Gastroenterology Research最新文献

{"title":"Cytomegalovirus Infection Is Associated With Adverse Outcomes Among Hospitalized Pediatric Patients With Inflammatory Bowel Disease.","authors":"Aravind Thavamani,&nbsp;Krishna Kishore Umapathi,&nbsp;Thomas J Sferra,&nbsp;Senthilkumar Sankararaman","doi":"10.14740/gr1588","DOIUrl":"https://doi.org/10.14740/gr1588","url":null,"abstract":"<p><strong>Background: </strong>Adults with inflammatory bowel disease (IBD) are at increased risk of developing cytomegalovirus (CMV) colitis, which is associated with adverse outcomes. Similar studies in pediatric IBD patients are lacking.</p><p><strong>Methods: </strong>We analyzed non-overlapping years of National Inpatient Sample (NIS) and Kids Inpatient Database (KID) between 2003 and 2016. We included all patients < 21 years with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC). Patients with coexisting CMV infection during that admission were compared with patients without CMV infection for outcome measures such as in-hospital mortality, disease severity, and healthcare resource utilization.</p><p><strong>Results: </strong>We analyzed a total of 254,839 IBD-related hospitalizations. The overall prevalence rate of CMV infection was 0.3% with an overall increasing prevalence trend, P < 0.001. Approximately two-thirds of patients with CMV infection had UC, which was associated with almost 3.6 times increased risk of CMV infection (confidence interval (CI): 3.11 to 4.31, P < 0.001). IBD patients with CMV had more comorbid conditions. CMV infection was significantly associated with increased odds of in-hospital mortality (odds ratio (OR): 3.58; CI: 1.85 to 6.93, P < 0.001) and severe IBD (OR: 3.31; CI: 2.54 to 4.32, P < 0.001). CMV-related IBD hospitalizations had increased length of stay by 9 days while incurring almost $65,000 higher hospitalization charges, P < 0.001.</p><p><strong>Conclusions: </strong>The prevalence of CMV infection is increasing in pediatric IBD patients. CMV infections significantly corelated with increased risk of mortality and severity of IBD leading to prolonged hospital stay and higher hospitalization charges. Further prospective studies are needed to better understand the factors leading to this increasing CMV infection.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/90/a1/gr-16-001.PMC9990534.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Ultrasound Predicts Risk of Occult Intra-Abdominal Metastases in Localized Gastric Cancer: A Validation Study.","authors":"Fares Ayoub,&nbsp;Christopher G Chapman,&nbsp;Heather Chen,&nbsp;Namrata Setia,&nbsp;Kevin Roggin,&nbsp;Uzma D Siddiqui","doi":"10.14740/gr1589","DOIUrl":"https://doi.org/10.14740/gr1589","url":null,"abstract":"<p><strong>Background: </strong>In gastric cancer (GC) patients without imaging evidence of distant metastasis, diagnostic staging laparoscopy (DSL) is recommended to detect radiographically occult peritoneal metastasis (M1). DSL carries a risk for morbidity and its cost-effectiveness is unclear. Use of endoscopic ultrasound (EUS) to improve patient selection for DSL has been proposed but not validated. We aimed to validate an EUS-based risk classification system predicting risk for M1 disease.</p><p><strong>Methods: </strong>We retrospectively identified all GC patients without positron emission tomography (PET)/computed tomography (CT) evidence of distant metastasis who underwent staging EUS followed by DSL between 2010 and 2020. T1-2, N0 disease was EUS \"low-risk\"; T3-4 and/or N+ disease was \"high-risk\".</p><p><strong>Results: </strong>A total of 68 patients met inclusion criteria. DSL identified radiographically occult M1 disease in 17 patients (25%). Most patients had EUS T3 tumors (n = 59, 87%) and 48 (71%) patients were node-positive (N+). Five (7%) patients were classified EUS \"low-risk\" and 63 (93%) were classified \"high-risk\". Of 63 \"high-risk\" patients, 17 (27%) had M1 disease. The ability of \"low-risk\" EUS to predict M0 disease at laparoscopy was 100% and DSL would have been avoided in five patients (7%). This stratification algorithm showed a sensitivity of 100% (95% confidence interval (CI): 80.5-100%) and a specificity of 9.8% (95% CI: 3.3-21.4%).</p><p><strong>Conclusions: </strong>Use of an EUS-based risk classification system in GC patients without imaging evidence of metastasis helps identify a subset of patients at low-risk for laparoscopic M1 disease who may avoid DSL and proceed directly to neoadjuvant chemotherapy or resection with curative intent. Larger, prospective studies are needed to validate these findings.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/96/04/gr-16-009.PMC9990533.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Reperfusion Injury After Liver Transplantation: Is There a Place for Conservative Management?","authors":"Aiman Obed,&nbsp;Saqr Alsakarneh,&nbsp;Mohammad Abuassi,&nbsp;Abdalla Bashir,&nbsp;Bashar Ali Ahmad,&nbsp;Anwar Jarrad,&nbsp;Thomas Lorf,&nbsp;Mohammad Almeqdadi","doi":"10.14740/gr1584","DOIUrl":"https://doi.org/10.14740/gr1584","url":null,"abstract":"<p><p>Ischemic reperfusion injury (IRI) after liver transplantation is a common cause of early allograft dysfunction with high mortality. The purpose of this case report series is to highlight an unusual clinical course in which complete recovery can occur following the identification of severe hepatic IRI post-transplantation and the implications of this finding on management strategies in patients with IRI post-transplant. Here, we include three cases of severe IRI following liver transplantation that are putatively resolved without retransplantation or definitive therapeutic intervention. All patients recovered until their final follow-up visits to our institution and developed no significant complications from their injury throughout the course of patient care by our institution after discharge from the hospital.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/cb/gr-16-050.PMC9990530.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Pseudoaneurysm of the Splenic Artery: Size/Rupture Correlation.","authors":"Safi Khuri,&nbsp;Mira Damouny,&nbsp;Subhi Mansour","doi":"10.14740/gr1590","DOIUrl":"https://doi.org/10.14740/gr1590","url":null,"abstract":"True arterial aneurysm is defined as a vascular lesion that involves the three layers of the arterial wall causing a vascular bulge. On the other hand, a false aneurysm, also known as pseudoaneurysm (PSA), is a vascular lesion that develops usually following a tear in one or two of the three arterial wall layers, with the developing lesion being contained by the outer adventitia or the local hematoma surrounding the PSA [1]. Giant PSA is defined as a vascular lesion greater than 5 cm in diameter. The splenic artery is the most common visceral artery to be involved in true and false aneurysms, with rates of 60% and 40%, respectively [2]. Although the prevalence rate of splenic artery aneurysm is reported to be 0.2-10.4%, the exact prevalence rate is yet to be known [3]. Splenic artery PSA is even rarer, with merely 300 cases reported in the English literature. Recently, due to the considerable increase in the use of the various imaging tests, such as abdominal ultrasound (US), computed tomography (CT) scan and magnetic resonance imaging (MRI), splenic artery aneurysms and PSA are detected with an increasing frequency [2]. Unlike true aneurysm, which is usually asymptomatic and incidentally discovered, splenic artery PSAs are usually symptomatic [2]. The most commonly reported symptoms are abdominal pain and hemorrhage, either intra-abdominal (into the peritoneal cavity) or intra-luminal (into the gastrointestinal (GI) tract) [4]. In a case series article, only 2.5% of splenic artery PSAs were incidentally found [2]. Etiologies for splenic artery PSA are diverse and include mainly pancreas-related pathologies (52%) (e.g., chronic pancreatitis the most common, acute pancreatitis and pancreatic pseudocyst), post thoraco-abdominal trauma (29%), post-surgical complication (3%) and peptic ulcer disease (2%) [2, 5]. The mechanism behind splenic artery PSA due to pancreasrelated pathology is explained by the “autodigestion theory”: leakage of pancreatic fluid, which includes proteolytic enzymes, into the nearby structures, resulting in structural damage of the arterial wall with subsequent PSA formation [6]. Although any artery can be affected, the most common is the splenic artery, followed by the gastroduodenal artery (GDA). The major concern regarding true or false splenic artery aneurysm is rupture, which may be lethal if left untreated [2]. Mortality rates following untreated ruptures are reported to be as high as 90% [7]. Splenic artery PSAs possess a greater risk for rupture than true aneurysms, and thus, immediate management is almost always required for the treatment of PSAs regardless of size [5, 7]. The risk of rupture with consequent hemorrhage is high at about 37% for splenic artery PSA [7, 8]. For true splenic artery aneurysm, a strong relationship exists between the size of the aneurysm and the risk for rupture and bleeding. On the contrary, it has been claimed that this relationship does not exist for the PSA subgroup [9], and size is not ","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/67/gr-16-056.PMC9990532.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9454325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Patients Diagnosed With Ineffective Esophageal Motility by the Chicago Classification Version 3.0 and Version 4.0 Criteria.","authors":"Alyssa W Tuan,&nbsp;Nauroz Syed,&nbsp;Ronaldo P Panganiban,&nbsp;Roland Y Lee,&nbsp;Shannon Dalessio,&nbsp;Sandeep Pradhan,&nbsp;Junjia Zhu,&nbsp;Ann Ouyang","doi":"10.14740/gr1563","DOIUrl":"https://doi.org/10.14740/gr1563","url":null,"abstract":"<p><strong>Background: </strong>The Chicago Classification version 4.0 (CCv4.0) of ineffective esophageal motility (IEM) is more stringent than the Chicago Classification version 3.0 (CCv3.0) definition. We aimed to compare the clinical and manometric features of patients meeting CCv4.0 IEM criteria (group 1) versus patients meeting CCv3.0 IEM but not CCv4.0 criteria (group 2).</p><p><strong>Methods: </strong>We collected retrospective clinical, manometric, endoscopic, and radiographic data on 174 adults diagnosed with IEM from 2011 to 2019. Complete bolus clearance was defined as evidence of exit of the bolus by impedance measurement at all distal recording sites. Barium studies included barium swallow, modified barium swallow, and barium upper gastrointestinal series studies, and collected data from these reports include abnormal motility and delay in the passage of liquid barium or barium tablet. These data along with other clinical and manometric data were analyzed using comparison and correlation tests. All records were reviewed for repeated studies and the stability of the manometric diagnoses.</p><p><strong>Results: </strong>Most demographic and clinical variables were not different between the groups. A lower mean lower esophageal sphincter pressure was correlated with greater percent of ineffective swallows in group 1 (n = 128) (r = -0.2495, P = 0.0050) and not in group 2. In group 1, increased percent of failed contractions on manometry was associated with increased incomplete bolus clearance (r = 0.3689, P = 0.0001). No such association was observed in group 2. A lower median integrated relaxation pressure was correlated with greater percent of ineffective contractions in group 1 (r = -0.1825, P = 0.0407) and not group 2. Symptom of dysphagia was more prevalent (51.6% versus 69.6%, P = 0.0347) in group 2. Dysphagia was not associated with intrabolus pressure, bolus clearance, barium delay, or weak or failed contractions in either group. In the small number of subjects with repeated studies, a CCv4.0 diagnosis appeared more stable over time.</p><p><strong>Conclusions: </strong>CCv4.0 IEM was associated with worse esophageal function indicated by reduced bolus clearance. Most other features studied did not differ. Symptom presentation cannot predict if patients are likely to have IEM by CCv4.0. Dysphagia was not associated with worse motility, suggesting it may not be primarily dependent on bolus transit.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f4/cb/gr-16-037.PMC9990528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9140333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrocolic Fistula: An Extraordinary Gastrointestinal Fistula.","authors":"Subhi Mansour,&nbsp;Rozan Marjiyeh-Awwad,&nbsp;Safi Khuri","doi":"10.14740/gr1576","DOIUrl":"https://doi.org/10.14740/gr1576","url":null,"abstract":"<p><p>Gastrocolic (GC) fistula, a rare gastrointestinal pathological condition, is defined as an abnormal connection between the stomach and the colon. Mostly, it involves the greater curvature of the stomach and the transverse part of the colon. Its precise incidence rate is unknown and largely differs between western and eastern nations. Etiological causes differ as well between the two worlds. Although several precipitating diseases are reported, nowadays, the most common causes are malignant diseases of the stomach (eastern countries) and colon (western world). Patients with GC fistulas usually present late and complain mainly of vomiting, diarrhea, and severe weight loss. This in turn leads to malnutrition, vitamin deficiencies and electrolyte disturbances. Being a rare condition, and usually forgotten, diagnosis is usually challenging to the treating physicians. Workup usually involves a combination of radiological and endoscopic tests. Long-term survival is unknown, and patients usually have poor prognosis. The aim of this review is to summarize the relevant articles in the English literature for this abnormal medical condition, with emphasis on the different etiologies, pathogenesis, clinical presentation, and management, in order to increase physicians' awareness of such uncommon medical problem.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/01/5b/gr-15-308.PMC9822667.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10558661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalization Outcomes of Acute Pancreatitis in Hematopoietic Stem Cell Transplant Recipients.","authors":"Hunza Chaudhry,&nbsp;Armaan Dhaliwal,&nbsp;Kanwal Bains,&nbsp;Aalam Sohal,&nbsp;Piyush Singla,&nbsp;Raghav Sharma,&nbsp;Dino Dukovic,&nbsp;Isha Kohli,&nbsp;Gagan Gupta,&nbsp;Devang Prajapati","doi":"10.14740/gr1579","DOIUrl":"https://doi.org/10.14740/gr1579","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) carries a significant morbidity and mortality worldwide. AP is a potential complication of hematopoietic stem cell transplantation (HSCT) although its incidence remains unclear. HSCT recipients are at increased risk of AP due to various factors but the effect of AP on mortality and resource utilization in the adult population has not been studied. We investigated the impact of AP on hospitalization outcomes among patients following HSCT.</p><p><strong>Methods: </strong>We queried the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-10 codes. All adult patients with a diagnosis or procedure code of HSCT were included in the study. Patients were divided into those with a diagnosis of AP and those without. Sensitivity analysis was performed for patients with a length of stay greater than 28 days. The relationship between AP and mortality, length of stay, total hospitalization cost, and charges was assessed using univariate analysis followed by multivariate analysis.</p><p><strong>Results: </strong>Of the 140,130 adult patients with HSCT, 855 (0.61%) patients developed AP. There was 1.74 times higher risk of mortality in patients with AP as compared to controls (adjusted odds ratio (aOR): 1.74, P = 0.0055). There was no statistically significant difference in the length of stay, hospitalization charge, or cost before sensitivity analysis. After sensitivity analysis, 13,240 patients were included, from which 125 (0.94%) had AP. There was 3.85 times higher risk of mortality in patients who developed AP as compared to controls (aOR: 3.85, P = 0.003). There was a statistically significant increase noted in the length of stay (adj coeff: 20.3 days, P = 0.002), hospital charges (+$346,616, P = 0.017), and cost (+$121,932.4, P = 0.001) in patients with AP as compared to those who did not develop AP.</p><p><strong>Conclusion: </strong>Recipients of HSCT who develop AP have shown to have higher mortality on sensitivity analysis. This study highlights that AP in HSCT patients is associated with worse outcomes and higher resource utilization. Physicians should be aware of this association as the presence of pancreatitis portends a poor prognosis.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/53/44/gr-15-334.PMC9822663.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10558659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features and Management of Small Bowel Masses Detected During Device-Assisted Enteroscopy: A Multi-Center Experience.","authors":"Michael G Noujaim,&nbsp;Claire Dorsey,&nbsp;Alice Parish,&nbsp;Daniel Raines,&nbsp;Lara Boudreaux,&nbsp;Mark Hanscom,&nbsp;David Cave,&nbsp;Donna Niedzwiecki,&nbsp;Daniel Wild","doi":"10.14740/gr1586","DOIUrl":"https://doi.org/10.14740/gr1586","url":null,"abstract":"<p><strong>Background: </strong>Small bowel mass lesions (SBMLs) are rare, span a range of different histologies and phenotypes, and our understanding of them is limited. Some lesions occur in patients with recognized polyposis syndromes and others arise sporadically. The current literature regarding SBMLs is limited to small retrospective studies, case reports, and small case series. This large multi-center study aims to understand the various clinical presentations, histologies and management options for SBMLs.</p><p><strong>Methods: </strong>After obtaining Institutional Review Board (IRB) approval, electronic records were used to identify all device-assisted enteroscopy (DAE) performed for luminal small bowel evaluation in adult patients at three US referral centers (Duke, LSU and UMass) from January 1, 2014, to October 1, 2020. We identified all patients within this cohort in whom a SBML was detected. Using a focused electronic medical record chart review, we collected patient, procedure, and lesion-related data and used descriptive statistics to explore relationships between these data and outcomes.</p><p><strong>Results: </strong>A total of 218 patients (49 at Duke, 148 at LSU, and 21 at UMass) in this cohort had at least one SBML found on DAE. The most common presenting symptoms were iron-deficiency anemia/bleeding (73.3%) and abnormal imaging (33.6%). Thirty-five percent of patients had symptoms for more than a year prior to their diagnosis. Most patients (71.6%) underwent video capsule endoscopy (VCE) prior to DAE and 84% of these exams showed the lesion. The lesion was seen less frequently (48.9%) on computed tomography (CT) scan performed prior to DAE. The majority of lesions were found on antegrade (56%) or retrograde (29.8%) double-balloon enteroscopy (DBE). The most common lesion phenotypes were submucosal (41.3%) and pedunculated (33%) with a much smaller number being sessile (14.7%) or obstructing/invasive (11%). They were found equally as commonly in the jejunum (46.3%) and ileum (49.5%). Most lesions were 10 - 20 mm in size (47%) but 22.1% were larger than 20 mm. The most common histologies were neuroendocrine tumors (NETs, 20.6%) and hamartomas (20.6%). Primary adenocarcinoma of the small bowel was rare, constituting only 5% of lesions. The majority of polyps (78.4%) were sporadic, compared to 21.7% associated with a polyposis or hereditary cancer syndrome, most commonly Peutz-Jeghers syndrome (18.3%). After DAE, 37.6% were advised to undergo surgical resection and 48% were advised to undergo endoscopic surveillance or no further management because of benign histology or successful endoscopic resection.</p><p><strong>Conclusions: </strong>In this multi-center retrospective study we found that SBMLs are more likely to be sporadic than syndromic, medium in size and either pedunculated or submucosal. NETs and hamartomas predominated and symptoms, most commonly anemia, can be present for more than a year prior to diagnosis. Close ","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/6b/gr-15-353.PMC9822661.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10554194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Open-Access, Interactive Decision-Support Tool to Facilitate Guideline-Driven Care for Hepatocellular Carcinoma.","authors":"Robert J Wong,&nbsp;Channa Jayasekera,&nbsp;Patricia Jones,&nbsp;Fasiha Kanwal,&nbsp;Amit G Singal,&nbsp;Aijaz Ahmed,&nbsp;Robert Taglienti,&nbsp;Zobair Younossi,&nbsp;Laura Kulik,&nbsp;Neil Mehta","doi":"10.14740/gr1573","DOIUrl":"https://doi.org/10.14740/gr1573","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is increasing in incidence and is a leading cause of cancer-related mortality worldwide. Adherence to HCC surveillance guidelines and appropriate treatment triage of liver lesions may improve receipt of curative-intent treatment and improved survival. Late-stage HCC diagnosis reflects sub-optimal implementation of effective HCC surveillance, whereas inappropriate treatment triage or linkage to care accounts for the non-receipt of curative-intent in close to half of early-stage HCC in the USA. A free, open-access decision-support tool for liver lesions that incorporates current guideline recommendations in a user-friendly interface could improve appropriate and timely triage of patients to appropriate care. This review provides a summary of gaps and disparities in linkage to HCC care and introduces a free, internet-based, interactive decision-support tool for managing liver lesions. This tool has been developed by the HCC Steering Committee of the Chronic Liver Disease Foundation and is targeted toward clinicians across specialties who may encounter liver lesions during routine care or as part of dedicated HCC surveillance.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/c4/gr-15-297.PMC9822660.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10558660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the Use of Endoscopic Retrograde Cholangiopancreatography in Pediatrics: A National Database Analysis of Demographics and Complication Rates.","authors":"Eric Lorio,&nbsp;Chris Moreau,&nbsp;Joel Edmund Michalek,&nbsp;Sandeep Patel","doi":"10.14740/gr1503","DOIUrl":"https://doi.org/10.14740/gr1503","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to aid in risk assessment of pediatric endoscopic retrograde cholangiopancreatography (ERCP) candidates by utilizing a national pediatric database with a large sample to assess how patient characteristics may affect ERCP complication rates.</p><p><strong>Methods: </strong>The Kids' Inpatient Database (KID) is a sample of pediatric discharges in states participating in the Healthcare Cost and Utilization Project (HCUP). This database provides demographic information, hospitalization duration, and outcome information for hospitalizations during which an ERCP occurred. International Classification of Diseases (ICD) codes were used to determine the hospitalization indication. ERCP complication rate was ascertained via ICD codes. All statistical analyses were performed using SAS 9.4.</p><p><strong>Results: </strong>Complications were seen in 5.4% of hospitalizations with mortality observed in less than 0.2%. This analysis captured a large Hispanic population, specifically in the South and West regions. Gallbladder calculus and cholecystitis were more likely to occur in females. A higher percentage of patients in the age 10 - 17 group were female (72.2% vs. 52.7%, P < 0.01) and Hispanic (33.4% vs. 22.7%, P < 0.01) compared to the age 0 - 9 group. Age 0 - 5 and male gender were associated with lower routine home discharge rates and longer lengths of stay. Complications occurred at a higher rate in ages 0 - 5, though the difference was not statistically significant.</p><p><strong>Conclusions: </strong>ERCP is a safe procedure for pediatric patients with low complication rates and rare mortality. We found statistically significant differences in the procedure indications between pediatric age groups, races, and genders. Age ≤ 5 years and male gender were associated with more complicated healthcare courses.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/4d/gr-15-314.PMC9822666.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10554199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}