Journal of clinical gastroenterology最新文献

{"title":"Correlation Between Different Shapes of Major Papilla With Outcomes of Endoscopic Retrograde Cholangiopancreatography in a Prospective Study.","authors":"Amirhossein Fahimi, Alale Langari, Gholamreza Roshandel, Fatemeh Hasani, Mohammad Ebrahim Kherad, Fatemeh Aghaei, Alireza Norouzi","doi":"10.1097/MCG.0000000000002151","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002151","url":null,"abstract":"<p><strong>Introduction: </strong>Several factors affect the difficulty, clinical success, and side effects related to endoscopic retrograde cholangiopancreatography (ERCP), of which the endoscopic appearance of the major papilla is one of the most important. This study aimed to investigate the outcomes related to ERCP in relation to major papilla morphology.</p><p><strong>Methods: </strong>This study was performed prospectively on 581 patients undergoing ERCP. During ERCP, the endoscopist determined the morphology of the major papilla before the cannulation. Primary outcomes included overall operative success rate and post-ERCP pancreatitis (PEP) at 30 days. Secondary outcomes included clinically significant bleeding, perforation, cholangitis or sepsis, difficult cannulation, number of cannulation attempts, and duration of cannulation.</p><p><strong>Results: </strong>Papilla type 2 (OR=2.36, 95% CI: 1.07-5.20) and type 3b (OR=3.19, 95% CI: 1.16-8.73) were associated with decreased odds of procedure success. PEP was directly associated with type 4 papilla (OR=3.30, 95% CI: 1.21-8.98). There were direct correlation between difficult cannulation and types 3a (OR=1.89, 95% CI: 1.20-2.98) and 3b (OR=5.05, 95% CI: 1.98-12.86), cannulation duration more than 10 minutes and types 2 (OR=2.66, 95% CI: 1.31-5.39), 3a (OR=2.18, 95% CI:1.30-3.64), and 3b (OR=4.97, 95% CI: 1.94-12.71), and attempted cannulation more than 5 times and types 3a (OR=1.64, 95% CI: 1.01-2.69), and 3b (OR=4.40, 95% CI: 1.75-11.09).</p><p><strong>Conclusion: </strong>The findings of this study showed that ERCP failure is associated with types 2 and 3b papilla, and papilla type 4 is an independent risk factor for PEP.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of Media Coverage of the NordICC Trial on Public Perspectives on Colonoscopy for Colorectal Cancer Screening.","authors":"Eden Sharabi, Kushagra Mathur, So Yung Choi, Barbara Hollander, Brennan Spiegel, Christopher V Almario","doi":"10.1097/MCG.0000000000002144","DOIUrl":"10.1097/MCG.0000000000002144","url":null,"abstract":"<p><strong>Introduction: </strong>Screening tests like colonoscopy can prevent colorectal cancer (CRC), yet their effectiveness is often questioned. The Nordic-European Initiative on Colorectal Cancer (NordICC) trial demonstrated that colonoscopy significantly reduces CRC incidence and mortality in per-protocol analysis. However, media coverage of the trial often focused on intention-to-screen findings that showed no change in mortality, possibly contributing to public confusion about colonoscopy benefits. This study aimed to assess whether such media articles undermined public perception and intent to undergo colonoscopic screening.</p><p><strong>Methods: </strong>We recruited a US nationally representative sample of unscreened adults aged 45 to 75 years at average CRC risk. Respondents were randomized 1:1 to read either a low-quality or high-quality article on NordICC, as rated by a panel of gastroenterologists. Before and after reading their article, participants reported whether they plan to be screened for CRC with a colonoscopy. Our primary outcome was a negative change in intent to undergo colonoscopic screening.</p><p><strong>Results: </strong>Among the 2013 participants who completed the survey, 1531 (76.1%) stated they planned to undergo colonoscopy or were undecided before reading the article. After reading the media report, 90 (12.0%) people in the low-quality article arm no longer planned to undergo colonoscopy versus 73 (9.3%) in the high-quality article arm; the difference was not statistically significant (P=0.08).</p><p><strong>Discussion: </strong>A widely promulgated article about NordICC rated as low-quality did not differentially impact attitudes towards colonoscopic CRC screening compared with another mainstream article rated as high-quality. Our study provides reassurance that most people will not summarily change health behaviors after reading a single article, regardless of perceived accuracy.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12302983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Ramadan Fasting on Dyspeptic Complaints.","authors":"Fethi Sada Zekey, Fatih Başak","doi":"10.1097/MCG.0000000000002141","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002141","url":null,"abstract":"<p><strong>Objective: </strong>Dyspepsia, a common gastrointestinal issue characterized by upper abdominal discomfort, can be influenced by diet, medication, and lifestyle changes. Ramadan fasting involves refraining from food and drink from dawn to sunset, affecting various physiological processes, including digestion. The fasting period can range from 12 to 18 hours depending on the year, potentially impacting the prevalence of dyspeptic symptoms. This study aimed to assess the effect of fasting on dyspeptic symptoms, taking into account demographic and clinical factors.</p><p><strong>Materials and methods: </strong>A cohort study examined 1258 clinic patients, with 150 meeting specific inclusion criteria. Dyspepsia was diagnosed using Rome IV criteria, with fasting hours taken into consideration. The relationship between dyspepsia, fasting, Non-Steroidal Anti-Inflammatory Drug use, and demographics was analyzed.</p><p><strong>Results: </strong>Dyspepsia was more prevalent in females (32%) compared with males (23%), with a higher proportion of non-fasting women among dyspeptic patients. Older patients (>65 y) had a higher prevalence of dyspepsia (P = 0.026). Fasting individuals had a 2.1 times greater likelihood of experiencing dyspeptic symptoms. Although Non-Steroidal Anti-Inflammatory Drug use was lower in fasting patients, no significant association with dyspepsia was observed (P = 0.139).</p><p><strong>Conclusion: </strong>Ramadan fasting increases the risk of dyspeptic symptoms, particularly in women and older adults. Factors such as medication timing and dietary changes during fasting may contribute to this risk. Highlighting the importance of the pre-dawn meal (Suhoor) in managing dyspeptic symptoms is essential. Tailored guidance should be provided to individuals at higher risk during Ramadan.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Budesonide Once Daily as Maintenance Treatment of Eosinophilic Esophagitis.","authors":"Karlien Raymenants, Lucas Wauters, Jan Tack, Tim Vanuytsel","doi":"10.1097/MCG.0000000000002139","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002139","url":null,"abstract":"<p><strong>Background: </strong>Swallowed topical corticosteroids (STC) are an effective first-line therapy for patients with eosinophilic esophagitis (EoE), both for induction and maintenance of remission. All interventional trials with STC used twice-daily dosing regimens. However, in other inflammatory gastrointestinal disorders, corticosteroids are given once daily (OD) with equal outcomes and improved compliance.</p><p><strong>Goals: </strong>To evaluate the effectiveness of topical budesonide maintenance treatment in a once-daily dosing schedule.</p><p><strong>Study: </strong>Retrospective analysis of confirmed patients with EoE, treated with topical budesonide as maintenance therapy OD, with adequate follow-up available. Patients currently treated with budesonide were contacted to fill out online questionnaires regarding symptoms and health-related quality of life (HRQOL). The primary end point was histologic remission, defined as peak eosinophil count (PEC) <15 eosinophils per high power field (HPF) after >12 weeks of budesonide OD.</p><p><strong>Results: </strong>We included 29 patients on STC OD (1 mg, N=28; 0.5 mg, N=1), either budesonide orodispersible tablet (BOT, Jorveza, Dr. Falk Pharma; N=12) or budesonide viscous solution (BVS; N=17). After a median follow-up of 767 days on OD dosing (range: 103 to 2396), 86% of patients were in histologic remission. Four patients had histologic disease activity, of which one was treated with BOT. Two patients experienced a slight increase in PEC after dose reduction of BVS to OD (to PEC of 25 and 35/HPF, respectively). However, after switching the formulation to BOT OD they achieved histologic remission.</p><p><strong>Conclusions: </strong>In this retrospective study, we demonstrated favorable results in the majority of patients treated with budesonide 1 mg OD as maintenance treatment for eosinophilic esophagitis.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of Spleen Dynamic Contrast-enhanced Ultrasound Parameters in Predicting Hepatic Vein Pressure Gradient for Patients With Liver Cirrhosis.","authors":"Tie Zhou, Yan Zhou, Lin Zhao, Yanmin Kan, Jianmin Ding, Cheng Sun, Xiang Jing","doi":"10.1097/MCG.0000000000002136","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002136","url":null,"abstract":"<p><strong>Goals: </strong>To explore dynamic contrast-enhanced ultrasound (CEUS) parameters in predicting hepatic vein pressure gradient (HVPG) for patients with liver cirrhosis (LC).</p><p><strong>Background: </strong>Noninvasive diagnosis of HVPG remains a challenge.</p><p><strong>Study: </strong>This prospective study included patients with LC undergoing hepatic vein catheterization and pressure measurement at the hospital from May 2021 to January 2023. The CEUS images (Mindray Resona R9, 1-6-MHz probe frequency; mechanical index=0.08; image depth=10 cm; focus at the lowest point of the diaphragm; dynamic range=70 dB; optimal gain; single SonoVue bolus injection) were taken for 60 seconds after injection and analyzed using VueBox. HVPG (ie, the gold standard for portal hypertension) was measured routinely by catheterization.</p><p><strong>Results: </strong>Fifty patients with LC were included in the study. The rise time (r=0.6, P<0.01), the fall time (r=0.7, P<0.01), the peak time (r=0.6, P<0.01), wash-in area under the curve (AUC) (r=0.5, P<0.01), the wash-out phase AUC (r=0.4, P<0.01) and wash-in and wash-out phase AUC (r=0.4, P<0.01) of the dynamic spleen CEUS were positively correlated with HVPG. The optimal fall time cutoff levels to predict HVPG ≥10 mm Hg and ≥12 mm Hg were 27.0 and 36.4 seconds, with the AUC being 0.958 and 0.941, respectively. The optimal area under the wash-in area cutoff level to predict HVPG ≥10 mm Hg and ≥12 mm Hg was 1,658,967.38 (a.u) and 4,244,015.90 (a.u), with the AUC being 0.865 and 0.877, respectively.</p><p><strong>Conclusions: </strong>The fall time and wash-in AUC obtained by dynamic CEUS may help diagnose HVPG in patients with LC without requiring invasive hepatic vein catheterization.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptoms in Persons With Either Active or Inactive Crohn's Disease Are Agnostic to Disease Phenotype: The Magic in Imagine Study.","authors":"Charles N Bernstein, Zoann Nugent, Remo Panaccione, Deborah A Marshall, Gilaad G Kaplan, Levinus A Dieleman, Stephen Vanner, Lesley A Graff, Anthony Otley, Jennifer Jones, Michelle Buresi, Sanjay Murthy, Mark Borgaonkar, Brian Bressler, Alain Bitton, Kenneth Croitoru, Sacha Sidani, Aida Fernandes, Paul Moayyedi","doi":"10.1097/MCG.0000000000002137","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002137","url":null,"abstract":"<p><strong>Background: </strong>We aimed to examine the relationship between disease symptoms and disease phenotype in a large Canadian cohort of persons with Crohn's disease (CD).</p><p><strong>Methods: </strong>Adults (n=1515) with CD from 14 Canadian centers participated in the Mind And Gut Interactions Cohort (MAGIC) between 2018 and 2023. Disease activity was measured using the 24-item IBD Symptom Inventory-Short-Form (IBDSI-SF). We compared the symptoms commonly associated with active versus inactive disease, and explored symptoms patterns in relation to disease phenotype, based on the Montreal Classification. To assess psychological status the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used.</p><p><strong>Results: </strong>The mean disease duration was 15.6±11.8 years. The 5 most common symptoms were similar for those with active disease, although at higher prevalence (89% to 98%) versus those with inactive disease (47% to 79%), and included fatigue, diarrhea, gas, bloating, and urgency. The intensity of symptoms was higher in those with active than inactive IBDSI-SF scores. The rank order and relative distribution of the symptoms and intensity of the symptoms reported were similar between those with different disease phenotypes B1, B2, and B3 and L1, L2, and L3. Persons with active IBDSI-SF had a higher prevalence of anxiety (24.6%) and depression (38.2%) versus persons with inactive IBDSI-SF (6.3% and 8%, respectively).</p><p><strong>Conclusions: </strong>Individuals with CD with active and inactive disease by IBDSI, experience similar symptoms, but the prevalence of symptoms and their intensity is greater in persons with active IBDSI. Persons with inactive IBDSI report many symptoms. There was no difference in symptom reporting by disease behavior or location.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-based Prediction of Mortality Among Malnourished Patients Hospitalized With Inflammatory Bowel Disease.","authors":"Berkeley N Limketkai, Zhaoping Li, Gerard E Mullin, Alyssa M Parian","doi":"10.1097/MCG.0000000000002138","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002138","url":null,"abstract":"<p><strong>Background: </strong>Malnourished patients hospitalized with inflammatory bowel disease (IBD) have a high risk of morbidity and mortality. Risk stratification can help identify patients who are most in need of medical and nutritional intervention.</p><p><strong>Goal: </strong>This study aimed to develop a machine-learning model that accurately predicts mortality in hospitalized IBD patients with protein-calorie malnutrition (PCM).</p><p><strong>Study: </strong>Hospitalized adults with IBD and PCM were identified in the 2016 to 2019 National Inpatient Sample (NIS). Random Forest Classifier (RFC) and Extreme Gradient Boosting (XGB) models were constructed using a 70% randomly sampled training set from the years 2016 to 2018, tested using the remaining 30% of 2016 to 2018 data, and externally validated using 2019 data. Patient characteristics were evaluated using weighted estimates that accounted for the complex sampling design of the NIS.</p><p><strong>Results: </strong>Among 879,730 malnourished patients hospitalized for IBD, 1930 (0.2%) died. Compared with malnourished patients who survived, those who died were generally older, White, had ulcerative colitis with multiple comorbidities, and admitted on the weekend. The accuracy, precision, sensitivity, and specificity for both models were 0.99, 0.98, 0.99, and 0.99, respectively. The area under the receiver operating characteristic curve was 0.91 for both models.</p><p><strong>Conclusion: </strong>Machine learning models can accurately predict mortality in malnourished patients hospitalized with IBD, while solely relying on readily available clinical data. Further integration of these tools into clinical practice could improve risk stratification of IBD patients with PCM and potentially reduce mortality in this high-risk population by prompting earlier intervention.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft Coagulation Versus Argon Plasma Coagulation After Large Non-pedunculated Colorectal Polyp Resection: A Meta-analysis.","authors":"Eric Smith, Yizhong Wu, Yichen Wang, Dushyant Singh Dahiya, Saurabh Chandan, Marcello Maida, Marco Spadaccini, Antonio Facciorusso, Aasma Shaukat, Daryl Ramai, Clive Miranda","doi":"10.1097/MCG.0000000000002119","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002119","url":null,"abstract":"<p><strong>Introduction: </strong>Thermal ablative methods (such as argon plasma coagulation (APC) and soft tip snare coagulation (STSC) are commonly used to treat polyp margins. We aim to appraise the current literature and compare clinical outcomes between patients with treated (with APC vs. STSC) and non-treated endoscopic mucosal resection (EMR) margins.</p><p><strong>Methods: </strong>We searched major databases from inception until November 2023 for randomly controlled trials (RCTs) comparing EMR of large non-pedunculated colorectal polyps with and without treated margins. Pooled data were analyzed for the primary outcome of recurrence at first screening colonoscopy, and adverse events. Analysis was performed using a random effects model and data were reported using 95% CIs.</p><p><strong>Results: </strong>A total of 5 RCT's were found, which included 1020 polyps (577 in treatment and 443 in control groups). Three studies included treatment with STSC and 3 studies used APC as the modality for margin ablation. Of the included patients, 53% were female and the average age was similar between treatment and control groups (65.9 vs. 66.1 y). Seventy-one percent of lesions were proximal to the splenic flexure. The mean follow-up to the first colonoscopy and average polyp size were comparable (6.3 vs. 6.2 mo; 28.2 vs. 28.0 mm, respectively). Pooled analysis showed that margin ablation was associated with significantly lower rates of recurrence [odds ratio (OR) 0.267, 95% CI 0.18-0.4, P<0.001] with low heterogeneity between studies (I2=0%, P=0.47). Pooled analysis showed no significant difference between STSC and APC in terms of recurrence (OR 0.6, 95% CI 0.27-1.7, I2=0%, P=0.3) or adverse events (OR 0.67, 95% CI 0.3-1.6, I2 13%, P=0.46).</p><p><strong>Conclusion: </strong>Our study shows that ablation of EMR margins is very effective at preventing recurrence at first surveillance colonoscopy. We found no difference between STSC or APC in terms of polyp recurrence or adverse outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FibroScan Discordance With Liver Biopsy Significantly Overestimates Advanced Fibrosis and Cirrhosis in MASLD Subjects With Class 3 Obesity: Implications for Resmetirom Eligibility.","authors":"Jena Velji-Ibrahim, Jordan Woodard, Jay Alden, Gary A Abrams","doi":"10.1097/MCG.0000000000002132","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002132","url":null,"abstract":"<p><strong>Goals: </strong>To investigate the effect of obesity on the stages of fibrosis discordance between FibroScan and liver biopsy.</p><p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of liver disease worldwide. Accurate fibrosis assessment is essential in MASLD patients for prognosis and treatment. Vibration-controlled transient elastography using FibroScan can overestimate liver fibrosis in obese patients.</p><p><strong>Study: </strong>This retrospective study included 245 MASLD patients who underwent FibroScan and liver biopsy. Participants were included with FibroScan controlled attenuation parameter (CAP) 250+, 10 liver stiffness measurements (LSM) with IQR/med ≤30%, and 10+ portal tracts on biopsy. Discordance was defined as a ≥2 stage difference between FibroScan and liver biopsy. Participants were stratified by BMI and obesity class to assess their association with discordance. We conducted a post hoc analysis to determine the implication of discordance on resmetirom eligibility. Data was entered into SPSS v28.</p><p><strong>Results: </strong>Among 245 patients, 29.4% exhibited a ≥2 stage discordance between FibroScan and biopsy. Class 3 obesity was significantly associated with discordance (38.6%) compared with class 2 obesity (24.6%) and class 0 to 1 obesity (18.4%). FibroScan suggested cirrhosis in 66 (57.9%) participants with class 3 obesity, however, liver biopsy confirmed cirrhosis in only 16 (24.2%) subjects and identified 28 (42.4%) subjects with stages 2 to 3 fibrosis, making them potentially eligible for resmetirom.</p><p><strong>Conclusions: </strong>FibroScan significantly overestimates advanced fibrosis and cirrhosis in class 3 obesity. A second noninvasive test is warranted for accurate liver-directed therapeutic allocation and to minimize unnecessary biopsies in MASLD management.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Liver Disease as a Risk Factor For Post-ERCP Complications: A Nationwide Retrospective Analysis.","authors":"Madhav Changela, Janak Bahirwani, Ernestine Faye Tan, Nishit Patel, Sanket Basida, Maulik Kaneriya, Amanda Singh, Deep Mehta, Kaushalkumar Suthar, Rodrigo Duarte-Chavez","doi":"10.1097/MCG.0000000000002131","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002131","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is indicated for multiple pancreatic and biliary pathologies and carries a heightened risk profile compared with other endoscopic procedures. Considerable research has been directed towards discerning risk factors associated with complications such as post-ERCP pancreatitis and post-ERCP bleeding. Despite this, data on chronic liver disease (CLD) as a risk factor for complications is limited. We aimed to assess the outcomes of patients with CLD who underwent therapeutic or diagnostic ERCP to determine whether these patients had different outcomes relative to patients without CLD.</p><p><strong>Methods: </strong>We used the National Inpatient Sample (NIS) database to inquire for all adult patients who underwent ERCP between 2016 and 2019 using the International Classification of Disease, Tenth Revision (ICD-10) coding. The group was stratified into 2 groups: patients with CLD and those without. The main outcome we looked at was the rate of post-ERCP pancreatitis, post-ERCP hemorrhage, and perforation between the 2 groups. The secondary outcomes were in-hospital mortality and length of stay. A multivariate regression model was used to estimate the association of CLD with ERCP outcomes.</p><p><strong>Results: </strong>We identified a total of 883,825 patients who underwent ERCP between 2016 and 2019. Among these, 21,212 (2.4%) had CLD and 862,613 (97.6%) did not have CLD. The mean age for patients in liver disease group was 61.66 years and in group without liver disease was 60.46 years. The predominant ethnicity in both groups was whites. Additional admission-related factors are outlined in Table 1. The rate of post-ERCP pancreatitis (8.8% vs. 6.7%, P < 0.001) with adjusted odds ratio (aOR) 1.3; and post-ERCP hemorrhage (8.8% vs. 6.69%, P < 0.001) with aOR 1.35, was higher in the patient group with CLD. The rate of post-procedure perforation was not significantly different in both groups. For secondary outcomes; the in-hospital mortality (3.03% vs. 1.58%, P < 0.001) and length of stay (7 days vs. 3 days, P < 0.001) were higher in the patients with chronic liver disease. The outcomes are mentioned in Table 2.</p><p><strong>Conclusion: </strong>Although ERCP is considered a safe procedure, it is one of the endoscopic procedures associated with the highest risk of complications. As a result, risk stratification is crucial. Certain demographics, conditions like end-stage renal disease, liver cirrhosis, and procedural factors have been identified as risk factors for post-ERCP complications. Our study represents newer data, with use of revised ICD codes, to demonstrate increased risk in patients with liver disease. On the basis of these results, ERCP should be used judiciously in this population and further studies are required for identifying reversible risk factors to improve outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948385","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}