides the state-of-the-art on the use of EEN treatment in CD and highlights the perceived barriers to its implementation in adult CD patients.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"493-501"},"PeriodicalIF":2.4,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/38/ceg-14-493.PMC8720860.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39800002","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}

{"title":"Delayed Bleeding After Endoscopic Resection of Colorectal Polyps: Identifying High-Risk Patients.","authors":"Oliver Bendall,&nbsp;Joel James,&nbsp;Katarzyna M Pawlak,&nbsp;Sauid Ishaq,&nbsp;J Andy Tau,&nbsp;Noriko Suzuki,&nbsp;Steven Bollipo,&nbsp;Keith Siau","doi":"10.2147/CEG.S282699","DOIUrl":"https://doi.org/10.2147/CEG.S282699","url":null,"abstract":"<p><p>Delayed post-polypectomy bleeding (DPPB) is a potentially severe complication of therapeutic colonoscopy which can result in hospital readmission and re-intervention. Over the last decade, rates of DPPB reported in the literature have fallen from over 2% to 0.3-1.2%, largely due to improvements in resection technique, a shift towards cold snare polypectomy, better training, adherence to guidelines on periprocedural antithrombotic management, and the use of antithrombotics with more favourable bleeding profiles. However, as the complexity of polypectomy undertaken worldwide increases, so does the importance of identifying patients at increased risk of DPPB. Risk factors can be categorised according to patient, polyp and personnel related factors, and their integration together to provide an individualised risk score is an evolving field. Strategies to reduce DPPB include safe practices relevant to all patients undergoing colonoscopy, as well as specific considerations for patients identified to be high risk. This narrative review sets out an evidence-based summary of factors that contribute to the risk of DPPB before discussing pragmatic interventions to mitigate their risk and improve patient safety.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"477-492"},"PeriodicalIF":2.4,"publicationDate":"2021-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/71/ceg-14-477.PMC8714413.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39652635","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}

{"title":"Emerging Data on Fistula Laser Closure (FiLaC) for the Treatment of Perianal Fistulas; Patient Selection and Outcomes.","authors":"Samuel O Adegbola,&nbsp;Kapil Sahnan,&nbsp;Phillip Tozer,&nbsp;Janindra Warusavitarne","doi":"10.2147/CEG.S269464","DOIUrl":"https://doi.org/10.2147/CEG.S269464","url":null,"abstract":"<p><p>Fistula laser closure (FiLaC) is a relatively new sphincter-sparing technique in fistula surgery that was initially reported in 2011. It involves the radial dissipation of laser energy in the fistula tract and, through a combination of coagulation and shrinkage of the tract, is proposed to result in progressive sealing of fistulas. Early studies have suggested minimal impact on continence and touted the advantage of minimal morbidity with potential of repeat procedures if the technique fails initially. Despite early promising results, ten years on, questions remain on the technique, patient selection and long-term outcomes. This narrative review assesses the evidence reported to-date of radially emitting laser fistula surgery in the treatment of perianal fistulas.</p>","PeriodicalId":10208,"journal":{"name":"Clinical and Experimental Gastroenterology","volume":"14 ","pages":"467-475"},"PeriodicalIF":2.4,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/9a/ceg-14-467.PMC8664604.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39839028","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}