Clinical and Translational Gastroenterology最新文献

{"title":"Association Between Trajectories of Estimated Plasma Volume Status and All-Cause Mortality in Patients With Severe Liver Cirrhosis.","authors":"Peng Yan, Renhui Deng, Laimin Luo","doi":"10.14309/ctg.0000000000001097","DOIUrl":"10.14309/ctg.0000000000001097","url":null,"abstract":"<p><strong>Introduction: </strong>The estimated plasma volume status (ePVS) has been identified as a potential prognostic marker for various critical illnesses. However, its prognostic value, especially regarding the assessment of ePVS changes over time in intensive care unit patients with liver cirrhosis, remains uncertain.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed adult patients with liver cirrhosis in the Medical Information Mart for Intensive Care IV database. We applied group-based trajectory modeling to identify distinct ePVS trajectories, selecting the optimal model based on the Bayesian information criterion, Akaike information criterion, average posterior probability, and clinical interpretability. Kaplan-Meier survival curve was used to compare the mortality in patients with cirrhosis with different ePVS trajectories. Hazard ratios were calculated to elucidate the association between trajectories and prognosis in Cox proportional hazard models. Restricted cubic splines were used to assess the relationship between ePVS and outcomes.</p><p><strong>Results: </strong>A total of 2,146 patients were included for analysis. Group-based trajectory modeling identified 4 different ePVS trajectories: traj 1 (low-level slow increase), traj 2 (medium-level stable), traj 3 (ascend-descend at moderate high level), and traj 4 (high level down slightly). The Kaplan-Meier analysis showed that the mortality probability of traj 4 was the highest among the ePVS trajectories. After adjusting for demographic characteristics, clinical parameters, comorbidities, and treatment, compared with traj 1, traj 4 remained independently associated with an increased 28-day mortality rate (hazard ratio = 1.65, 95% CI: 1.15-2.38, P = 0.007). The restricted cubic splines analysis showed a significant nonlinear association between ePVS and the risk of death. The subgroup analysis results were generally consistent, and no significant interaction was detected.</p><p><strong>Discussion: </strong>Different ePVS trajectories are significantly associated with intensive care unit mortality in patients with liver cirrhosis and may serve as powerful indicators for risk stratification and prognosis assessment in this population.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988199","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":"Cumulative mean pulmonary artery pressure as a marker of hepatic congestion in patients with chronic heart failure.","authors":"Chelsea Pan, Shweta Motiwala, Liviu Klein, Jin Ge","doi":"10.14309/ctg.0000000000001104","DOIUrl":"10.14309/ctg.0000000000001104","url":null,"abstract":"<p><p>Patients with chronic heart failure (HF) are at increased risk of congestive hepatopathy, yet current clinical markers have limited predictive value. In this proof-of-concept study, we leveraged hemodynamic data from the CardioMEMS device to evaluate the association between pulmonary artery pressure and hepatic congestion, as assessed by MELD-XI score and abdominal imaging findings. We demonstrate that cumulative mean pulmonary artery pressure (mPAP) is associated with MELD-XI score, supporting the potential utility of longitudinal PAP monitoring in estimating hepatic dysfunction. The stronger association observed with cumulative mPAP, compared with cross-sectional measurements, suggests that persistent venous congestion over time may be more relevant to hepatic injury than single time-point value.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963083","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":"International Case-Control Study of DNA Methylation Biomarkers for the Minimally Invasive Diagnosis of Esophageal Squamous Cell Carcinoma.","authors":"Yulan Cheng, Adithi Banavar, Ke Ma, Paul Stephen Obwoya, Kija Luhuti, Caleb Tuhumwire, Shayan Gheshlaghi, Kelly Fan, Yifan Yang, Kuangwen Hsieh, Alexander C Hasnain, Yousra Ahmed, Saowanee Ngamruengphong, Mouen Khashab, Vikesh Singh, James P Hamilton, Eun Ji Shin, Patarajarin Akarapipad, Beatrice P Mushi, Msiba Selekwa, Elia Mmbaga, Yona Ringo, Christine Tumuhimbise, Florence Tusiime, Katherine Van Loon, Emmanuel Byaruhanga, Tza-Huei Wang, Samson Okello, Geoffrey C Buckle, Stephen J Meltzer","doi":"10.14309/ctg.0000000000001089","DOIUrl":"10.14309/ctg.0000000000001089","url":null,"abstract":"<p><strong>Introduction: </strong>Esophageal squamous cell carcinoma (ESCC), the most common type of esophageal cancer worldwide, is usually diagnosed by esophagogastroduodenoscopy, an expensive procedure having limited availability in low- and middle-income countries. We therefore developed a diagnostic strategy that applies ESCC-specific DNA methylation biomarkers to nonendoscopically-obtained esophageal mucosal samples.</p><p><strong>Methods: </strong>We used a novel approach based on a search of 5 publicly available GEO and TCGA datasets, which contained 196 organ-specific normal controls. We selected 6 new methylation markers, combining these with 5 markers identified in a previous study. We then performed a case-control analysis of 174 esophageal cytologic samples collected using a swallowable sponge-capsule device, one sample each from 93 patients with ESCC and 81 noncancer control patients. Based on these molecular data, a classification algorithm was built in a training set of 122 patients using the least absolute shrinkage and selection operator (LASSO) method, which was then tested in a separate cohort of 52 patients. Coefficients of the LASSO regression model were used to select markers that contributed most strongly to the classification.</p><p><strong>Results: </strong>All 11 markers tested exhibited significantly higher methylation levels in all 93 ESCC sponge samples than in 81 normal control sponges, with P -values below 0.001. Furthermore, individual areas under the receiver operating characteristic curve (AUCs) for the 11 markers, C1ORF70, PPFIA3, SKOR1, ZNF132, TAC1, JPH4, ZNF542, KLF16, CG20655070, SLC35, and PAX9, were 0.91, 0.90, 0.89, 0.89, 0.89, 0.89, 0.87, 0.87, 0.83, 0.82, 0.81, and 0.65, respectively. Based on LASSO regression applied to all 11 markers, 4 (C1ORF70, CG20655070, SKOR1, and PPFIA3) were retained in our final model. A composite score based on this final model achieved an area under the receiver operating characteristic curve of 0.93 in the 122-patient training cohort and 0.92 in the 52-patient test set.</p><p><strong>Discussion: </strong>When used in combination with a minimally invasive sponge-capsule device, ESCC methylation biomarkers may improve the diagnosis of ESCC. This strategy harbors potential to mitigate the deadly worldwide public health impact of ESCC.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944482","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 Retrograde Appendicitis Therapy Versus Laparoscopic Appendectomy for Acute Appendicitis: A 10-Year Single-Center Retrospective Cohort Study.","authors":"Zixuan Wang, Yongkang Lai, Yong Zhu, Yin Zhu, Linhui Zheng, Shunhua Long, Xu Shu","doi":"10.14309/ctg.0000000000001094","DOIUrl":"10.14309/ctg.0000000000001094","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic retrograde appendicitis therapy (ERAT) is a minimally invasive, organ-preserving treatment of acute appendicitis (AA), but comparative evidence with laparoscopic appendectomy (LA) remains limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 450 patients with AA who underwent ERAT or LA between January 2016 and December 2025. A 1:1 propensity score-matched cohort was established. The primary end point was 1-year treatment success. Secondary end points included perioperative recovery, healthcare utilization, clinically relevant complications, recurrence, and salvage treatment.</p><p><strong>Results: </strong>After matching, 122 patients were included in each group. One-year treatment success was lower after ERAT than after LA (104/122 [85.2%] vs 120/122 [98.4%]; P < 0.001). ERAT was associated with shorter operative/procedure time (48.0 vs 74.0 minutes), shorter postoperative fasting (1.0 vs 3.0 days), lower analgesic use (2.5% vs 64.8%), and lower hospitalization costs (12,306 vs 15,746 CNY; all P < 0.001). Clinically relevant complications occurred in 4.9% and 13.9% of patients, respectively ( P = 0.027). During follow-up, recurrence occurred in 16 ERAT-treated patients and in no LA-treated patients (13.1% vs 0%). Most recurrences occurred within 6 months, and all recurrent cases achieved clinical resolution after salvage treatment.</p><p><strong>Discussion: </strong>ERAT had a lower 1-year treatment success rate than LA but was associated with faster recovery and lower hospitalization costs. Recurrences occurred mainly within 6 months and were successfully managed with salvage treatment. These findings highlight the trade-off between short-term recovery and recurrence risk. Prospective multicenter randomized trials are needed to clarify the clinical role and patient-selection criteria for ERAT.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911102","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":"Topical Vitamin C and N-Acetylcysteine for Reducing Symptoms After Lugol Chromoendoscopy: A Multicenter Randomized Controlled Trial.","authors":"Xuan Fu, Jiali Chang, Shiyu Peng, Chenlu Li, Xinyu Xie, Jian Qin, Jiaxue Li, Guochen Shang, Hao Liu, Weigang Chen, Shuxin Tian","doi":"10.14309/ctg.0000000000001085","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001085","url":null,"abstract":"<p><strong>Background: </strong>Lugol chromoendoscopy improves detection of esophageal squamous neoplasia but can cause short-term retrosternal and pharyngeal discomfort. We evaluated topical vitamin C solution (VCS) and N-acetylcysteine (NAC) after Lugol staining.</p><p><strong>Methods: </strong>In this multicenter, randomized, double-blind, saline-controlled trial, 748 participants were allocated 1:1:1 to 0.9% normal saline (NS), 2% VCS, or 10% NAC after Lugol chromoendoscopy. The co-primary outcomes were overall post-procedure symptoms at 15 and 30 minutes. The main efficacy analysis was complete-case and included 681 participants; extreme-case analyses evaluated the effect of missing outcomes.</p><p><strong>Results: </strong>At 15 minutes, symptoms occurred in 44.34% of the NS group, 8.80% of the VCS group, and 9.43% of the NAC group. Relative risks versus NS were 0.198 (95% CI 0.126-0.312) for VCS and 0.213 (95% CI 0.140-0.322) for NAC. At 30 minutes, the corresponding incidences were 31.67%, 4.17%, and 4.10%, with relative risks of 0.132 (95% CI 0.067-0.257) and 0.129 (95% CI 0.068-0.245). Conclusions were unchanged in extreme-case sensitivity analyses. VAS category distributions favored both active-treatment groups. Median time to onset of decolorization was 11 seconds with NS and 2 seconds with each active solution; median time to complete decolorization was >180, 6, and 12 seconds, respectively.</p><p><strong>Conclusions: </strong>Topical VCS and NAC each reduced short-term symptoms after Lugol chromoendoscopy compared with NS and promoted rapid mucosal decolorization. The direct comparison between VCS and NAC was exploratory and does not establish equivalence or non-inferiority.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918594","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":"The Role and Therapeutic Potential of Gut Microbiota and Their Extracellular Vesicles in Neurological, Cardiovascular, and Metabolic Diseases.","authors":"Zhirong Rao, Linwei Li, Ying Liang, Xiaotian Huang, Qiong Liu","doi":"10.14309/ctg.0000000000001101","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001101","url":null,"abstract":"<p><p>Gut microbiota-derived extracellular vesicles (EVs) have emerged as important mediators of host-microbiota communication, influencing physiological and pathological processes across multiple organ systems through gut-organ axes. These nanoscale vesicles can exert either protective or pathogenic effects depending on their microbial origin, molecular cargo, and host context. Increasing evidence suggests that microbiota-derived EVs contribute to the pathogenesis of neurological, cardiovascular, and metabolic disorders by modulating immune, inflammatory, and metabolic pathways. In addition, their stability, accessibility in biological fluids, and capacity for targeted delivery have generated interest in their use as diagnostic biomarkers and therapeutic platforms. In this narrative review, we summarize current evidence regarding the role of gut microbiota-derived EVs in representative neurological, cardiovascular, and metabolic diseases, highlighting both their detrimental and beneficial effects. We further discuss their translational potential, current challenges in clinical application, and emerging strategies for EV-based diagnostics and therapeutics. Collectively, this review provides a conceptual and translational framework for advancing microbiota-derived EV research toward clinical practice.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918575","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":"Efficacy and Safety of a Novel All In One Device for Colorectal Hybrid ESD: A Multicenter Prospective Study.","authors":"Jiashaer Bahetinuer, Bao-Hui Song, Rong Lin, Rui Li, Lin Miao, You-Xiang Chen, Xu-Cheng Huo, Ping-Hong Zhou, Ming-Yan Cai","doi":"10.14309/ctg.0000000000001099","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001099","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to verify the efficacy and safety of a novel all-in-one device for colorectal hybrid endoscopic submucosal dissection (ESD). We further evaluated its clinical outcomes and cost- effectiveness compared with conventional ESD.</p><p><strong>Methods: </strong>All In One (AIO) assisted hybrid ESD was prospectively performed on 161 patients (173 colorectal neoplasms) across five centers from November 2021 to November 2022.The primary outcome was the en bloc resection rate. Secondary outcomes were the complete resection rate and the incidences of adverse events. For the secondary retrospective comparative analysis, 345 patients (362 colorectal neoplasms) who underwent conventional ESD in the lead center during the same period were retrospectively identified and include to compare with the AIO group for outcomes and cost-effectiveness.</p><p><strong>Results: </strong>In the prospective study, the en bloc resection rate was 97.7% (169/173), and the complete resection rate was 94.2% (163/173). The intraoperative and postoperative bleeding rates were 4.6% (8/173) and 1.2% (2/173). No perforation or abdominal pain was observed, and the incidence of fever was 1.2% (2/173). In the propensity score-matched retrospective comparison, the en bloc resection rates were 97.8% in AIO groups and 96.3% in conventional group (p=0.722). The complete resection rates were 94.8% in both groups. There was no difference between the adverse events rates (all p>0.05). It also demonstrated significantly reduced procedural time and costs with AIO assisted hybrid ESD (both p<0.001).</p><p><strong>Conclusions: </strong>The novel AIO device for colorectal hybrid ESD is safe and effective. It also reduced the procedural time and cost compared to convention ESD.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911011","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":"Greener Choices in Biliary Imaging: A Prospective Carbon Footprint Comparison of Endoscopic Ultrasound Versus Magnetic Resonance Cholangiopancreatography for Intermediate-Likelihood Choledocholithiasis.","authors":"Hardik Rughwani, Nitin Jagtap, David M de Jong, Abhishek Tyagi, Tharani Putta, Ashirwad Pasumarthy, Abul Khair Khan, Rakesh Kalapala, Mohan Ramchandani, Sundeep Lakhtakia, D Nageshwar Reddy","doi":"10.14309/ctg.0000000000001098","DOIUrl":"10.14309/ctg.0000000000001098","url":null,"abstract":"<p><strong>Introduction: </strong>Health care accounts for nearly 5% of global greenhouse gas emissions, and medical imaging is among its most energy-intensive activities. For intermediate-likelihood common bile duct stones, endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are both guideline-endorsed with comparable diagnostic accuracy, yet their environmental costs have never been directly compared.</p><p><strong>Methods: </strong>In this prospective study, we measured the per-procedure carbon footprint of EUS and MRCP using the Greenhouse Gas Protocol and India's grid emission factor. We recorded EUS procedure times individually; MRCP emissions were derived from a validated power model that captures the continuous cryocooler load maintaining magnet superconductivity around the clock, with shared infrastructure allocated by real case volume. We performed sensitivity analyses across scanner utilization, energy-allocation method, scan duration, and grid carbon intensity. The study followed the European Society of Gastrointestinal Endoscopy Endoscopic Sustainability PrimAry Reporting Essentials reporting standard.</p><p><strong>Results: </strong>EUS generated 4.53 kg CO 2 e per procedure and MRCP 18.90 kg CO 2 e per procedure, making MRCP 4.2 times more carbon-intensive. The continuously running cryocooler was the single largest fixed contributor to MRCP emissions (23.4% in standby alone), a 24/7 load absent in EUS. Choosing EUS for 108 patients saved 1,552 kg CO 2 e, equivalent to the annual carbon uptake of 74 mature trees. EUS remained the lower-carbon option across sensitivity analyses, although the advantage narrowed and could reverse on low-carbon grids.</p><p><strong>Discussion: </strong>For bile duct stone evaluation, EUS offers the same diagnostic answer at substantially lower carbon cost where grid electricity is carbon-intensive, adding environmental impact to accuracy, safety, and cost in the decision.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911087","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":"Thymic Stromal Lymphopoietin as a Therapeutic Target for the Treatment of Eosinophilic Esophagitis.","authors":"Seema S Aceves, Marc E Rothenberg, Margaret H Collins, Albert J Bredenoord, Jonathan M Spergel, Richa B Tripathi, Joseph D Spahn, Andrew W Lindsley, Joseph D Sherrill, Amit D Parulekar","doi":"10.14309/ctg.0000000000001091","DOIUrl":"10.14309/ctg.0000000000001091","url":null,"abstract":"<p><p>Thymic stromal lymphopoietin (TSLP) is a key upstream epithelial cytokine, and its overexpression is associated with inflammation, leading to immune dysfunction, epithelial barrier disruption, and tissue remodeling. TSLP is implicated in the pathogenesis of multiple atopic diseases, including asthma, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis (EoE). EoE is a chronic, type 2 (T2) inflammatory disease linked to a delayed-type hypersensitivity response to food antigens and characterized by eosinophil-predominant mucosal inflammation and esophageal dysfunction. TSLP expression and TSLP-mediated T2 inflammatory activity are elevated in esophageal biopsies in patients with active EoE compared with patients with inactive EoE and healthy individuals. In phase 3 clinical trials, a monoclonal antibody against TSLP, called tezepelumab, has shown significant improvements in clinical outcomes compared with placebo in other atopic conditions that have a shared T2 inflammatory disease pathology and epithelial remodeling pathway with EoE, such as asthma and chronic rhinosinusitis with nasal polyps. In this review, we present evidence of TSLP involvement in mediating and exacerbating EoE pathology and discuss how targeting TSLP activity could be a viable therapeutic option for EoE treatment.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891167","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":"Splenic Elastography as a Predictor of Gastroesophageal Varices in Cirrhosis.","authors":"Jorge Pacheco Oliva, Ninoska Isamar Meléndez Rodríguez, Abel Alberto Sánchez Orozco","doi":"10.14309/ctg.0000000000001092","DOIUrl":"https://doi.org/10.14309/ctg.0000000000001092","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal varices are a major complication of portal hypertension in cirrhosis, associated with high morbidity and mortality. Noninvasive predictors are needed to reduce reliance on endoscopy. Splenic elastography has emerged as a potential tool to assess portal hypertension severity.</p><p><strong>Methods: </strong>We conducted prospective, descriptive cross-sectional study at Hospital Roosevelt, Guatemala, in 2024, including 78 patients with recent diagnosis of cirrhosis confirmed by ultrasonography. Patients with hepatocellular carcinoma, acute decompensation, or conditions interfering with splenic stiffness measurement were excluded. Splenic stiffness was measured using transient elastography with the M probe. Endoscopy was performed within two weeks. Diagnostic accuracy for gastroesophageal varices was assessed using ROC analysis.</p><p><strong>Results: </strong>Mean age was 56.1 years (SD 12.6), and 70.5% were female. The most frequent etiology was viral hepatitis (30.77%), followed by alcohol-related liver disease (19.23%) and metabolic dysfunction-associated steatotic liver disease (MASLD, 11.53%). Most patients were Child-Pugh A (80.76%), with a mean MELD-Na of 11.99 (SD 5.46). Gastroesophageal varices were present in 57.69%, and large varices in 26.92%. Splenic elastography showed an AUC of 0.72 (95% CI: 0.59-0.83), with sensitivity of 82.22% and specificity of 66.67% at ≥27 kPa. Median stiffness increased progressively with variceal size, from 25 kPa in absence of varices to 50 kPa in large varices (P <0.001). No significant correlation was found with Child-Pugh class (P=0.538) or MELD-Na (P =0.121).</p><p><strong>Discussion: </strong>Splenic elastography demonstrated moderate accuracy for predicting gastroesophageal varices in cirrhosis. Stiffness values correlated significantly with variceal size, supporting its role as a noninvasive marker of variceal severity. Larger external validation studies are warranted.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891170","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}