Journal of clinical gastroenterology最新文献

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Decreased Completion of Ordered Laboratories and Imaging in Telehealth Compared With In-person Hepatology Encounters. 与亲临现场的肝病就诊相比,远程医疗中的化验和影像检查完成率有所下降。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-04-01 DOI: 10.1097/MCG.0000000000002023
Jacqueline B Henson, Yuval A Patel, April H Wall, Andrew J Muir
{"title":"Decreased Completion of Ordered Laboratories and Imaging in Telehealth Compared With In-person Hepatology Encounters.","authors":"Jacqueline B Henson, Yuval A Patel, April H Wall, Andrew J Muir","doi":"10.1097/MCG.0000000000002023","DOIUrl":"10.1097/MCG.0000000000002023","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate order completion after telehealth compared with in-person encounters.</p><p><strong>Background: </strong>Completion of ordered testing, including laboratories and imaging, is an important aspect of successful outpatient care of patients with liver disease. Whether the completion of orders from telehealth encounters differs from in-person visits is unknown.</p><p><strong>Materials and methods: </strong>Completion of ordered laboratories and imaging from hepatology encounters at our center from 2021 to 2022 were evaluated and compared between video telehealth and in-person visits. Laboratory completion was evaluated at 14 days, 30 days, and 90 days, and imaging completion was assessed at 1 year.</p><p><strong>Results: </strong>Telehealth encounters were significantly less likely to have laboratories completed at all evaluated time points (14 d: 40.7% vs 90.9%; 30 d: 50.9% vs 92.2%; 90 d: 63.9% vs 94.3%, P < 0.001 for all). Among telehealth encounters, encounters in patients more remote from the center were less likely to have laboratories completed. Imaging ordered at telehealth encounters was also less likely to be completed within 1 year (62.5% vs 70.1%, P < 0.001), including liver ultrasounds (59.1% vs 67.6%, P = 0.001), which persisted when limited to encounters for cirrhosis (55.8% vs 66.4%, P = 0.01).</p><p><strong>Conclusions: </strong>Telehealth encounters were significantly less likely to have ordered laboratories and imaging completed compared with in-person visits, which has important clinical implications for effective outpatient care of patients with liver disease. Further research is needed to better understand the barriers to order completion for telehealth visits and ways to optimize this to improve the effectiveness of this visit modality.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"354-360"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620094","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}
引用次数: 0
Preinjection With Ligation-Assisted Endoscopic Mucosal Resection for Barrett's Dysplasia and Early Esophageal Adenocarcinoma: Characteristic Histological Features of the Depth of Resection. 预注射与结扎辅助内镜黏膜切除术治疗巴雷特发育不良和早期食管腺癌:切除深度的组织学特征。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-04-01 DOI: 10.1097/MCG.0000000000002026
Thomas J Williams, Phyu Hlaing, Adrian M Maher, Neal Walker, Bradley J Kendall, Gerald Holtmann, Luke F Hourigan
{"title":"Preinjection With Ligation-Assisted Endoscopic Mucosal Resection for Barrett's Dysplasia and Early Esophageal Adenocarcinoma: Characteristic Histological Features of the Depth of Resection.","authors":"Thomas J Williams, Phyu Hlaing, Adrian M Maher, Neal Walker, Bradley J Kendall, Gerald Holtmann, Luke F Hourigan","doi":"10.1097/MCG.0000000000002026","DOIUrl":"10.1097/MCG.0000000000002026","url":null,"abstract":"<p><strong>Background and aim: </strong>Endoscopic mucosal resection (EMR) is an established technique for the diagnosis and treatment of high-grade dysplasia (HGD) and early esophageal adenocarcinoma (EAC) in Barrett's esophagus. Submucosal preinjection is not universally used or generally recommended when performing routine ligation-assisted EMR. Prior studies, however, have demonstrated evidence of at least superficial muscle injury on ligation-assisted EMR without submucosal injection. There are limited published data supporting any potential benefit of submucosal preinjection. Our aim was to review this technique and determine the rate of any degree of muscle injury in patients with Barrett's HGD and EAC treated with submucosal preinjection before ligation-assisted EMR.</p><p><strong>Methods: </strong>Patients undergoing submucosal preinjection before ligation-assisted EMR for Barrett's esophagus at a single institution between 2012 and 2016 were identified. Data were collected regarding patient demographics and medical history, endoscopy and histopathology findings, adverse events, and subsequent outcomes. All EMR specimens were reviewed by an expert gastrointestinal pathologist.</p><p><strong>Results: </strong>One hundred fifty consecutive EMR procedures were performed on 70 patients. Of 70 patients, 85.7% of patients were men, with a median age of 68 years. EAC was identified in 75 specimens (50%) and HGD in 44 specimens (29.3%). Deep resection margins were clear of adenocarcinoma in all specimens. Muscularis propria was not identified in any of the 150 specimens. There were no cases of post-EMR perforation.</p><p><strong>Conclusions: </strong>Preinjection before ligation-assisted EMR achieved complete excision with histologically clear margins, without histological evidence of any inadvertent muscularis propria.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"321-324"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620097","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}
引用次数: 0
Endoscopic Ultrasound-Guided Fine Needle Acquisition for Evaluation of Pancreatic Neuroendocrine Tumors: A Meta-Analysis. 评估胰腺神经内分泌肿瘤的内镜超声引导下细针采集:一项 Meta 分析。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-04-01 DOI: 10.1097/MCG.0000000000002070
Xiaohua Ye, Hongjun Hua, Chunxiao Hu, Jianying Dai, Chenjiao Wu, Jiaping Huai, Zhe Shen
{"title":"Endoscopic Ultrasound-Guided Fine Needle Acquisition for Evaluation of Pancreatic Neuroendocrine Tumors: A Meta-Analysis.","authors":"Xiaohua Ye, Hongjun Hua, Chunxiao Hu, Jianying Dai, Chenjiao Wu, Jiaping Huai, Zhe Shen","doi":"10.1097/MCG.0000000000002070","DOIUrl":"10.1097/MCG.0000000000002070","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this meta-analysis was to assess the diagnostic performance of EUS-FNA/B in patients with panNETs.</p><p><strong>Methods: </strong>We conducted a computerized search of the MEDLINE and Embase databases to identify relevant articles. The primary outcomes involved grading concordance rate, diagnostic rate, and correlation coefficient (Cohen's κ) for FNA/B samples compared with surgical specimens. Secondary outcomes included sample adequacy, mean number of passes, and adverse events.</p><p><strong>Results: </strong>Forty-five studies involving 2978 patients were finally included. The pooled concordance rate between EUS-FNA/B and surgical grading was 0.77 (95% CI: 0.73-0.80; I2 =48.2%). A significantly higher level of concordance was observed in G1 subgroup (0.88, 95% CI: 0.84-0.91), whereas the G2 subgroup revealed the lowest level of agreement (0.59, 95% CI: 0.52-0.65; P < 0.001). Pooled diagnostic rate for FNA/B sampling was 0.83 (95% CI: 0.79-0.86; I2 =63.3%). In addition, FNB outperformed FNA in terms of sample adequacy (0.93 for FNB vs. 0.81 for FNA; P =0.007) and number of needle passes required (2.53 for FNB vs. 3.32 for FNA; P =0.013). Moreover, the overall level of agreement for grading was moderate (κ=0.59, 95% CI: 0.49-0.68; I2 =84.5%). There were a limited number of adverse events that had minor influence on patient outcomes (0.03, 95% CI: 0.02-0.05; I2 =19.2%).</p><p><strong>Conclusions: </strong>EUS-FNA/B is a reliable approach for the diagnosis and preoperative grading of panNET, with FNB demonstrating superior performance compared with FNA.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"310-320"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307769","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}
引用次数: 0
Development and Validation of Crohn's Perianal Fistula Educational Videos and Website for Increasing Patient Knowledge and Engagement. 克罗恩肛周瘘教育视频和网站的开发和验证,以增加患者的知识和参与。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-25 DOI: 10.1097/MCG.0000000000002156
Carine Khalil, Muskaan Mehra, Yixin Yang, So Yung Choi, Jan Ballesteros, Zoe Krut, Nirupama Bonthala, Karen Zaghiyan, Phillip Gu, Yee Hui Yeo, Brennan M R Spiegel, Christopher V Almario
{"title":"Development and Validation of Crohn's Perianal Fistula Educational Videos and Website for Increasing Patient Knowledge and Engagement.","authors":"Carine Khalil, Muskaan Mehra, Yixin Yang, So Yung Choi, Jan Ballesteros, Zoe Krut, Nirupama Bonthala, Karen Zaghiyan, Phillip Gu, Yee Hui Yeo, Brennan M R Spiegel, Christopher V Almario","doi":"10.1097/MCG.0000000000002156","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002156","url":null,"abstract":"<p><strong>Introduction: </strong>There are few online resources that provide authoritative and comprehensive information on Crohn's perianal fistula (CPF). In this study, we aimed to use a human-centered design thinking approach to develop and validate 2 educational CPF videos and an accompanying website to support patients with CPF.</p><p><strong>Methods: </strong>We used a design thinking approach to understand the unmet educational needs of patients with CPF. We conducted 3 rounds of interviews with a diverse sample of patients with CPF and used the resulting insights to iteratively develop 2 unbranded educational videos optimized for social media and an accompanying website. To validate the 2 videos, we performed an online survey with CPF patients to assess the impact of the videos on patient activation as measured by the patient activation measure (PAM).</p><p><strong>Results: </strong>Our design thinking approach with 20 CPF patients allowed us to empathize with them, gain an in-depth understanding of their informational needs, and iteratively test and update the educational materials based on their input. Using their feedback, we created 2 videos (\"What is a Crohn's perianal fistula?\" and \"How to treat Crohn's perianal fistula?\") and a corresponding website called \"Heal My Fistula.\" In qualitative testing, patients described both videos and the website as \"accurate\", \"informative\", \"simple\", \"easy to understand\", and in line with their expectations. In validation testing through a pre-post survey (N=357), both videos led to statistically significant improvements in PAM scores (P<0.001).</p><p><strong>Conclusion: </strong>Through a human-centered design thinking approach, we developed and validated 2 informative videos and a website (healmyfistula.org) for addressing the educational needs of patients with CPF.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012261","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}
引用次数: 0
Midterm Evaluation of EUS-guided Gastroenterostomy for Gastric Outlet Obstruction: An International Collaborative Study. eus引导胃肠造口术治疗胃出口梗阻的中期评价:一项国际合作研究。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-13 DOI: 10.1097/MCG.0000000000002174
Andrew Canakis, Monica Gaidhane, Haroon M Shahid, Amy Tyberg, Dillon C Miller, Romy Bareket, Conan Chen, Petko Karagyozov, Avik Sarkar, Jessica L Widmer, Everson L Artifon, Prashant Kedia, Salil Chowdhury, Divya M Chalikonda, Vincent Dioguardi, David E Loren, Thomas E Kowalski, Alexander Schlachterman, Anand Kumar, Austin Chiang, Domenica Cunto, Carolos Robles-Medranda, Michel Kahaleh
{"title":"Midterm Evaluation of EUS-guided Gastroenterostomy for Gastric Outlet Obstruction: An International Collaborative Study.","authors":"Andrew Canakis, Monica Gaidhane, Haroon M Shahid, Amy Tyberg, Dillon C Miller, Romy Bareket, Conan Chen, Petko Karagyozov, Avik Sarkar, Jessica L Widmer, Everson L Artifon, Prashant Kedia, Salil Chowdhury, Divya M Chalikonda, Vincent Dioguardi, David E Loren, Thomas E Kowalski, Alexander Schlachterman, Anand Kumar, Austin Chiang, Domenica Cunto, Carolos Robles-Medranda, Michel Kahaleh","doi":"10.1097/MCG.0000000000002174","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002174","url":null,"abstract":"<p><strong>Background: </strong>EUS-guided gastroenterostomy (EUS-GE) is a minimally invasive therapy for the management of gastric outlet obstruction (GOO). EUS-GE has demonstrated excellent short-term efficacy without the risks of surgical bypass. However, there is limited data on follow-up outcomes. In this study, we collected 6-month follow-up data on patients who underwent EUS-GE for benign and malignant etiologies, to aim to show the shift in paradigm in their management algorithm.</p><p><strong>Methods: </strong>This was a retrospective multicenter study across 7 international centers of consecutive patients undergoing EUS-GE over a 4-year period who were entered in a dedicated registry. Demographic characteristics, procedure-related information, and follow-up data were collected. Primary outcome was the 6-month data on clinical resolution of GOO.</p><p><strong>Results: </strong>Ninety-one patients were included (71 malignant and 20 benign cases). Technical success was 99% due to high expertise and volume. Clinical success at 48 hours was 97% (88/90) with an average procedure time of 47 minutes and length of stay of 5.86 days. At 3 months, 87 (95.6%) patients had achieved clinical resolution. At 6 months, 48 (53%) subjects were alive, 40 (44%) were deceased, 3 were lost to follow-up (3.3%) and 1 (1%) had a recurrence of GOO. Clinical success at 6 months follow-up was 98% (47/48).</p><p><strong>Conclusions: </strong>The majority of patients with GOO who undergo EUS-GE showed clinical resolution at 6-month follow-up. Patients with malignant etiology are appropriately palliated during their life span. Further prospective studies are necessary to obtain long-term data regarding EUS-GE for benign etiologies.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605152","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}
引用次数: 0
Efficacy of a CBT Self-Help App (Zemedy) Versus an Education, Relaxation, and Mindfulness App for IBS: Results from Post-Treatment, 3-Month, and 6-Month Follow-Up. CBT自助应用程序(Zemedy)与教育、放松和正念应用程序对IBS的疗效:治疗后、3个月和6个月随访的结果
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-12 DOI: 10.1097/MCG.0000000000002164
Melissa Hunt, Anika Dalvie, Simay Ipek, Sophia Glinski, Riley Macks
{"title":"Efficacy of a CBT Self-Help App (Zemedy) Versus an Education, Relaxation, and Mindfulness App for IBS: Results from Post-Treatment, 3-Month, and 6-Month Follow-Up.","authors":"Melissa Hunt, Anika Dalvie, Simay Ipek, Sophia Glinski, Riley Macks","doi":"10.1097/MCG.0000000000002164","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002164","url":null,"abstract":"<p><strong>Goals: </strong>To test the efficacy of a self-help cognitive behavioral therapy (CBT) for irritable bowel syndrome (IBS) app compared with an active control app.</p><p><strong>Background: </strong>IBS is a disorder of gut-brain interaction that can result in significant distress, disability, and psychiatric co-morbidity. CBT is an effective treatment for IBS. Self-help CBT apps can increase accessibility but should be tested against active controls.</p><p><strong>Methods: </strong>This randomized controlled trial (NCT04665271) compared a CBT for IBS self-help app (Zemedy) to an active education, lifestyle management, relaxation, and mindfulness control app. A total of 453 individuals were screened in and offered allocation to treatment. Participants who actually downloaded their assigned app (N=267) were evenly split between the CBT app (N=136) and the active control (N=131). Follow-up data (CBT N=74, control N=82) were collected immediately post-treatment, at which point the control group was offered crossover to CBT. Follow-up data were collected at 3 (N=65) and 6 (N=32) months. Primary outcomes included IBS symptom severity and IBS quality of life. Secondary outcomes included catastrophizing, visceral anxiety, fear of food, and depression.</p><p><strong>Results: </strong>At post-treatment, the CBT group improved significantly across all outcomes. The control group also improved on all outcomes except fear of food. In the intent-to-treat analysis the CBT group improved significantly more than the control group on both primary and secondary outcomes except depression. Gains were maintained at 3 and 6 months, although attrition was considerable.</p><p><strong>Conclusion: </strong>Self-help CBT for IBS may be effective and can be delivered successfully through apps, although we did not have data on engagement. Psychoeducation about symptom management strategies, relaxation, and mindfulness are active treatment components, but CBT is better at addressing underlying maintaining factors like catastrophizing, visceral anxiety, and fear of food.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605150","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}
引用次数: 0
Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction: A Systematic Review and Meta-analysis. 恶性胆道远端梗阻放置自膨胀金属支架后胆囊炎的危险因素:系统回顾和荟萃分析。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-11 DOI: 10.1097/MCG.0000000000002171
Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A Gromski, Mohammad Al-Haddad
{"title":"Risk Factors for Cholecystitis After Self-expandable Metallic Stent Placement for Malignant Distal Biliary Obstruction: A Systematic Review and Meta-analysis.","authors":"Hashem Albunni, Azizullah Beran, Nwal Hadaki, Mark A Gromski, Mohammad Al-Haddad","doi":"10.1097/MCG.0000000000002171","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002171","url":null,"abstract":"<p><strong>Background and goals: </strong>Endoscopic biliary stenting is a standard palliative procedure to improve the quality of life in patients with unresectable malignant distal biliary obstruction (MDBO). Self-expandable metallic stents (SEMS) are preferred for their longer patency than plastic stents. However, cholecystitis can complicate SEMS placement by obstructing the cystic duct. This meta-analysis aims to identify risk factors for cholecystitis after SEMS placement for MDBO.</p><p><strong>Study: </strong>We conducted a comprehensive database search to identify published studies. Only full-text articles using multivariate models to assess risk factors were included. Pooled adjusted odds ratios (OR) with 95% CIs were obtained.</p><p><strong>Results: </strong>Eleven retrospective cohort studies (4291 patients who underwent SEMS placement for MDBO) were included, analyzing 8 unique risk factors. Predictors of cholecystitis after SEMS placement for MDBO included tumor involvement of the cystic duct take-off (OR 5.61, 95% CI 3.36-9.36, P< 0.001; I²=65%), SEMS placement across the orifice of the cystic duct (OR 1.97, 95% CI 1.27-3.07, P=0.003; I²=0%), gallstones presence (OR 2.56, 95% CI 1.65-3.98, P< 0.001; I²=0%), flow of contrast agent into gallbladder (OR 3.91, 95% CI 1.11-13.79, P=0.03; I²=75%), and use of covered metal stent (OR 2.77, 95% CI 1.42-5.43, P=0.003; I²=0%). Prior biliary drainage, tumor invasion to the feeding artery, and stent length ≤60 mm were not associated with an increased cholecystitis risk.</p><p><strong>Conclusions: </strong>Our meta-analysis examined adjusted risk factors to reliably estimate the main risk factors associated with cholecystitis after SEMS placement for MDBO. Integrating our findings into a prediction model may help identify high-risk individuals.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597009","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}
引用次数: 0
Upadacitinib Results in Endoscopic Remission in Patients With Inflammatory Bowel Disease and Prior Tofacitinib Failure. Upadacitinib导致炎症性肠病和既往托法替尼失败患者的内镜缓解。
IF 2.7 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-06 DOI: 10.1097/MCG.0000000000002157
Scott David Lee, Kendra J Kamp, Jeffrey Jacobs, Jason Harper, Mitra Barahimi, Kindra Dawn Clark-Snustad
{"title":"Upadacitinib Results in Endoscopic Remission in Patients With Inflammatory Bowel Disease and Prior Tofacitinib Failure.","authors":"Scott David Lee, Kendra J Kamp, Jeffrey Jacobs, Jason Harper, Mitra Barahimi, Kindra Dawn Clark-Snustad","doi":"10.1097/MCG.0000000000002157","DOIUrl":"10.1097/MCG.0000000000002157","url":null,"abstract":"<p><strong>Goals: </strong>Assess the safety and effectiveness of upadacitinib in patients with prior tofacitinib failure.</p><p><strong>Background: </strong>Patients with severe, refractory Crohn's disease (CD) or ulcerative colitis (UC) and inadequate response to medical therapy have a high risk of complications. A better understanding of treatment response in the setting of prior failure may improve disease control in high-risk patients. Currently, the response to a subsequent Janus Kinase (JAK) inhibitor after prior JAK failure is poorly understood.</p><p><strong>Study: </strong>We retrospectively assessed the safety and effectiveness of upadacitinib in patients with prior tofacitinib failure.</p><p><strong>Results: </strong>We report on 26 patients (10 UC, 16 CD) treated with upadacitinib after tofacitinib failure. Mean age 40.2 years, mean disease duration 14.4 years (range 2 to 33), and previously failed a median of 5 advanced therapies. The mean upadacitinib treatment duration was 13.9 months (SD 4.5). On upadacitinib, 83.3% (n=10/12) of patients achieved clinical response, 66.7% (n=8/12) clinical remission, 71.4% (n=10/14) endoscopic improvement, 57.1% (n=8/14) endoscopic remission, and 35.7% (n=5/14) endoscopic healing. The mean Simple Endoscopic Score in CD decreased from 14.3 (SD: 8.3) to 8.6 (SD: 9.0) (P=0.24). The mean Mayo Endoscopic Subscore significantly decreased from 2.7 (SD 0.8) to 0.9 (SD 1.2) (P=0.006). 73.1% of patients on upadacitinib reported adverse events, most commonly minor infections and acne. No serious adverse events, major cardiovascular events, malignancies, or Shingles were observed.</p><p><strong>Conclusions: </strong>Upadacitinib was tolerated in most patients and resulted in clinical and endoscopic improvement in the majority of patients with severe, refractory CD or UC with prior tofacitinib failure, regardless of previous clinical response to tofacitinib. Further studies would define the long-term safety, efficacy, and predictors of response after previous JAK exposure.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597068","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}
引用次数: 0
Early Readmissions of Necrotizing Pancreatitis in the US: Where Do We Stand? 美国坏死性胰腺炎的早期再入院:我们在哪里?
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-06 DOI: 10.1097/MCG.0000000000002167
Dushyant Singh Dahiya, Bhanu Siva Mohan Pinnam, Saurabh Chandan, Hassam Ali, Manesh Kumar Gangwani, Sahib Singh, Andrew Canakis, Fariha Hasan, Amna Iqbal, Amir H Sohail, Saqr Alsakarneh, Mohammad Al-Haddad, Neil R Sharma, Amit Rastogi
{"title":"Early Readmissions of Necrotizing Pancreatitis in the US: Where Do We Stand?","authors":"Dushyant Singh Dahiya, Bhanu Siva Mohan Pinnam, Saurabh Chandan, Hassam Ali, Manesh Kumar Gangwani, Sahib Singh, Andrew Canakis, Fariha Hasan, Amna Iqbal, Amir H Sohail, Saqr Alsakarneh, Mohammad Al-Haddad, Neil R Sharma, Amit Rastogi","doi":"10.1097/MCG.0000000000002167","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002167","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing pancreatitis (NP), a severe form of pancreatitis characterized by necrosis of pancreatic tissue, is associated with a significant health care burden worldwide. In this study, we assess early readmissions of NP in the US.</p><p><strong>Methods: </strong>The National Readmission Database from 2016 to 2020 was utilized to identify all index and 30-day readmissions of NP in the US. Hospitalization characteristics, readmission rates, clinical outcomes, predictors of readmissions, and health care burden were assessed. P-values <0.05 were statistically significant.</p><p><strong>Results: </strong>From 2016 to 2020, 43,968 index admissions for NP were identified. Of which, 18.6% were readmitted within 30 days. There was a higher proportion of males on index and 30-day readmission. On readmission, NP was identified as the admitting diagnosis in only 27.64% of the patients, followed by pancreatitis without necrosis (17.7%), sepsis (8.8%), pancreatic pseudocyst (6.85%), and chronic pancreatitis (2.5%). Biliary pancreatitis (aHR 1.46, 95% CI 1.30-1.65, P<0.001), idiopathic pancreatitis (aHR 1.45, 95% CI 1.33-1.57, P<0.001), and other etiologies of pancreatitis (aHR 1.74, 95% CI 1.46-2.06, P<0.001) had a higher risk of 30-day readmission compared with alcohol-induced pancreatitis. We noted lower inpatient mortality (2.11 vs. 2.97%, aOR:0.65, 95% CI 0.50-0.83, P=0.001), mean length of stay (7.36 vs. 10.97 days, mean difference 3.86, 95% CI 4.25-3.48, P<0.001), and total hospitalization charges ($75,282 vs. $125,480, mean difference $53,979, 95% CI $59,417-$48,541, P<0.001) for 30-day readmissions compared with index NP hospitalizations.</p><p><strong>Conclusion: </strong>About one-fifth of NP patients were readmitted within 30 days. However, these patients had lower mortality and health care burden compared with index hospitalization.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596907","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}
引用次数: 0
Initial Experience With Endoscopic Ultrasound-guided Laser Ablation of Retroperitoneal Lymph Node Metastases. 超声内镜引导下激光消融腹膜后淋巴结转移的初步经验。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-03-03 DOI: 10.1097/MCG.0000000000002160
Min Xu, Guo Tian, Danxia Xu, Tian'an Jiang
{"title":"Initial Experience With Endoscopic Ultrasound-guided Laser Ablation of Retroperitoneal Lymph Node Metastases.","authors":"Min Xu, Guo Tian, Danxia Xu, Tian'an Jiang","doi":"10.1097/MCG.0000000000002160","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002160","url":null,"abstract":"<p><strong>Goals: </strong>To assess the feasibility and safety of endoscopic ultrasound-guided laser ablation (EUS-LA) of retroperitoneal lymph node (RPLN) metastasis.</p><p><strong>Background: </strong>RPLN metastasis is challenging to treat, partly due to hazardous location. EUS-LA is a new attractive option for lesions in high-risk or percutaneous difficult-to-reach locations. Here, we reported the initial experience with EUS-LA of RPLN metastases.</p><p><strong>Study: </strong>From November 2016 through July 2023, patients with oligometastatic RPLN metastases who were not eligible or refused surgery were prospectively enrolled. EUS-LA was performed using a neodymium: yttrium-aluminum-garnet (Nd: YAG) laser beam fiber ablation system. The technical success rate, focal control rate, visual analog scale (VAS) scores, and adverse events were assessed.</p><p><strong>Results: </strong>Nineteen patients with 25 RPLN metastases were included in the study. EUS-LA was performed successfully in all patients. The 3-month, 6-month, and 12-month focal control rates were 96.0%, 86.4%, and 76.5%, respectively. During a median follow-up of 24 months (3 to 46 mo), the median diameter of the RPLN metastases changed from 22 mm (12 to 44 mm) at baseline to 8.5 mm (6 to 39 mm) at the final follow-up. After ablation, the VAS scores decreased significantly in all patients with pain. Two patients experienced self-limited abdominal pain, and no moderate or severe adverse events were reported.</p><p><strong>Conclusions: </strong>EUS-LA showed high technical feasibility and an acceptable safety profile in the treatment of oligometastatic RPLN metastases. In patients at high surgical risk, EUS-LA can be considered as an alternative therapeutic modality, which warrants a long-term follow-up study to verify the efficacy.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597000","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}
引用次数: 0
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