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Endoscopic sleeve gastroplasty plus lifestyle intervention in patients with MASH: a multicentre, sham-controlled, randomized trial. 内镜下套筒胃成形术加生活方式干预治疗MASH患者:一项多中心、假对照、随机试验。
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.10.027
Javier Abad, Elba Llop, María Teresa Arias-Loste, Diego Burgos-Santamaría, José Luis Martínez Porras, Paula Iruzubieta, Javier Graus, Belén Ruiz-Antoran, María Rosario Sánchez Yuste, Manuel Romero-Gómez, Agustin Albillos, Javier Crespo, José Luis Calleja
{"title":"Endoscopic sleeve gastroplasty plus lifestyle intervention in patients with MASH: a multicentre, sham-controlled, randomized trial.","authors":"Javier Abad, Elba Llop, María Teresa Arias-Loste, Diego Burgos-Santamaría, José Luis Martínez Porras, Paula Iruzubieta, Javier Graus, Belén Ruiz-Antoran, María Rosario Sánchez Yuste, Manuel Romero-Gómez, Agustin Albillos, Javier Crespo, José Luis Calleja","doi":"10.1016/j.cgh.2024.10.027","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.10.027","url":null,"abstract":"<p><strong>Background and aims: </strong>Metabolic dysfunction-associated steatohepatitis(MASH) is commonly seen in biopsy proven steatotic liver disease(SLD). Life-style intervention reaching a weight loss higher than 10% promotes MASH resolution, but this goal is only achieved by a small number of patients. Endoscopic sleeve gastroplasty(ESG) has recently emerged as a safe and effective option to promote weight loss in obese population. We report the results of a multicenter, randomized, controlled and double-blind study to evaluate the effectiveness and safety of ESG in MASH patients METHODS: Forty patients were randomized 1:1 to ESG plus lifestyle modification vs. sham endoscopy (SE) plus lifestyle intervention. Inclusion criteria included biopsy proven MASH with NAS≥3 and fibrosis stage F0-F3. Eighteen patients from the ESG group and 19 from the ESI group completed follow-up during 72 weeks. Baseline to end of follow-up changes in body weight, liver tests, liver stiffness(VCTE) and liver histology were recorded RESULTS: Total Body weight loss(TBWL) was 9.47%(±9.38) in ESG group vs 3.91%(±5.43) in ESI group(p<0.05). Liver stiffness decreased 5.63(±7.17) KPa in ESG group vs 0.2(±5.38) KPa in ESI group(p<0.05). Steatosis was significantly reduced in ESG group(-0.94±0.87) vs ESI group(-0.26±0.99)[p= 0.033]. No differences on NAS(-1.89±2.11 vs -1.47±2.01) score neither fibrosis(-0.1±0.91 vs -0.84±1.21) was seen. In patients achieving weight loss>10% we found a significant improvement on NAS score(-4±0.94 vs. -0.81±1.62, p<0.01), but not in fibrosis stage(-0.3±1.06 vs -0.59±1.25). Only 2 patients of ESG group had adverse events that required admission that resolved conservatively in 72 hours CONCLUSION: ESG is an effective and safe method to promote weight reduction associated with significant improvement in patients with MASH and obesity.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Global Trend of MASH-associated Liver Cancer: A Systematic Analysis From the Global Burden of Disease 2021. mash相关肝癌的全球趋势——来自2021年全球疾病负担的系统分析
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.10.026
Pojsakorn Danpanichkul, Kanokphong Suparan, Chuthatip Kaeosri, Pimtawan Jatupornpakdee, Abdelrahman M Attia, Thanathip Suenghataiphorn, Jerapas Thongpiya, Banthoon Sukphutanan, Daniel Q Huang, Mazen Noureddin, Amit G Singal, Karn Wijarnpreecha, Ju Dong Yang
{"title":"Global Trend of MASH-associated Liver Cancer: A Systematic Analysis From the Global Burden of Disease 2021.","authors":"Pojsakorn Danpanichkul, Kanokphong Suparan, Chuthatip Kaeosri, Pimtawan Jatupornpakdee, Abdelrahman M Attia, Thanathip Suenghataiphorn, Jerapas Thongpiya, Banthoon Sukphutanan, Daniel Q Huang, Mazen Noureddin, Amit G Singal, Karn Wijarnpreecha, Ju Dong Yang","doi":"10.1016/j.cgh.2024.10.026","DOIUrl":"10.1016/j.cgh.2024.10.026","url":null,"abstract":"<p><strong>Background & aims: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are the leading causes of liver disease and are emerging as the main risk factors for primary liver cancer (PLC). However, updated global data on MASH remain scarce.</p><p><strong>Methods: </strong>This study analyzed data from the Global Burden of Disease study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from MASH-associated PLC, stratified by geographical region, sociodemographic index, age, and sex.</p><p><strong>Results: </strong>There were 42,290 incident cases, 40,920 deaths, and 995,470 DALYs from PLC globally. Global incidence (+98%), death (+93%), and DALYs (+76%) from MASH-associated PLC increased steeply over the study period. Among different etiologies, only MASH-associated PLC had increased mortality rates (annual percent change [APC], +0.46; 95% confidence interval [CI], 0.33%-0.59%). Africa and low sociodemographic index countries exhibited the highest age-standardized incidence, death, and DALYs from MASH-associated PLC. DALYs increased in females (APC, 0.24%; 95% CI, 0.06%-0.42%), whereas they remained stable in males. Americas experienced the highest percentage increase in age-standardized incidence rate (APC, 2.09%; 95% CI, 2.02%-2.16%), age-standardized death rate (APC, 1.96%; 95% CI, 1.69%-2.23%), and age-standardized DALYs (APC, 1.96%; 95% CI, 1.63%-2.30%) from MASH-associated PLC.</p><p><strong>Conclusions: </strong>Over the past 2 decades, the burden of MASH-associated PLC has risen, though there are sociodemographic and geographic disparities. This necessitates urgent strategies across the globe to mitigate the epidemic of MASH-associated PLC as well as its metabolic drivers.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Serum Albumin and Its Trajectory Are Associated With Therapeutic Outcomes in Ulcerative Colitis. 血清白蛋白及其轨迹与溃疡性结肠炎的治疗结果相关。
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.10.036
Jieqi Zheng, Xi Zhang, Liqian Zhang, Li Li, Minhu Chen, Rirong Chen, Shenghong Zhang
{"title":"Serum Albumin and Its Trajectory Are Associated With Therapeutic Outcomes in Ulcerative Colitis.","authors":"Jieqi Zheng, Xi Zhang, Liqian Zhang, Li Li, Minhu Chen, Rirong Chen, Shenghong Zhang","doi":"10.1016/j.cgh.2024.10.036","DOIUrl":"10.1016/j.cgh.2024.10.036","url":null,"abstract":"<p><strong>Background & aims: </strong>The relationship between serum albumin levels and therapeutic outcomes in ulcerative colitis (UC) has been debated. Additionally, the dynamic changes in albumin levels remain understudied.</p><p><strong>Methods: </strong>We conducted a pooled analysis of 5 clinical trials involving 3268 patients with UC. Short- and long-term therapeutic outcomes were assessed at the end of the induction and maintenance phases. Multivariate logistic regression and random effects models were used to pool the predictive effects of albumin levels. The dynamic trajectory of albumin was fitted using latent class growth mixed models.</p><p><strong>Results: </strong>Baseline and week-2 albumin were independent predictors of short-term outcomes, with pooled adjusted odds ratios (aORs) of 1.07 (95% confidence interval [CI],1.05-1.09) and 1.11 (95% CI, 1.08-1.15) per 1 g/L increase for clinical response, respectively. Higher post-induction albumin levels predicted better long-term outcomes, including clinical (aOR, 1.16; 95% CI, 1.12-1.21), endoscopic (aOR, 1.13; 95% CI, 1.10-1.16), and histologic remission (aOR, 1.11; 95% CI, 1.03-1.18). Furthermore, there are 3 classes of albumin trajectories: sustained medium-to-high, rapidly ascending, and poor response. Compared with the sustained medium-to-high class, patients in the poor response class had a lower probability of long-term endoscopic remission (aOR, 0.35; 95% CI, 0.23-0.50; P < .001), whereas no significant difference was observed between the rapidly ascending class and the sustained medium-to-high class.</p><p><strong>Conclusion: </strong>Higher albumin levels were associated with better therapeutic outcomes in patients with UC. However, patients with low but rapidly ascending albumin levels would achieve outcomes comparable to those with medium-to-high levels of albumin.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Persistent Lugol-unstained Lesions: A New Predictor of Progression to Esophageal Squamous Cell Carcinoma? 持续lugol -未染色病变:食管鳞状细胞癌进展的新预测因子?
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.11.020
Ali Soroush, Sanford M Dawsey
{"title":"Persistent Lugol-unstained Lesions: A New Predictor of Progression to Esophageal Squamous Cell Carcinoma?","authors":"Ali Soroush, Sanford M Dawsey","doi":"10.1016/j.cgh.2024.11.020","DOIUrl":"10.1016/j.cgh.2024.11.020","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and Safety of Budesonide Orodispersible Tablets for Eosinophilic Esophagitis up to 3 Years: An Open-Label Extension Study. 布地奈德口腔分散片治疗3年以上嗜酸性食管炎的疗效和安全性:一项开放标签扩展研究
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.10.034
Luc Biedermann, Christoph Schlag, Alex Straumann, Alfredo J Lucendo, Stephan Miehlke, Michael Vieth, Cecilio Santander, Constanza Ciriza de Los Rios, Christoph Schmöcker, Ahmed Madisch, Petr Hruz, Jamal Hayat, Ulrike von Arnim, Albert Jan Bredenoord, Stefan Schubert, Mike Halstead, Sabrina Pfurr, Ralph Mueller, Alain M Schoepfer, Stephen Attwood
{"title":"Efficacy and Safety of Budesonide Orodispersible Tablets for Eosinophilic Esophagitis up to 3 Years: An Open-Label Extension Study.","authors":"Luc Biedermann, Christoph Schlag, Alex Straumann, Alfredo J Lucendo, Stephan Miehlke, Michael Vieth, Cecilio Santander, Constanza Ciriza de Los Rios, Christoph Schmöcker, Ahmed Madisch, Petr Hruz, Jamal Hayat, Ulrike von Arnim, Albert Jan Bredenoord, Stefan Schubert, Mike Halstead, Sabrina Pfurr, Ralph Mueller, Alain M Schoepfer, Stephen Attwood","doi":"10.1016/j.cgh.2024.10.034","DOIUrl":"10.1016/j.cgh.2024.10.034","url":null,"abstract":"<p><strong>Background & aims: </strong>Budesonide orodispersible tablets (BOT) have been shown to be safe and effective in phase III double-blind trials of induction and 48-week maintenance therapy of eosinophilic esophagitis (EoE). We now analyzed the long-term efficacy and safety of BOT in a 96-week open-label extension (OLE) study.</p><p><strong>Methods: </strong>All patients with EoE in the 48-week double-blind maintenance study were eligible to receive BOT treatment for up to 96 weeks. Dosage was 0.5 or 1.0 mg BOT, twice daily, at investigator's discretion. Clinical, histologic, endoscopic, quality of life, and safety measures were assessed.</p><p><strong>Results: </strong>A total of 186 patients participated in the OLE up to 96 weeks. At week 96, 81.9% of patients had clinical remission, defined as an EoE Symptom Activity Index (EEsAI) score of ≤20 vs 77.7% at OLE baseline. A further 80.1% of patients were in histologic remission, defined as peak eosinophils per high-power field of <5, at week 96 vs 91.8% at OLE baseline. Mean EoE endoscopic reference scores (EREFS) were 1 at all time points measured. Mean EoE Quality of Life (EoE-QoL-A) Scale scores improved from 3.3 at OLE baseline to 3.5 at week 96. No new safety concerns were observed across 96 weeks of treatment. Suspected symptomatic candidiasis occurred at similar rates to prior BOT studies and was predominantly mild and resolved with treatment.</p><p><strong>Conclusions: </strong>Clinical and histologic remission of EoE could be maintained with BOT in a large majority of patients for up to 96 weeks, and for up to 144 weeks in patients with uninterrupted BOT therapy across all trials. No additional safety concerns were identified with long-term BOT treatment (ClinicalTrials.gov, Number: NCT02493335).</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hypercoagulation after Hospital Discharge in Acute Severe Ulcerative Colitis: A Prospective Study. 急性重度溃疡性结肠炎患者出院后高凝:一项前瞻性研究。
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.10.031
Benjamin J Griffiths, Michael J R Desborough, Marjolijn Duijvestein, Geert R A D'Haens, Yuhong Yuan, Robert V Bryant, Nicola Curry, Simon P L Travis, Vipul Jairath
{"title":"Hypercoagulation after Hospital Discharge in Acute Severe Ulcerative Colitis: A Prospective Study.","authors":"Benjamin J Griffiths, Michael J R Desborough, Marjolijn Duijvestein, Geert R A D'Haens, Yuhong Yuan, Robert V Bryant, Nicola Curry, Simon P L Travis, Vipul Jairath","doi":"10.1016/j.cgh.2024.10.031","DOIUrl":"10.1016/j.cgh.2024.10.031","url":null,"abstract":"<p><strong>Background & aims: </strong>Venous thromboembolism is a serious complication during and following hospitalization with acute severe ulcerative colitis (ASUC). We evaluated serial thrombotic profiles of patients with ASUC from the point of hospitalization up to 12 weeks postdischarge and compared these with control patients with quiescent ulcerative colitis.</p><p><strong>Methods: </strong>Twenty-seven patients with ASUC and 25 control patients with quiescent ulcerative colitis were recruited. Thrombin generation (endogenous thrombin potential), rotational thromboelastometry (EXTEM and FIBTEM maximum clot firmness), procoagulant factors, anticoagulant factors, and fibrinolytic markers were assessed for those with ASUC on admission (Day 1), Day 5, 4 weeks, and at 8-12 weeks. These assessments were performed on a single occasion for control patients.</p><p><strong>Results: </strong>Endogenous thrombin potential and maximum clot firmness were significantly elevated in patients with ASUC compared with control subjects and remained significantly elevated for 4 weeks and for 8-12 weeks after admission (P < .05), respectively. Von Willebrand factor antigen, factor VIII, Clauss fibrinogen concentration, and platelet count were significantly increased from presentation to 8-12 weeks and are likely to account for changes in the global hemostatic profile.</p><p><strong>Conclusions: </strong>Global measures of hemostasis demonstrated that patients with ASUC were prothrombotic compared with control subjects with quiescent colitis. This difference was maintained 8-12 weeks after the initial presentation, supporting clinical observations that patients with ASUC have an elevated risk of venous thromboembolism after hospital discharge.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Optimal Duration of pH Monitoring: Testing the Validity of Lyon 2.0 Recommendations for Wireless pH Measurement. pH监测的最佳持续时间:测试里昂2.0无线pH测量建议的有效性。
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.11.009
Radu I Rusu, Mark R Fox, Rami Sweis, Sebastian Zeki, Jason M Dunn, Angela Anggiansah, Jafar Jafari, Annastazia Learoyd, Terry Wong
{"title":"The Optimal Duration of pH Monitoring: Testing the Validity of Lyon 2.0 Recommendations for Wireless pH Measurement.","authors":"Radu I Rusu, Mark R Fox, Rami Sweis, Sebastian Zeki, Jason M Dunn, Angela Anggiansah, Jafar Jafari, Annastazia Learoyd, Terry Wong","doi":"10.1016/j.cgh.2024.11.009","DOIUrl":"10.1016/j.cgh.2024.11.009","url":null,"abstract":"<p><strong>Background & aims: </strong>The Lyon 2.0 consensus recommends 96-hour wireless pH studies for gastroesophageal reflux disease (GERD) diagnosis; however, the optimal length of pH measurement has not been established. Further, it is uncertain if, and under what circumstances, shorter recording times are sufficient for a conclusive diagnosis.</p><p><strong>Methods: </strong>Data from 944 patients with 4-day recordings was reviewed. Patients were classified at 24, 48, and 72 hours against the 96-hour reference standard. Acid exposure time (AET) <4% was conclusively negative, and AET >6% was conclusively positive for GERD. Esophagitis was an independent marker of disease. The effect of utilizing average day, worst day, and dominant-pattern analysis (≥2 negative or positive days) was compared. Groups defined by AET thresholds from 1% to 7% at 24 and 48 hours were followed to assess when short recording periods were sufficient for conclusive diagnosis.</p><p><strong>Results: </strong>Diagnostic accuracy improved with study duration (P < .00001). The proportion of patients with inconclusive results (AET 4%-6%) reduced from 113 of 944 at 24 hours to 40 of 113 at 96 hours (35% of subgroup; P = .02), with similar results for dominant pattern analysis. Diagnostic sensitivity for 24-, 48-, and 72-hour pH-monitoring for AET 6% threshold increased with study duration from 62.5% to 76.6% and 88.2%, respectively, when compared with the 96-hour reference standard.</p><p><strong>Conclusion: </strong>The results of this analysis validate the recommendation that prolonged reflux studies of at least 72 hours duration provide optimal AET measurements for GERD diagnosis. Prolonging studies can also resolve inconclusive results based on 24- and 48-hour studies.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Global Distribution of Colorectal Cancer Staging at Diagnosis: An Evidence Synthesis. 结直肠癌诊断分期的全球分布:证据综合。
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.11.019
Lanwei Guo, Le Wang, Lin Cai, Yuelun Zhang, Xiaoshuang Feng, Chenxin Zhu, Wendong Gao, Rafael Cardoso, Haiyan Yang, Min Dai, Hermann Brenner, Hongda Chen
{"title":"Global Distribution of Colorectal Cancer Staging at Diagnosis: An Evidence Synthesis.","authors":"Lanwei Guo, Le Wang, Lin Cai, Yuelun Zhang, Xiaoshuang Feng, Chenxin Zhu, Wendong Gao, Rafael Cardoso, Haiyan Yang, Min Dai, Hermann Brenner, Hongda Chen","doi":"10.1016/j.cgh.2024.11.019","DOIUrl":"10.1016/j.cgh.2024.11.019","url":null,"abstract":"<p><strong>Background & aims: </strong>Stage at diagnosis is a key prognostic factor for colorectal cancer (CRC) survival. We aimed to assess the global distribution of CRC staging at diagnosis using population-based or hospital-based registry data.</p><p><strong>Methods: </strong>We systematically searched in MEDLINE and Embase from their inception until December 6, 2023. Gray literature was searched through published cancer reports. Studies from population-based or hospital-based cancer registries reporting the stage distribution of diagnosed CRC were included. We extracted stage-specific proportions among patients with CRC based on TNM; Surveillance, Epidemiology, and End Results; or Dukes staging systems. Subgroup analyses by sex, age, tumor site, calendar period, and status of population-based screening were performed. Correlations between the Human Development Index (HDI), Socio-Demographic Index (SDI), and the distant metastatic CRC proportion were also evaluated.</p><p><strong>Results: </strong>A total of 84 eligible studies/reports from 46 countries were analyzed, covering 3.8 million patients. Among 36 countries included in the main analysis, the most recent distant metastatic CRC proportions varied from 16.2% in Puerto Rico to 28.2% in Oman and Latvia, with a median of 23.7% (interquartile range, 21.8%-26.3%). Higher metastatic proportions were observed in younger patients, those with colon cancer, and those without screening implementation, with no apparent difference between males and females. Over time, some countries/regions, such as Southern Portugal (36.5% in 2000 to 22.2% in 2016), showed declining proportions of metastatic CRC, whereas others remained stable (eg, Austria, Belgium) or increased (eg, United States, Slovenia, Spain). Higher HDI and SDI were correlated with lower proportions of distant metastatic CRC (HDI: ρ = -0.48; SDI: ρ = -0.26).</p><p><strong>Conclusion: </strong>Global disparities in CRC staging exist, indicating a need for targeted interventions to enhance early detection and management, especially in high-metastasis areas.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictors of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-analysis. ercp后胰腺炎的预测因素:一项全面的系统回顾和荟萃分析。
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.11.014
Azizullah Beran, Tarek Aboursheid, Adel Hajj Ali, Tarek Nayfeh, Hashem Albunni, Alejandra Vargas, Mouhand F Mohamed, Khaled Elfert, Mohammad Shaear, Ite Obaitan, Nasir Saleem, Awais Ahmed, Mark A Gromski, John M DeWitt, Mohammad Al-Haddad, James L Watkins, Evan Fogel, Jeffrey J Easler
{"title":"Predictors of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-analysis.","authors":"Azizullah Beran, Tarek Aboursheid, Adel Hajj Ali, Tarek Nayfeh, Hashem Albunni, Alejandra Vargas, Mouhand F Mohamed, Khaled Elfert, Mohammad Shaear, Ite Obaitan, Nasir Saleem, Awais Ahmed, Mark A Gromski, John M DeWitt, Mohammad Al-Haddad, James L Watkins, Evan Fogel, Jeffrey J Easler","doi":"10.1016/j.cgh.2024.11.014","DOIUrl":"10.1016/j.cgh.2024.11.014","url":null,"abstract":"<p><strong>Background & aims: </strong>Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP).</p><p><strong>Methods: </strong>We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (ORs) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed.</p><p><strong>Results: </strong>A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR, 1.81; high credibility), prior acute pancreatitis (OR, 2.59; moderate), age ≤40 years (OR, 2.33; moderate), asymptomatic choledocholithiasis (OR, 4.76; low), prior PEP (OR, 4.40; low), sphincter of Oddi dysfunction (OR, 3.11; low), and female gender (OR, 1.70; low). Key procedure-related predictors of PEP were any guidewire passage into the pancreatic duct (PD) (OR, 2.18; high), first ERCP with a native papilla (OR, 1.91; high), endoscopic papillary balloon dilation of an intact papilla (OR, 2.91; moderate), pancreatic acinarization (OR, 4.23; low), any PD cannulation (OR, 2.73; low), pancreatic sphincterotomy (OR, 2.64; low), difficult cannulation (OR, 2.60; low), any pancreatogram (OR, 2.40; low), and precut sphincterotomy (OR, 1.98; low).</p><p><strong>Conclusions: </strong>Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
High Risk of Digestive Cancers in Patients With Celiac Disease: A Nationwide Case-Control Cohort Study. 乳糜泻患者患消化系统癌的高风险:一项全国病例对照队列研究
IF 11.6 1区 医学
Clinical Gastroenterology and Hepatology Pub Date : 2024-12-16 DOI: 10.1016/j.cgh.2024.10.028
Anne-Sophie Jannot, Yannick Girardeau, Stanislas Chaussade, Romain Coriat, Nadine Cerf-Bensussan, Georgia Malamut
{"title":"High Risk of Digestive Cancers in Patients With Celiac Disease: A Nationwide Case-Control Cohort Study.","authors":"Anne-Sophie Jannot, Yannick Girardeau, Stanislas Chaussade, Romain Coriat, Nadine Cerf-Bensussan, Georgia Malamut","doi":"10.1016/j.cgh.2024.10.028","DOIUrl":"10.1016/j.cgh.2024.10.028","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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