Indian Journal of Gastroenterology最新文献

{"title":"Role of therapeutic plasma exchange on survival in pediatric acute liver failure and acute-on chronic liver failure: A systematic review and meta-analysis.","authors":"Kalpana Panda, Devi Prasad Dash, Prateek Kumar Panda, Mrutunjay Dash, Prasant Kumar Saboth, Girish Kumar Pati","doi":"10.1007/s12664-025-01742-2","DOIUrl":"10.1007/s12664-025-01742-2","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic plasma exchange (TPE) has emerged as a promising treatment option for pediatric liver failure (PLF) either as a standalone therapy or as a bridge to liver transplant; however, its precise impact on survival outcomes has not been investigated systematically to date. This meta-analysis aims to evaluate the effect of TPE on survival of pediatric patients with liver failure.  METHODS: PubMed, Scopus and Embase databases were searched to include all studies till August 2024 reporting the effect of TPE on survival of acute and acute-on-chronic liver failure patients of age < 18 years. Primary outcome measures were overall survival (OS) and transplant-free survival (TFS) at Day ≥ 28 in pediatric acute liver failure (PALF) and pediatric acute-on-chronic liver failure (pACLF) patients undergoing TPE. The secondary outcome measure was to determine changes in biochemical parameters (international nrmalized ratio [INR], bilirubin and ammonia) pre and post-TPE in them.</p><p><strong>Results: </strong>Twelve studies (8 = exclusive PALF cohorts and 4 = combined PALF + pACLF cohorts) comprising 310 patients (273 = PALF and 37 = pACLF) who received TPE were included. Pooled OS at Day ≥ 28 for PLF after TPE is 61% (95% CI: 55-66%, p = 0.03, I² = 49%). The estimated pooled TFS in them was 35% (95% CI: 29-41%, p = < 0.01, I² = 84%). On sub-group analysis, the standard-volume TPE group had both higher OS and TFS in comparison to the high-volume sub-group. There was a significant improvement in all three biochemical parameters post-TPE compared to pre-TPE values. None of the included studies reported any TPE-related mortality or potentially fatal side effects.</p><p><strong>Conclusion: </strong>TPE shows the potential to improve overall survival in pediatric liver failure, mostly acting as a bridge to liver transplant or native liver recovery. Further, well-designed, adequately powered, randomized-controlled trials are needed to confirm TPE's survival benefit in PLF.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":"618-633"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of clips, devices and sprays in endoscopic hemostasis: An update (with videos).","authors":"Nikhil Sonthalia, Rajesh Puri, Shivam Sethi","doi":"10.1007/s12664-025-01815-2","DOIUrl":"10.1007/s12664-025-01815-2","url":null,"abstract":"<p><p>Clips, devices and sprays are important tools in the armamentarium of interventional endoscopists which are needed to tackle challenging clinical scenarios. There has been a revolutionary change in the design and features of modern-day endoscopic clips that has greatly increased its applicability. Both through-the-scope clip (TTS clip) and over-the-scope clips (OTSC) have their role in day-to-day clinical practice with each having some advantages and disadvantages. Sprays have been an important adjunct to clips which can be extremely useful in difficult clinical scenarios where clips may not work. There has been growing evidence with regard to its use in literature. Many different types of TTS clips are available that have combination of different properties such as size, tail length, rotatability, re-openability and tensile strength. Two types of OTSC are available which differs according to their design and mechanism of application. Though TTS clips are still most used clips in day-to-day practice, we recommend that OTSCs should be used as a primary modality in patients who are at high risk of rebleeding such as patients on dual anti-platelets, those requiring to restart anticoagulation early, patients with chronic kidney disease and in large (> 1.5 cm) fibrotic ulcer bleeds. Herein, we describe technical and clinical aspects, types, applications and optimal usage techniques of different clips, devices and sprays commonly used in endoscopy.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":"595-604"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of direct intrahepatic portosystemic shunt and other major radiological interventions in patients with Budd-Chiari syndrome.","authors":"Sayan Malakar, Nishant Shah, Umair Shamsul Hoda, Avinash D Gautam, Rajanikant R Yadav, Srikanth Kothalkar, Rahul Jangra, Gaurav Pandey, Akash Roy, Praveer Rai, Samir Mohindra, Uday C Ghoshal","doi":"10.1007/s12664-024-01733-9","DOIUrl":"10.1007/s12664-024-01733-9","url":null,"abstract":"<p><strong>Introduction: </strong>Radiological interventions in Budd-Chiari syndrome (BCS) include anatomical recanalization of the hepatic vein (HV), inferior vena cava (IVC) angioplasty and stenting. In case of technical difficulty and anatomical non-feasibility, an ultrasound-guided direct intrahepatic portosystemic shunt (DIPSS) is created. We aimed at evaluating the outcome of patients managed with DIPSS and comparing it with anatomical recanalization.</p><p><strong>Methods: </strong>We retrieved the data of patients with BCS managed at our institution between 2011 and 2021. Safety, efficacy and long-term outcomes were assessed and compared between radiological interventions.</p><p><strong>Results: </strong>Total 236 patients with BCS underwent radiological intervention in the study period. As many as 96 patients were excluded and 140 patients were included in the final analysis. The majority were males (F:M = 54:86). The median age at the time of diagnosis was 30 years (interquartile range: 25-37 years). The median follow-up period was 58 (14-72) months. On imaging, 53% (74) patients had combined HV and IVC block followed by isolated HV block in 54 patients (38.5%) and isolated IVC block in 12 patients (8.5%). As many as 32 patients were managed by DIPSS. Among others, 56 patients underwent IVC angioplasty with HV stenting and 30 required HV angioplasty and stenting. DIPSS had a comparable technical success rate (100% vs. 98.2% vs. 96%, respectively p > 0.5). However, the median stent patency was higher in the DIPSS group (72 [48-96] months) compared to IVC angioplasty and HV stenting (46 [36-60] months; p = 0.02) and HV angioplasty-stenting (42 [30-48] months; p = 0.04) groups. They had similar re-thrombosis rates (28%, 34% and 21%, respectively; p > 0.05). Overall complications were rare (3.5%) and no patient in the DIPSS group had adverse events.</p><p><strong>Conclusion: </strong>DIPSS is a safe and effective salvage procedure with an excellent long-term outcome in patients with BCS. It has a longer median stent patency compared to the anatomical recanalization group.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":"708-718"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated peritoneal amyloidosis in multiple myeloma presenting as persistent colicky pain.","authors":"Rinkal Kakadiya, Arvind Malvia","doi":"10.1007/s12664-025-01827-y","DOIUrl":"https://doi.org/10.1007/s12664-025-01827-y","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor re:Comparison of DIPSS and other interventions in Budd-Chiari syndrome.","authors":"Motij Kumar Dalai, Deepak S, Sanjay Jagdish Chandnani","doi":"10.1007/s12664-025-01855-8","DOIUrl":"https://doi.org/10.1007/s12664-025-01855-8","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-reflux mucosal ablation: A good method for proton pump inhibitor dependent gastroesophageal reflux disease.","authors":"Jing-Yu Zhu, Yi-Heng Yao, Ming Qi, Liang Liu","doi":"10.1007/s12664-025-01867-4","DOIUrl":"https://doi.org/10.1007/s12664-025-01867-4","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of endoscopic ultrasound in diagnosis and management of autoimmune pancreatitis.","authors":"Gauri Kumbhar, Akhil Mahajan, Rahul Puri, Sridhar Sundaram","doi":"10.1007/s12664-025-01852-x","DOIUrl":"https://doi.org/10.1007/s12664-025-01852-x","url":null,"abstract":"<p><p>Autoimmune pancreatitis (AIP) is a rare inflammatory disorder of the pancreas, often mistaken for pancreatic cancer. Despite definitive diagnostic criteria such as histology, imaging, serology, other organ involvement and response to therapy (HISORt), International Consensus Diagnostic Criteria (ICDC) and Japan Pancreas Society (JPS) criteria being available for AIP, making a diagnosis of AIP remain a rarity in the evaluation of a pancreatic mass or distal bile duct obstruction. A significant proportion of patients are diagnosed only after surgical resection. Endoscopic ultrasound (EUS) is the main modality for establishing diagnosis of AIP. Considering the rarity of the disease, there are no classical findings on EUS associated with AIP. Histopathology remains the crux for diagnosing AIP with need for EUS-guided sampling. Both focal and diffuse forms of AIP are described with different EUS findings in both. The focal form mimics pancreatic cancer closely. The disease is also known to have extra-pancreatic involvement with cholangiopathy also seen often in association. Diffuse involvement of the pancreas is unusual and may be rarely seen with diffuse pancreatic infiltrative diseases. The primary consideration remains differentiating AIP from carcinoma of pancreas, where EUS plays a significant role. Adjunct techniques such as EUS-guided elastography and contrast harmonic EUS can add value in diagnosing AIP. Advances in tissue sampling, including availability of better needles for core biopsy, have aided in improving the diagnostic yield of AIP. In this narrative review, we aim to highlight the increasing role of EUS for establishing diagnosis of AIP while elaborating its role in evaluation, sampling and therapeutic monitoring.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of a mesenchymal phenotype grading system combining tumor budding and FRMD6 expression for disease-free survival in colorectal carcinomas.","authors":"Subham Bhowmik, Lalita Mehra, Tamoghna Ghosh, Priyanka Mani, Ashok Tiwari, Sunil Kumar, Akash Jha, Rajni Yadav, S V S Deo, Atul Sharma, Prasenjit Das","doi":"10.1007/s12664-025-01861-w","DOIUrl":"https://doi.org/10.1007/s12664-025-01861-w","url":null,"abstract":"<p><strong>Background/objectives: </strong>The mesenchymal phenotype in solid epithelial tumors contributes to aggressive outcomes. This study examined histological indicators of tumor mesenchymal phenotypes, including the Glasgow Microenvironment Score (GMS), tumor budding (TB) grades and Ferm Containing Domain 6 (FRMD6) expression in colorectal carcinomas (CRC) and correlated these with disease-free survival (DFS).</p><p><strong>Methods: </strong>Total 101 CRC cases were included. Peri-tumoral inflammation was classified as low (none/mild) and high (band/dense cup-like) infiltration. Tumor stromal percentage was assessed as low (≤ 50% intra-tumor stroma) and high (> 50% fibrosis) based on intra-tumoral fibrosis. TB at the invasive border was categorized as low (0-9/0.785 mm²) and high (≥ 10/0.785 mm²). FRMD6 expression was graded as low and high according to the median H score. All these parameters were correlated with DFS.</p><p><strong>Results: </strong>The mean DFS in this cohort was 19.7 months. While the GMS grades did not correlate with DFS at 36 months (p 0.71) and 48 months (p 0.79), TB and FRMD6 grades separately were significantly correlated with DFS at 36 months (TB p 0.001 and FRMD6 p 0.004) and 48 months (TB p 0.002 and FRMD6 p 0.008). When combined, the mesenchymal classification using GMS + TB + FRMD6 did not show correlation with DFS at 36 months (p 0.09) and 48 months (p 0.49). However, mesenchymal phenotyping combining TB + FRMD6 showed a significant correlation with DFS both at 36 months (p < 0.001) and 48 months (p < 0.001) in multivariate analysis. In this cohort, CRCs with low-GMS, low-TB and low-TB + GMS grades were found to be mostly mismatch repair (MMR) deficient (GMS p 0.007, TB p 0.03 and GMS + TB p 0.009).</p><p><strong>Conclusion: </strong>Mesenchymal tumor phenotyping combining TB and FRMD6 expression correlates well with DFS in CRCs.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of artificial intelligence-based patient education models for irritable bowel syndrome.","authors":"Anand Kumar Raghavendran, Balaji Musunuri, Siddheesh Rajpurohit, Ganesh Pai C, Shiran Shetty, Pretty Kumari, Rakshand Shetty, Athish Shetty, Ganesh Bhat","doi":"10.1007/s12664-025-01872-7","DOIUrl":"https://doi.org/10.1007/s12664-025-01872-7","url":null,"abstract":"<p><strong>Background: </strong>Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a significant psycho-social burden. Despite medical advancements, patient education on IBS remains inadequate. This study compared two large language models (LLMs)-ChatGPT-4 and Gemini-1-for their performance in addressing IBS-related patient queries.</p><p><strong>Methods: </strong>Thirty-nine IBS-related frequently asked questions (FAQs) from IBS organizations and hospital websites were categorized into six domains: general understanding, symptoms and diagnosis, causes, dietary considerations, treatment and lifestyle factors. Responses from ChatGPT-4 and Gemini-1 were evaluated by two independent gastroenterologists for comprehensiveness and accuracy, with a third reviewer resolving disagreements. Readability was measured using five standardized indices (Flesch Reading Ease [FRE], Simple Measure of Gobbledygook [SMOG], Gunning Fog Index [GFI], Automated Readability Index [ARI], Reading Level Consensus [ARC]) and empathy was rated on a 4-point Likert scale by three reviewers.</p><p><strong>Results: </strong>Gemini produced comprehensive and accurate answers for 94.9% (37/39) of questions, with two rated as mixed (vague/outdated). ChatGPT achieved 89.7% (35/39) comprehensive responses, with four rated mixed. Domain-wise, both models performed best in \"symptoms and diagnosis\" and \"treatment\", while mixed responses were most frequent in \"general understanding\" and \"lifestyle\". There was no significant difference in comprehensiveness (p = 0.67). Readability analysis showed both LLMs generated difficult-to-read content: Gemini's FRE score was 35.83 ± 3.31 vs. ChatGPT's 32.33 ± 5.57 (p = 0.21), corresponding to college-level proficiency. ChatGPT's responses were more empathetic, with all responses rated moderately empathetic; Gemini was mostly rated minimally empathetic (66.7%).</p><p><strong>Conclusion: </strong>While ChatGPT and Gemini provided extensive information, their limitations-such as complex language and occasional inaccuracies-must be addressed. Future improvements should focus on enhancing readability, contextual relevance and accuracy to better meet the diverse needs of patients and clinicians.</p>","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes and quality of life after surgical repair of benign biliary stricture following bile duct injury during cholecystectomy.","authors":"Peeyush Varshney, Vinay K Kapoor","doi":"10.1007/s12664-025-01874-5","DOIUrl":"https://doi.org/10.1007/s12664-025-01874-5","url":null,"abstract":"","PeriodicalId":13404,"journal":{"name":"Indian Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}