Digestive Diseases最新文献

{"title":"Associations between Dynamic Contrast-Enhanced Magnetic Resonance Imaging with Histopathological Features in Cholangiocarcinoma.","authors":"Hans-Jonas Meyer, Johann Potratz, Dörthe Jechorek, Kai Ina Schramm, Jan Borggrefe, Alexey Surov","doi":"10.1159/000540958","DOIUrl":"10.1159/000540958","url":null,"abstract":"<p><strong>Introduction: </strong>The relationships between histopathology and imaging remain elusive, and investigating the underlying reasons for tumor microstructure leading to an imaging phenotype is of clinical importance. In the present study, a cross-sectional guided biopsy specimen was used to correlate prebioptic magnetic resonance imaging (MRI) with immunohistochemical staining of the histopathologic specimen using precise spatial biopsy localization.</p><p><strong>Methods: </strong>Twenty-seven patients with mass-forming cholangiocarcinoma (CCA) were included in the present analysis. All patients were imaged with a 1.5 T clinical scanner at least 1 month prior to biopsy. The contrast-enhanced dynamic sequences were analyzed with quantified signal intensities. The bioptic specimens were obtained by cross-sectional guided biopsy and further analyzed for cell density, proliferation index (Ki67), tumor-infiltrating lymphocytes, tumor-stroma ratio (TSR), and collagen.</p><p><strong>Results: </strong>There were no statistically significant correlations between MRI signal intensities and cell count, TSR, Ki67 index, and CD45 count. Only a moderate correlation was observed between relative signal intensities of the venous phase and the collagen-stained area (r = 0.40, p = 0.04).</p><p><strong>Conclusion: </strong>DCE-MRI is not associated with histopathological features in CCA. The complex interactions of tumor and tumor microenvironment are not reflected in the MRI phenotype.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-8"},"PeriodicalIF":4.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Value of Serum Creatinine-to-Bilirubin Ratio in Predicting the Severity and Prognosis of Acute Pancreatitis.","authors":"Jun-Yi Chen, Jun-Lian He, Feng-Yi Feng, Xiao-Ya Yang, Wen-Rui Xie","doi":"10.1159/000541901","DOIUrl":"10.1159/000541901","url":null,"abstract":"<p><strong>Introduction: </strong>Bilirubin (BIL) and creatinine (Cr) have long been recognized as potential early indicators of disease severity. A recent study found that the Cr-to-BIL ratio (CTR) was more sensitive and specific than either serum Cr or BIL alone. Our research focused on the clinical significance of CTR in evaluating the severity and prognosticating outcomes of acute pancreatitis (AP) in patients.</p><p><strong>Methods: </strong>Patients diagnosed with AP at the First Affiliated Hospital of Guangdong Pharmaceutical University between July 1, 2016, and December 31, 2020 were included. The analysis then focused on examining the relationship between CTR levels and the severity of the illness, the occurrence of complications, and the prognosticating outcomes for individuals diagnosed with AP. A total of 286 AP patients were enrolled.</p><p><strong>Results: </strong>Multivariate regression analyses indicated that AP patients with elevated CTR levels were more likely to develop severe AP. They exhibited higher MODS, Ranson, and APACHE-II scores, an increased incidence of organ failures (acute heart failure [AHF], acute kidney injury [AKI], and acute myocardial infarction), higher 30-day all-cause mortality rates, and a worse prognosis, often requiring more frequent use of vasoactive and diuretic agents compared to those with lower CTR levels. When CTR >14.05, AP patients had increased occurrence of AHF and AKI, higher 30-day all-cause mortality rates, more frequently using vasoactive agent and diuretic agent. Besides, the disease severity scores (MODS, Ranson, and APACHE-II) and hospital stays were markedly increased.</p><p><strong>Conclusion: </strong>AP patients with elevated CTR levels are prone to more severe disease progression, increased complications, and poorer outcomes compared to those with lower CTR levels.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease Progression for Histologic Diagnosis of Metabolic Dysfunction-Associated Steatotic Liver Disease in the Real-World: A Nationwide US Study.","authors":"Xinrong Zhang, Leslie Yeeman Kam, Scott D Barnett, Linda Henry, Ramsey Cheung, Mindie H Nguyen","doi":"10.1159/000541945","DOIUrl":"10.1159/000541945","url":null,"abstract":"<p><strong>Introduction: </strong>We compared clinical characteristics and outcomes in real-world metabolic dysfunction-associated steatotic liver disease (MASLD) patients with or without liver biopsy using a nationwide cohort in United States (USA) to fill in gaps in selection of biopsy patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult MASLD patients using Marketscan® Databases (1/2007-12/2021). Patients were categorized into those with or without liver biopsy during follow-up.</p><p><strong>Results: </strong>We analyzed 540,326 MASLD patients: 23,732 with and 516,594 without biopsy. Only 4% of MASLD patients received liver biopsy and biopsy rate decreased in the last 5 years (9.4%-3.6%). After 1:5 propensity score matching on baseline characteristics including age, sex, and comorbidities, a total of 23,731 patients with biopsy and 118,396 matched patients without biopsy were analyzed. The incidence per 1,000 person-years for hepatocellular carcinoma (HCC) was 0.22 versus 2.18, cirrhosis 29.75 versus 90.44, and hepatic decompensation 15.84 versus 28.25 compared patients with and without biopsy. In multivariable analysis, patients with biopsy had more than 9 times higher risk of developing HCC, 3 times higher risk of cirrhosis, and 78% higher risk of hepatic decompensation. In subgroup analysis, the association remained consistent when stratified by age (<50 and ≥50), sex, and diabetes mellitus. Predictors of having biopsy included age, metabolic diseases, and living in North central or Northeast of USA.</p><p><strong>Conclusion: </strong>These data can inform clinical patient management that biopsy patients likely represent a selected group at higher risk for disease progression, especially in clinical trials for MASLD therapies.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal Inflammation and Permeability in Patients Recovered from SARS-CoV-2 Infection.","authors":"Antonella Gallo, Celeste Ambra Murace, Michela Maria Corbo, Francesca Sarlo, Grazia De Ninno, Silvia Baroni, Giovanni Fancello, Luca Masucci, Marcello Covino, Matteo Tosato, Francesco Landi, Massimo Montalto","doi":"10.1159/000540381","DOIUrl":"10.1159/000540381","url":null,"abstract":"<p><strong>Introduction: </strong>Different works suggest a close link between long COVID gastrointestinal (GI) manifestations and the post-infection disorders of gut-brain interaction (PI-DGBIs). However, the actual mechanisms underlying long-term GI sequelae are still not clear. Our study was aimed to assess both intestinal inflammation and permeability among subjects recovered from SARS-CoV-2 infection and their eventual correlation with long-term GI sequelae.</p><p><strong>Methods: </strong>Eighty-six subjects attending the post-COVID service and recovered from SARS-CoV-2 infection for 6 months were investigated for long COVID manifestations. Those subjects complaining of long-term GI symptoms were further evaluated by Rome IV questionnaire to assess PI-DGBIs. Intestinal inflammation (by fecal calprotectin, FC) and permeability (by serum and fecal levels of zonulin) were evaluated in all subjects. The Hospital Anxiety and Depression Scale (HADS) and the Gastrointestinal Quality of Life Index (GIQLI) questionnaires were further provided to all participants.</p><p><strong>Results: </strong>Thirty-seven subjects (43%) complained of long-term GI symptoms, while 49 subjects (57%) did not. Thirty-three subjects fulfilled Rome IV criteria for PI-DGBIs. FC values resulted higher in those subjects who did not complain GI symptoms (p = 0.03), although remaining quite close to the normal range. No significant differences were shown regarding the assessment of intestinal permeability. By GIQLI, long-term GI sequelae were inversely correlated with quality of life (p = 0.009).</p><p><strong>Conclusion: </strong>Long COVID GI complaints unlikely recognize underlying local inflammatory mechanisms. Since the healthcare, economic, and social burden of post-COVID DGBIs, a deeper understanding of this emerging condition should be encouraged to improve management of the affected subjects.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron and Vitamin B12 Deficiency in Patients with Autoimmune Gastritis and Helicobacter pylori Gastritis: Results from a Prospective Multicenter Study.","authors":"Malgorzata Osmola, Nicolas Chapelle, Marie-Anne Vibet, Edith Bigot-Corbel, Damien Masson, Caroline Hemont, Adam Jirka, Justine Blin, David Tougeron, Driffa Moussata, Dominique Lamarque, Regis Josien, Jean-François Mosnier, Jérôme Martin, Tamara Matysiak-Budnik","doi":"10.1159/000535206","DOIUrl":"10.1159/000535206","url":null,"abstract":"<p><strong>Introduction: </strong>Iron and vitamin B12 deficiencies are common in patients with atrophic gastritis, but there are limited data on the prevalence of these deficiencies in different types of atrophic gastritis.</p><p><strong>Methods: </strong>This multicenter, prospective study assessed micronutrient concentrations in histologically confirmed autoimmune gastritis (AIG, n = 45), Helicobacter pylori-related non-autoimmune gastritis (NAIG, n = 109), and control patients (n = 201). A multivariate analysis was performed to determine factors influencing those deficiencies.</p><p><strong>Results: </strong>The median vitamin B12 concentration was significantly lower in AIG (367.5 pg/mL, Q1, Q3: 235.5, 524.5) than in NAIG (445.0 pg/mL, Q1, Q3: 355.0, 565.0, p = 0.001) and control patients (391.0 pg/mL, Q1, Q3: 323.5, 488.7, p = 0.001). Vitamin B12 deficiency was found in 13.3%, 1.5%, and 2.8% of AIG, NAIG, and control patients, respectively. Similarly, the median ferritin concentration was significantly lower in AIG (39.5 ng/mL, Q1, Q3: 15.4, 98.3 ng/mL) than in NAIG (80.5 ng/mL, Q1, Q3: 43.6, 133.9, p = 0.04) and control patients (66.5 ng/mL, Q1, Q3: 33.4, 119.8, p = 0.007). Iron deficiency and iron deficiency adjusted to CRP were present in 28.9% and 33.3% of AIG, 12.8% and 16.5% of NAIG, and 12.9% and 18.4% of controls, respectively. Multivariate analysis demonstrated that AIG patients had a higher risk of developing vitamin B12 deficiency (OR: 11.52 [2.85-57.64, p = 0.001]) and iron deficiency (OR: 2.92 [1.32-6.30, p = 0.007]) compared to control patients. Factors like age, sex, and H. pylori status did not affect the occurrence of vitamin B12 or iron deficiency.</p><p><strong>Conclusion: </strong>Iron and vitamin B12 deficiencies are more commonly observed in patients with AIG than in those with NAIG or control patients. Therefore, it is essential to screen for both iron and vitamin B12 deficiencies in AIG patients and include the treatment of micronutrient deficiencies in the management of atrophic gastritis patients.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"145-153"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Stiffness Determined by Transient Elastography Is a Simple and Highly Accurate Predictor for Presence of Liver Cirrhosis in Clinical Routine.","authors":"Peter Lemmer, Lydia Christina Rohr, Marie Henning, Kerem Bulut, Paul Manka, Ali Canbay, Jan-Peter Sowa","doi":"10.1159/000538426","DOIUrl":"10.1159/000538426","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection of patients with advanced chronic liver disease is critical for the prevention of complications and inclusion in surveillance programs for hepatocellular carcinoma. In daily clinical care, it remains challenging to differentiate early cirrhosis from lower fibrosis grades without performing a liver biopsy. The aim of the present study was to assess the performance of different non-invasive detection tools to differentiate cirrhosis from lower fibrosis grades.</p><p><strong>Methods: </strong>Data of 116 patients (51 male, 65 female) with chronic liver disease of various origins undergoing liver biopsy was analyzed. Routine laboratory values, liver stiffness measurement (LSM) by transient elastography, and histological liver assessment were collected.</p><p><strong>Results: </strong>Robust and significant correlations with the histological fibrosis stage were identified for LSM (r = 0.65), the FAST score (0.64), the FIB-4 (0.48), serum aspartate aminotransferase (AST) concentration (0.41), NFS (0.33), international normalized ratio (INR; 0.30), methacetin breath test results (-0.40), and serum albumin concentration (-0.29) by spearman rank correlation. Receiver operating characteristic curves were built for these parameters to separate patients with cirrhosis from those with any other fibrosis stage. The highest AUC was achieved by LSM (0.9130), followed by the FAST score (0.8842), the FIB-4 (0.8644), the NFS (0.8227), INR (0.8142), serum albumin (0.7710), and serum AST (0.7620). The most promising clinical applicability would be an LSM value of 12.2 kPa, achieving 95.7% sensitivity and 75.3% specificity.</p><p><strong>Conclusion: </strong>LSM and FAST score seem to be robust non-invasive measurements for liver fibrosis. LSM and FAST scores may have the potential to reliably detect patients with liver cirrhosis in clinical routine settings.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"265-275"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Endoscopic Control for Patients with Serrated Polyposis Syndrome.","authors":"Michiko Nakaoka, Hideyuki Chiba, Mikio Kobayashi, Naoya Okada, Jun Arimoto, Jun Tachikawa, Keiichi Ashikari, Hiroki Kuwabara","doi":"10.1159/000534968","DOIUrl":"10.1159/000534968","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advances in endoscopic treatment, patients with serrated polyposis syndrome (SPS) occasionally require surgery due to numerous or unresectable polyps, recurrence, and treatment-related adverse events.</p><p><strong>Methods: </strong>We retrospectively evaluated 43 patients with SPS undergoing diagnosis and treatment at Omori Red Cross Hospital from 2011 to 2022. Resection of all polyps ≥3 mm in size was planned during the clearing phase; endoscopic control was defined as complete, endoscopic polyp removal. During the surveillance phase, patients underwent annual colonoscopy and resection of newly detected polyps ≥3 mm in size.</p><p><strong>Results: </strong>Thirty-eight patients (88%) achieved endoscopic control, two (5%) required surgery after endoscopic treatment because of colorectal cancer (CRC), and three (7%) have not yet achieved endoscopic control and are planning treatment. Endoscopic control was achieved with a median of four colonoscopies at 8 months. Ten polyps (median value) were resected per patient during the clearing phase. Three polyps ≥50 mm in size, six located in the appendiceal orifice, and seven with severe fibrosis could be resected by endoscopic submucosal dissection (ESD). All patients underwent treatment with a combination of cold snare polypectomy (CSP), endoscopic mucosal resection/hot polypectomy, and/or ESD. No case required surgery due to difficulty with endoscopic treatment. Delayed bleeding was observed in 2 cases (0.3%). Twenty-one patients underwent colonoscopies during the surveillance phase. Fifty-three polyps were resected using CSP; no CRC, sessile serrated lesions with dysplasia, or advanced adenoma were detected.</p><p><strong>Conclusion: </strong>SPS can be effectively, efficiently, and safely controlled with appropriate endoscopic management.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"31-40"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic Dysfunction-Associated Fatty Liver Disease on Distinct Microbial Communities at the Bacterial Phylum Level.","authors":"Haruki Uojima, Yoshihiko Sakaguchi, Kazuyoshi Gotoh, Takashi Satoh, Hisashi Hidaka, Akira Take, Kazue Horio, Shunji Hayashi, Chika Kusano","doi":"10.1159/000534284","DOIUrl":"10.1159/000534284","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data are available on the correlation between microbial communities and metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to evaluate the influence of MAFLD on diverse microbial communities.</p><p><strong>Methods: </strong>We recruited 43 patients with a nonviral liver disease. Enrolled patients were divided into two groups according to MAFLD criteria. The fecal microbial composition was evaluated using the variable V3-V4 region of the 16S ribosomal RNA region, which was amplified using polymerase chain reaction. First, we assessed the influence of MAFLD on distinct microbial communities at the bacterial phylum level. Next, the correlation between the microbial communities and diversity in patients with MAFLD was evaluated.</p><p><strong>Results: </strong>Among the enrolled participants, the non-MAFLD and MAFLD groups consisted of 21 and 22 patients, respectively. Sequences were distributed among ten bacterial phyla. The relative abundance of Firmicutes was significantly higher in the MAFLD group than in the non-MAFLD group (p = 0.014). The microbial diversity was not significantly influenced by the presence of MAFLD (Chao-1 index: p = 0.215 and Shannon index: p = 0.174, respectively); nonetheless, the correlation coefficient between the abundances of Firmicutes and microbial diversity was higher in the non-MAFLD group than in the MAFLD group.</p><p><strong>Conclusion: </strong>The presence of MAFLD increased the relative abundances of Firmicutes at the bacterial phylum level, which may cause the discrepancy between the abundances of Firmicutes and diversity in patients with MAFLD.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"61-69"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41106173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onset Time and Characteristics of Postprocedural Bleeding after Endoscopic Resection of Colorectal Lesions: A Multicenter Retrospective Study.","authors":"Qiyun Xiao, Maximilian Eckardt, Awsan Mohamed, Helmut Ernst, Alexander Behrens, Nils Homann, Thomas Hielscher, Georg Kähler, Matthias Ebert, Sebastian Belle, Tianzuo Zhan","doi":"10.1159/000534109","DOIUrl":"10.1159/000534109","url":null,"abstract":"<p><strong>Introduction: </strong>Postprocedural bleeding is a major adverse event after endoscopic resection of colorectal lesions, but the optimal surveillance time after endoscopy is unclear. In this study, we determined onset time and characteristics of postprocedural bleeding events.</p><p><strong>Methods: </strong>We retrospectively screened patients who underwent endoscopic resection of colorectal lesions at three German hospitals between 2010 and 2019 for postprocedural bleeding events using billing codes. Only patients who required re-endoscopy were included for analysis. For identified patients, we collected demographic data, clinical courses, characteristics of colorectal lesions, and procedure-related variables. Factors associated with late-onset bleeding were determined by univariate and multivariate logistic regression analysis.</p><p><strong>Results: </strong>From a total of 6,820 patients with eligible billing codes, we identified 113 cases with postprocedural bleeding after endoscopic mucosal (61.9%) or snare resection (38.1%) that required re-endoscopy. The median size of the culprit lesion was 20 mm (interquartile range 14-30 mm). The median onset time of postprocedural bleeding was day 3 (interquartile range: 1-6.5 days), with 48.7% of events occurring within 48 h. Multivariate logistic regression analysis demonstrates that a continued intake of antiplatelet drugs (OR: 3.98, 95% CI: 0.89-10.12, p = 0.025) and a flat morphology of the colorectal lesion (OR: 2.98, 95% CI: 1.08-8.01, p = 0.031) were associated with an increased risk for late postprocedural bleeding (&gt;48 h), whereas intraprocedural bleeding was associated with a decreased risk (OR: 0.12, 95% CI: 0.04-0.50, p = 0.001).</p><p><strong>Conclusion: </strong>Significant postprocedural bleeding can occur up to 18 days after endoscopic resection of colorectal lesions, but was predominantly observed within 48 h. Continued intake of antiplatelet drugs and a flat polyp morphology are associated with risk for late postprocedural bleeding.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"78-86"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Admission, Medical, and Surgical Procedures for Acute Diverticulitis Are More Appropriate when Using a Diagnostic and Therapeutic Assistance Pathway: An Experience from a Referral Center.","authors":"Walter Elisei, Pierluigi Marini, Roberto Faggiani, Stefano Manfroni, Gabriele Ricci, Noemi Di Fuccia, Valerio Papa, Antonio Tursi","doi":"10.1159/000540216","DOIUrl":"10.1159/000540216","url":null,"abstract":"<p><strong>Introduction: </strong>Our aim was to assess the impact of the Diagnostic and Therapeutic Assistance Pathway (PDTA) developed for acute diverticulitis (AD) on the management of patients with AD and referring to the emergency room (ER) in a referral center.</p><p><strong>Methods: </strong>This retrospective study includes all patients diagnosed with AD and referring to the ER between January 1, 2021, and December 31, 2022 (after approval of PDTA), compared to the same period of 2015-2019. Length of stay in ER, medical and surgical management, and length in hospital stay (in days) were also measured according to the type of disease (uncomplicated vs. complicated).</p><p><strong>Results: </strong>ER admission due to AD during the period 2015-2019 was 240 ± 13 cases per year, while it was 290 cases in 2022 (p = 0.05). After adopting the PDTA, the rate of length of stay in ER >24 h for AD was significantly reduced (p = 0.01); the median rate of hospital admission for AD was significantly reduced (p < 0.05); the rate of medical treatment of uncomplicated disease was increased (p = 0.01), while the rate of surgical management was decreased (p = 0.05); the rate of medical treatment of complicated disease was increased (p = 0.01), while the rate of surgical management was decreased (p = 0.001); the hospital stay was significantly reduced in both uncomplicated (p = 0.05) and complicated (p = 0.05) AD.</p><p><strong>Conclusions: </strong>The development and the routine use of a PDTA dedicated to AD have significantly improved the management of these patients, reducing the ER stay, the surgical procedures, and the overall hospital stay.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"522-528"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}