Clinical and Translational Gastroenterology最新文献

{"title":"Actual and perceived risk of colorectal neoplasia in first-degree relatives of colorectal cancer patients.","authors":"Julia Hibbert, Korbinian Weigl, Kaja Tikk, Stefanie J Klug, Matthias Schwab, Svitlana Igel, Oliver Müller, Marcus Pichler, Enrico N DeToni, Alexander Philipp, Jutta Nagel, Renate Schmelz, Anna-Magdalena Brosch, Frank Kolligs, Michael Hoffmeister, Hermann Brenner","doi":"10.14309/ctg.0000000000000893","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000893","url":null,"abstract":"<p><strong>Background: </strong>Individuals with a family history (FH) of colorectal cancer (CRC) are at increased risk of CRC. We aimed to assess the objective role and subjective perception of risk factors for colorectal neoplasia within this high-risk group.</p><p><strong>Methods: </strong>Questionnaire and screening colonoscopy results were obtained from individuals aged 40-54 years with a reported FH of CRC in a first-degree relative (FDR) in a multicenter cross-sectional study in Germany. Descriptive statistics characterized the cohort and distribution of risk factors. Multivariable logistic regression was used to derive adjusted odds ratios (aOR) and corresponding 95%-confidence intervals (CI) to evaluate factors associated with colorectal neoplasia and with subjectively perceived increased CRC-risk.</p><p><strong>Results: </strong>Among 922 participants, 220 (23.9%) were diagnosed with colorectal neoplasia, 63 (6.8%) of these being advanced lesions. Strong associations with advanced neoplasia were observed for obesity (aOR 2.44, 95%-CI 1.12-5.22), smoking (aOR 1.47, 95%-CI 1.14-1.88 per 10-pack-years) and physical activity <45 minutes/day (aOR 2.51, 95%-CI 1.11-5.25). For smoking and physical activity, but not for obesity, similar associations were also seen with any colorectal neoplasia. No associations were seen with number and age at diagnosis of affected family members. By contrast, the latter factors, but none of the behavioral factors were strongly associated with subjectively perceived CRC-risk.</p><p><strong>Conclusion: </strong>Within a cohort of individuals aged 40-54 years with a FH of CRC, obesity, smoking and lack of physical activity represented the most prominent modifiable risk factors for the development of advanced colorectal neoplasia but did not significantly impact risk perception in these high-risk participants.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMAGING PREDICTORS OF PANCREATIC HEALTH AND ISLET YIELD IN PEDIATRIC TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION.","authors":"Michelle Saad, Nadeen Abu Ata, Syed Ahmad, Christopher Anton, Appakalai N Balamurugan, John Brunner, Lin Fei, Qin Sun, Maisam Abu-El-Haija, Andrew T Trout","doi":"10.14309/ctg.0000000000000891","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000891","url":null,"abstract":"<p><strong>Introduction: </strong>Total pancreatectomy and islet auto-transplantation (TPIAT) can alleviate symptoms in chronic pancreatitis (CP). We aimed to identify pre-TPIAT imaging markers predicting explanted pancreas health and islet yield.</p><p><strong>Methods: </strong>We retrospectively analyzed 104 pediatric TPIAT patients, excluding those with pre-surgical diabetes or pancreatic surgeries. Pancreas parenchymal volume was manually segmented and T1 signal intensity ratio pancreas to spleen (T1 SIRp/s) was calculated. An islet biologist assessed fat infiltration, fibrosis, and islet yield. Logarithmic transformation and regression analyses were used for variance stabilization and predictive modeling.</p><p><strong>Results: </strong>94 patients (60% female, median age 12.5 years) were included. Univariate analyses revealed that an increase in pancreas volume was associated with less fibrosis (OR=0.88 per 5 mL, 95% CI: 0.77-0.99, p<0.05), higher pellet volume, total islet equivalent (TIE) and total islet count (TIC). For advanced fibrosis, an increase in T1 SIRp/s was linked to decreased odds (OR=0.74 per 0.1 unit, 95% CI: 0.59-0.92, p<0.05), whereas a higher Cambridge score was associated with increased odds (OR=1.34 per 1 unit of Cambridge, 95% CI: 1.01-1.77, p<0.05). A model incorporating segmented pancreas volume and T1 SIRp/s predicted advanced fibrosis with an AUC of 0.75 (95%CI: 0.64-0.87). Additionally, models that included larger pancreas volume and the absence of acute pancreatitis predicted TIC and TIE.</p><p><strong>Conclusion: </strong>In children with CP, non-invasive cross-sectional imaging focused on the parenchyma can guide the management, as a smaller parenchymal bulk and lower T1 SIRp/s predict advanced fibrosis, while larger pancreas volume and T1 SIRp/s predict larger pellet volumes.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional and national burden of chronic hepatitis B-related cirrhosis from 1990 to 2021 and projections to 2050: a finding from the Global Burden of Disease Study 2021.","authors":"Jinyan Sun, Jin Guo","doi":"10.14309/ctg.0000000000000890","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000890","url":null,"abstract":"<p><strong>Background: </strong>Chronic hepatitis B (CHB) is a widespread liver infection caused by Hepatitis B virus (HBV), affecting 296 million people globally. The disease often progresses to severe conditions like cirrhosis, hepatocellular carcinoma, and liver failure. This study aimed to evaluate the global, regional, and national burden of chronic hepatitis B-related cirrhosis from 1990 to 2021 and projected the disease development from 2022-2050.</p><p><strong>Methods: </strong>This study utilized data from the GBD 2021 database to analyze the global burden of CHB-related cirrhosis. Metrics such as incidence, prevalence, deaths, DALYs, YLDs, and YLLs were examined. Descriptive analysis explored the burden distribution by gender, age, sociodemographic Index (SDI) levels and country in 1990 and 2021. Trend analysis used Estimated Annual Percentage Change (EAPC) to assess changes in age-standardized rates over time. The Auto-Regressive Integrated Moving Average (ARIMA) model and the Exponential Smoothing (ES) model were applied to predict future trends.</p><p><strong>Results: </strong>In 2021, CHB-related cirrhosis caused 4.8 million incident cases, 432,000 deaths, and 13.9 million DALYs globally, with decreasing trends in age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR) since 1990. Males exhibited higher burdens than females. Age-specific analysis revealed the highest ASIR in those <5 years and the highest ASMR in the 85-89 age group. Regionally, the greatest burden was observed in low SDI areas, with Sierra Leone and Egypt showing the highest rates. Projections indicate stable mortality but declining incidence and slightly increasing DALYs globally by 2050, with minor sex-specific variations.</p><p><strong>Conclusion: </strong>The 2021 Global Burden of Disease Study highlights progress in reducing CHB-related cirrhosis. Targeted efforts and lessons from successful interventions are essential to further alleviate this burden and improve outcomes worldwide.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Trends on Intercostal Chest Tube Placement For Hepatic Hydrothorax Despite Negative Impact on Patient Outcomes: A National Inpatient Sample Database Analysis.","authors":"Aishwarya Thakurdesai, Sheel Patel, Winston Dunn, Paul Kwo, Ashwani K Singal","doi":"10.14309/ctg.0000000000000889","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000889","url":null,"abstract":"<p><strong>Background and aims: </strong>Hepatic hydrothorax (HH) significantly contribute to morbidity in decompensated cirrhosis. Intercostal chest tube (ICT) insertion is discouraged in HH management. We examined trends in ICT use and impact on outcomes in hospitalized HH patients.</p><p><strong>Methods: </strong>A retrospective cohort study (10/2015- 12/2019) was conducted using the National Inpatient Sample (NIS) to identify HH hospitalizations among patients with decompensated cirrhosis. Propensity score matching compared patients who received ICT to those who did not. Outcomes included in-hospital mortality (IHM), length of stay (LOS), total charges (TC), and complications.</p><p><strong>Results: </strong>Among 127,627 cirrhosis hospitalizations, 7843 (6.2%) had HH. Compared to those without HH, these patients had longer LOS, higher TC, and more acute kidney injury (AKI) and sepsis (P<0.001). HH was not associated with increased IHM, but ICT and spontaneous bacterial empyema (SBE) were, each conferring ∼1.5-fold higher odds. ICT was used in 1312 (16.7%) HH cases, with increasing use over time (p=0.037). In a matched cohort of HH hospitalizations (1277 with ICT; 2554 without), ICT use was linked to higher IHM (11.6% vs. 8.5%), longer LOS (14.6 vs. 8.7 days), and greater TC ($196,000 vs. $112,000). Complications were more frequent with ICT: AKI (45% vs. 39%), sepsis (18% vs. 10%), and SBE (12.5% vs. 2%) (P<0.001). ICT use was associated with 44% higher odds of IHM, OR (95% CI): 1.44 (1.15-1.81).</p><p><strong>Conclusion: </strong>HH occurs in 6.2% of cirrhosis hospitalizations, with one of six receiving ICT. ICT use is increasing despite poorer outcomes and greater resource utilization. Studies targeted toward better patient selection as well as provider education are needed to mitigate ICT use in HH.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Obesity on Colon/Liver Resection With Colorectal Liver Metastasis: Analysis of US Nationwide Inpatient Sample 2005-2020.","authors":"Tun-Sung Huang, Jiunn-Chang Lin, Hung-Fei Lai, Po-Chun Wang, Wen-Ching Ko, Kung-Chen Ho","doi":"10.14309/ctg.0000000000000885","DOIUrl":"10.14309/ctg.0000000000000885","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity and overweight are linked to increased postoperative issues in patients with colorectal cancer (CRC). However, the impact of obesity on outcomes of simultaneous colon and liver resections for colorectal liver metastasis (CRLM) is not well studied. This study was to assess the impact of obesity and overweight on outcomes of simultaneous colon/rectum and liver resection in patients with CRLM.</p><p><strong>Methods: </strong>This retrospective study analyzed data from the US Nationwide Inpatient Sample between 2005 and 2020. Regression analysis evaluated associations between obesity/overweight and in-hospital outcomes.</p><p><strong>Results: </strong>Of the 3,269 patients included, 413 were overweight or obese. Overweight and obese patients were younger and had higher rates of comorbidities such as heart failure, diabetes, hypertension, nonalcoholic fatty liver disease, and chronic pulmonary disease compared with nonobese patients. Overweight and obesity were associated with an increased risk of unfavorable discharge (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.00-2.07) and a greater likelihood of developing any complication (aOR 1.27, 95% CI 1.05-1.5). In addition, overweight and obese patients had significantly higher odds of experiencing acute kidney injury (aOR 1.61, 95% CI 1.15-2.25), with the effect being more pronounced in patients younger than 60 years (aOR 1.80, 95% CI 1.13-2.87).</p><p><strong>Discussion: </strong>Overweight and obesity are associated with increased risks of complications, particularly acute kidney injury, and unfavorable discharge in patients undergoing simultaneous colon and liver resection for CRLM.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Short Duration FODMAP Restriction on Breath Gases and Gastrointestinal Symptoms.","authors":"Mythili P Pathipati, Aonghus Shortt, Claire Shortt, Barry McBride, Lorcan O'Rourke, Robert Burke, William D Chey, Lin Chang, Kyle Staller","doi":"10.14309/ctg.0000000000000886","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000886","url":null,"abstract":"<p><strong>Background and aims: </strong>IBS symptoms are thought to relate in part to the accumulation of luminal gases following ingestion of fermentable carbohydrates (i.e. FODMAPs). To understand this relationship, participants monitored breath hydrogen (H2) and methane (CH4) levels using an at-home breath analysis device and recorded symptoms and meals in real-time using the associated app.</p><p><strong>Methods: </strong>We studied 1,984 users from July 2021 to April 2025. Participants first completed a baseline week on their habitual diet, followed by a one-week low FODMAP diet (\"Reset\"), with continued tracking of meals, symptoms, and post-prandial H2 and CH4 levels. Breath H2 and CH4 were measured in parts per million (PPM), and area under the curve (AUC) was calculated to assess gas production during typical waking hours. Participants recorded dietary intake and gastrointestinal symptoms after meals (i.e. non-fasting).</p><p><strong>Results: </strong>Breath H2, CH4, and gastrointestinal symptoms (bloating, abdominal pain, and flatulence) were significantly reduced following FODMAP restriction (all p < 0.0001). Both mild/absent and moderate/severe symptom groups showed significant improvements in symptoms with greater absolute reductions seen in the moderate/severe group. Exhaled gas levels, particularly H2, exhibited diurnal variation corresponding to mealtimes and symptom patterns.</p><p><strong>Conclusion: </strong>This study suggests that breath H2 and CH4 may be influenced by short-term dietary changes and could be a useful biomarker of response to FODMAP restriction. Future studies should investigate whether non-fasting breath H2 and CH4 levels, in response to habitual dietary intake, is predictive of response to the low-FODMAP diet.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single GNAS droplet-based digital PCR analysis of pancreatic cyst fluid: An effective up-front strategy for mucinous cyst diagnosis by EUS-FNA.","authors":"Araujo Ik, Soy G, Ginès A, Sendino O, Fernández-Esparrach G, Sánchez-Montes C, Cuatrecasas M, Archilla I, Montironi C, Silvia Alós, Ausania F, Domínguez-Fraile M, Villagrasa V, López-Guerra M, Colomer D, Vaquero Ec","doi":"10.14309/ctg.0000000000000887","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000887","url":null,"abstract":"<p><strong>Background and aims: </strong>Accurate diagnosis of mucinous pancreatic cystic lesions (mPCNs) remains a clinical challenge. This study investigated the utility of single GNAS ddPCR analysis as a novel approach to refine the diagnostic accuracy of mPCNs using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).</p><p><strong>Methods: </strong>Patients who underwent EUS-FNA and GNAS pancreatic cyst fluid (PCF) analyses for PCL assessment were prospectively enrolled. Cysts were categorized as mPCNs, non-mPCNs, or inconclusive (i)PCLs by integrating increasing information levels: high-resolution imaging and non-DNA PCF features (level 1), GNAS PCF analysis (level 2) and surgical pathology (level 3).</p><p><strong>Results: </strong>140 patients were included, 25 of whom underwent pancreatic surgery. Level 1 identified 68 mPCNs (49%), 24 non-mPCNs (17%), and 48 iPCLs (34%). GNAS mutations were detected in 42/68 (62%) mPCNs, 1/24 (4%) non-mPCNs, and 16/48 (33%) iPCLs. Level 2 increased mPCN detection to 62% and reduced iPCLs by one-third. Mutated GNAS showed 66% sensitivity for diagnosing mPCNs in the whole cohort and 65% in resected cases, outperforming both imaging and non-DNA PCF mucinous criteria, with 100% specificity and limited concordance with CEA, cytology, and fluid viscosity, highlighting its complementary diagnostic value. Cost-effectiveness simulations for iPCLs demonstrated that GNAS-ddPCR significantly reduced diagnostic costs by 24% compared to NGS testing.</p><p><strong>Conclusion: </strong>Single GNAS-ddPCR analysis in PCF supported mPCNs diagnosis in 62% of cases and uncovered 33% of iPCLs as mPCNs with 100% specificity. It adds complementary value to standard cyst fluid markers offering a simple and cost-effective tool for improving PCL diagnosis via EUS-FNA.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unequal burdens: Irritable bowel syndrome in sexual and gender minority communities vs cisgender heterosexual individuals.","authors":"Sara Alejandra Reyes-Diaz, Bryan Adrian Priego-Parra, Héctor Ricardo Ordaz-Alvarez, Emma Lorena Núñez-Jiménez, Claudia Leticia Dorantes-Nava, Fátima Higuera-de la Tijera, Mercedes Amieva-Balmori, Christopher Velez, José María Remes-Troche","doi":"10.14309/ctg.0000000000000883","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000883","url":null,"abstract":"<p><strong>Introduction: </strong>Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that negatively impacts quality of life. Given the significant health disparities faced by the sexual and gender minority (SGM) communities, it is essential to explore IBS within the context of sexual orientation and gender identity (SOGI). This study this study aimed to compare the severity of gastrointestinal and psychological symptoms between cisgender heterosexual and SGM individuals with IBS.</p><p><strong>Materials and methods: </strong>This cross-sectional study recruited 718 participants, with 60.7% being women and a median age of 22. Of these, 542 (75.5%) identified as cisgender heterosexuals, and 176 (24.5%) identified as SGM. Participants, including both IBS patients and healthy controls (HCs), completed a 60-item electronic survey addressing SOGI, the Rome IV IBS criteria, the Hospital Anxiety and Depression Scale (HAD), and the Irritable Bowel Syndrome Severity Scale (IBS-SSS). Statistical analyses included the Student's t-test, Wilcoxon rank-sum test, Kruskal-Wallis test, and Pearson's or Spearman's correlations.</p><p><strong>Results: </strong>SGM individuals with IBS reported significantly higher IBS-SSS scores (p=0.032) and anxiety levels (p=0.032) than their cisgender heterosexual counterparts. Additionally, the prevalence of lesbian women was higher in the IBS group compared to HCs (p=0.041). Cisgender heterosexual participants were more likely to report mild IBS symptoms compared to LGBTQIA+ participants (p=0.025).</p><p><strong>Conclusions: </strong>SGM individuals with IBS experience more severe symptoms and greater psychological distress compared to cisgender heterosexuals. These findings underscore the need to consider SOGI in healthcare to ensure that management strategies for IBS are inclusive and effectively address the unique needs of all individuals.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Indomethacin for Chronic Pancreatitis: Results From the PAIR Randomized Placebo-Controlled Trial.","authors":"Samuel Han, Santhi Swaroop Vege, Phil A Hart, Jami L Saloman, Jun Xu, Liang Li, Zobeida Cruz-Monserrate, Tonya M Palermo, Rachel Hill, Wenrui Hao, Dhiraj Yadav, Mark Topazian, Darwin L Conwell","doi":"10.14309/ctg.0000000000000888","DOIUrl":"10.14309/ctg.0000000000000888","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic pancreatitis (CP) remains difficult to manage with few treatment options. Prior studies have implicated prostaglandin E 2 (PGE 2 ) in mediating chronic inflammation in the pancreas. Therefore, we aimed to evaluate whether indomethacin, a cyclooxygenase-2 enzyme inhibitor, would reduce PGE 2 levels in CP.</p><p><strong>Methods: </strong>In this pilot multicenter randomized controlled trial, participants with CP received oral indomethacin (50 mg) or placebo twice daily for 28 days. Measurement of PGE 2 levels in pancreatic fluid collected endoscopically after secretin administration at baseline and posttreatment (day 28) was performed. Quality of life and pain were also assessed at baseline and posttreatment.</p><p><strong>Results: </strong>A total of 27 participants were randomized (indomethacin = 13, placebo = 14). Although PGE 2 levels decreased after treatment in pancreas fluid, plasma, and saliva in the indomethacin group, there was no significant difference in mean change in pancreas fluid PGE 2 levels between the indomethacin and placebo groups (-457.7 pg/mL vs -840.4 pg/mL, P = 0.25). There was also no significant change in pain severity composite score (-1.3 indomethacin vs -0.5 placebo, P = 0.33), but the improvement in pain interference score (-2.9 indomethacin vs -0.4, P = 0.058) trended toward significance. There was no difference in adverse events between the 2 groups.</p><p><strong>Discussion: </strong>In this phase 1/2 study, oral indomethacin was safe and well tolerated by patients with CP. Although there was no significant difference in change in PGE 2 levels, further studies are needed to determine the effect of indomethacin on the inflammatory pathway of CP and patient-centered outcomes.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Submucosal Dissection and Transanal Endoscopic Microsurgery in the Treatment of Rectal Neuroendocrine Tumors: Systematic Review and Meta-Analysis of the Observational Studies.","authors":"Krzysztof Dąbkowski, Karolina Skonieczna-Żydecka, Katarzyna Gaweł, Wojciech Marlicz, Piotr Szredzki, Andrzej Białek","doi":"10.14309/ctg.0000000000000882","DOIUrl":"10.14309/ctg.0000000000000882","url":null,"abstract":"<p><strong>Introduction: </strong>Rectal neuroendocrine tumors (rNETs) are subepithelial lesions with potential of malignancy. Despite the guidelines recommending that rNETs measuring 10-20 mm should be removed either endoscopic submucosal dissection (ESD) or transanal endoscopic microsurgery (TEM), the management with these entities is still a clinical dilemma. We performed a meta-analysis to compare ESD and TEM regarding method effectiveness and safety in the treatment of rNETs.</p><p><strong>Methods: </strong>PubMed/MEDLINE/Embase/EBSCO/CINAHL was searched up for observational studies analyzing the efficacy and safety of both methods in the treatment of rNETs.</p><p><strong>Results: </strong>A total of 59 observational studies with a total of n = 2,804 participants were included. In a subgroup analysis, we demonstrated that the R0 resection rate was significantly ( P = 0.002) lower for ESD (rate: 0.854) than for TEM (0.924). The recurrence rate differed significantly ( P = 0.008); the lowest (event rate [ER] = 0.015) was found for ESD and the highest for TEM (ER = 0.035). The overall bleeding rate was 0.046 and perforation rate was 0.023 and no significant differences ( P = 0.274 for bleeding, P = 0.808 for perforation) were found by intervention type. The rate of other complications (wound dehiscence, soilage, incontinence, rectovaginal fistula, pelvic pain, retroperitoneal emphysema, coagulation syndrome) was significantly ( P = 0.000) higher for TEM (ER = 0.107) than ESD (ER = 0.013). We also included 4 comparative studies with 490 patients. Using random-effects analysis, we found that the risk ratio for R0 resection was approximately 10% lower for ESD. Our analysis showed significantly greater size ( P = 0.01) and follow-up ( P = 0.03) in the group treated with TEM.</p><p><strong>Discussion: </strong>The efficacy of TEM is higher than ESD with a higher risk of complications in this method. Lesions with a greater size are treated with TEM, and recurrence rate is greater for this procedure. Long follow-up is needed after the treatment of rNETs to detect the recurrence early.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144539215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}