Gastroenterology Research最新文献

{"title":"Quality of Capsule Endoscopy Reporting in Patients Referred for Double Balloon Enteroscopy.","authors":"Joshua Lee,&nbsp;Jonathan Reichstein,&nbsp;Iris Vance,&nbsp;Daniel Wild","doi":"10.14740/gr1596","DOIUrl":"https://doi.org/10.14740/gr1596","url":null,"abstract":"<p><strong>Background: </strong>Abnormal video capsule endoscopy (VCE) findings often require intervention with double balloon enteroscopy (DBE). Accurate VCE reporting is important for procedural planning. In 2017 the American Gastroenterological Association (AGA) published a guideline that included recommended elements for VCE reporting. The aim of this study was to examine adherence to the AGA reporting guidelines for VCE.</p><p><strong>Methods: </strong>The medical records of all patients who underwent DBE at a tertiary academic center between February 1, 2018, and July 1, 2019, were retrospectively reviewed to identify the VCE report that prompted DBE. Data were collected on the presence of each reporting element recommended by the AGA. Differences in reporting between academic and private practices were compared.</p><p><strong>Results: </strong>A total of 129 VCE reports were reviewed (84 private practice and 45 academic practice). Reports consistently included indication, date, endoscopist, findings, diagnosis, and management recommendations. Timing of anatomic landmarks and abnormalities were included in only 87.6% of reports and preparation quality in only 26.2%. Reports from private practice groups were significantly more likely to include the type of capsule (P < 0.001). VCE reports from academic centers were more likely to include adverse outcomes (P < 0.001), pertinent negatives (P = 0.0015), extent of exam (P = 0.009), previous investigations (P = 0.045), medications (P < 0.001), and document communication to patient/referring physician (P = 0.001).</p><p><strong>Conclusions: </strong>Most VCE reports in both private and academic settings included the important elements recommended by the AGA; however only 87% listed the times of landmarks and abnormal findings, which are crucial in determining the type and direction of approach for subsequent interventions. It is unclear whether the quality of VCE reporting influences the outcome of subsequent DBE.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"92-95"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/93/gr-16-092.PMC10181337.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829178","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":"Incidence and Cross-Continents Differences in Endoscopic Retrograde Cholangiopancreatography Outcomes Among Patients With Cirrhosis: A Systematic Review and Meta-Analysis.","authors":"Saqr Alsakarneh,&nbsp;Fouad Jaber,&nbsp;Khalid Ahmed,&nbsp;Fares Ghanem,&nbsp;Wael T Mohammad,&nbsp;Mohamed K Ahmed,&nbsp;Mohamad Khaled Almujarkesh,&nbsp;Thomas Bierman,&nbsp;John Campbell,&nbsp;Yazan Abboud,&nbsp;Muhammad Shah Miran,&nbsp;John H Helzberg,&nbsp;Hassan M Ghoz","doi":"10.14740/gr1610","DOIUrl":"https://doi.org/10.14740/gr1610","url":null,"abstract":"Background There are conflicting data on the frequency and variability of endoscopic retrograde cholangiopancreatography (ERCP) outcomes in patients with cirrhosis. Our aim was to systematically review the literature on the incidence of post-ERCP adverse events in cirrhotic patients and to examine the differences across continents. Methods We searched PubMed/MEDLINE, EMBASE, Scopus, and Cochrane databases to identify studies reporting adverse events after ERCP in patients with cirrhosis from conception to September 30, 2022. The random effects model was used to calculate odds ratios (ORs), mean differences (MDs), and confidence intervals (CIs). A P value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Cochrane Q-statistic (I2). Results Twenty-one studies that included 2,576 cirrhotic patients and 3,729 individual ERCPs were analyzed. The pooled overall rate of adverse events after ERCP in patients with cirrhosis was 16.98% (95% CI: 13.06-21.29%, P < 0.001, I2 = 86.55%). ERCPs performed in Asia had the highest ERCP adverse events with an overall complication rate of 19.90%, while the lowest overall adverse events were in North America at 13.04%. The pooled post-ERCP bleeding, pancreatitis, cholangitis and perforation were 5.10% (95% CI: 3.33-7.19%, P < 0.001, I2 = 76.79%), 3.21% (95% CI: 2.20-5.36%, P = 0.03, I2 = 42.25%), 3.02% (95% CI: 1.19-5.52%, P < 0.001, I2 = 87.11%), and 0.12% (95% CI: 0.00 - 0.45, P = 0.26, I2 = 15.76%), respectively. The pooled post-ERCP mortality rate was 0.22% (95% CI: 0.00-0.85%, P = 0.01, I2 = 51.86%). Conclusions This meta-analysis shows that the overall complication rates after ERCP, bleeding, pancreatitis, and cholangitis are high in patients with cirrhosis. Because cirrhotic patients are more likely to have post-ERCP complications, with significant cross-continent variations, the risks and benefits of ERCP in this patient population should be carefully considered.","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 2","pages":"105-117"},"PeriodicalIF":1.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/65/gr-16-105.PMC10181340.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9829175","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":"A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease.","authors":"Dushyant Singh Dahiya,&nbsp;Sohaib Mandoorah,&nbsp;Manesh Kumar Gangwani,&nbsp;Hassam Ali,&nbsp;Nooraldin Merza,&nbsp;Muhammad Aziz,&nbsp;Amandeep Singh,&nbsp;Abhilash Perisetti,&nbsp;Rajat Garg,&nbsp;Chin-I Cheng,&nbsp;Priyata Dutta,&nbsp;Sumant Inamdar,&nbsp;Madhusudhan R Sanaka,&nbsp;Mohammad Al-Haddad","doi":"10.14740/gr1605","DOIUrl":"https://doi.org/10.14740/gr1605","url":null,"abstract":"<p><strong>Background: </strong>End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA).</p><p><strong>Methods: </strong>We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified.</p><p><strong>Results: </strong>Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD.</p><p><strong>Conclusions: </strong>PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 1","pages":"17-24"},"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/3c/af/gr-16-017.PMC9990529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9140335","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":"The Impact of Metabolic Syndrome on the Prognosis of High-Risk Alcoholic Hepatitis Patients: Redefining Alcoholic Hepatitis.","authors":"Shahid Habib,&nbsp;Traci Murakami,&nbsp;Varun Takyar,&nbsp;Krunal Patel,&nbsp;Cristian Dominguez,&nbsp;Yongcheng Zhan,&nbsp;Omid Mehrpour,&nbsp;Chiu-Hsieh Hsu","doi":"10.14740/gr1556","DOIUrl":"https://doi.org/10.14740/gr1556","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Alcoholic hepatitis (AH) is characterized by acute symptomatic hepatitis associated with heavy alcohol use. This study was designed to assess the impact of metabolic syndrome on high-risk patients with AH with discriminant function (DF) score ≥ 32 and its effect on mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the hospital database for ICD-9 diagnosis codes of acute AH, alcoholic liver cirrhosis, and alcoholic liver damage. The entire cohort was categorized into two groups: AH and AH with metabolic syndrome. The effect of metabolic syndrome on mortality was evaluated. Also, an exploratory analysis was used to create a novel risk measure score to assess mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A large proportion (75.5%) of the patients identified in the database who had been treated as AH had other etiologies and did not meet the American College of Gastroenterology (ACG)-defined diagnosis of acute AH, thus had been misdiagnosed as AH. Such patients were excluded from analysis. The mean body mass index (BMI), hemoglobin (Hb), hematocrit (HCT), and alcoholic liver disease/non-alcoholic fatty liver disease index (ANI) were significantly different between two groups (P &lt; 0.05). The results of a univariate Cox regression model showed that age, BMI, white blood cells (WBCs), creatinine (Cr), international normalized ratio (INR), prothrombin time (PT), albumin levels, albumin &lt; 3.5, total bilirubin, Na, Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), MELD ≥ 21, MELD ≥ 18, DF score, and DF ≥ 32 had a significant effect on mortality. Patients with a MELD greater than 21 had a hazard ratio (HR) (95% confidence interval (CI) of 5.81 (2.74 - 12.30) (P &lt; 0.001). The adjusted Cox regression model results showed that age, Hb, Cr, INR, Na, MELD score, DF score, and metabolic syndrome were independently associated with high patient mortality. However, the increase in BMI and mean corpuscular volume (MCV) and sodium significantly reduced the risk of death. We found that a model including age, MELD ≥ 21, and albumin &lt; 3.5 was the best model in identifying patient mortality. Our study showed that patients admitted with a diagnosis of alcoholic liver disease with metabolic syndrome had an increased mortality risk compared to patients without metabolic syndrome, in high-risk patients with DF ≥ 32 and MELD ≥ 21. A bivariate correlation analysis revealed that patients with AH with metabolic syndrome were more likely to have infection (43%) compared to AH (26%) with correlation coefficient of 0.176 (P = 0.03, CI: 0.018 - 1.0).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In clinical practice, the diagnosis of AH is inaccurately applied. Metabolic syndrome significantly increases the mortality risk in high-risk AH. It signifies that the presence of features of metabolic syndrome modifies the behavior of AH in acute settings, warranting different therapeutic strategies. We propose that in defining AH, patients overlappi","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"16 1","pages":"25-36"},"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/1a/e0/gr-16-025.PMC9990531.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437750","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":"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":"16 1","pages":"1-8"},"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":"16 1","pages":"9-16"},"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":"16 1","pages":"50-55"},"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":"16 1","pages":"56-58"},"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":"16 1","pages":"37-49"},"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":"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":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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":"15 6","pages":"353-363"},"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}