Revista Espanola De Enfermedades Digestivas最新文献

{"title":"SEPD-AEED Position Statement ‒ Integration of digestive ultrasound in gastroenterology services as a clinical, educational and organizational necessity.","authors":"Federico Argüelles-Arias, Joaquín Poza Cordón, María Dolores Martín Arranz, Luis Téllez, Julio Iglesias-García, Marisa Iborra, Judith Gómez-Camarero, Aitor Orive, Rafael Gómez Rodríguez","doi":"10.17235/reed.2025.11670/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11670/2025","url":null,"abstract":"<p><p>The Spanish Society of Digestive Diseases (SEPD) and the Spanish Association of Digestive Ultrasound (AEED), as leading scientific societies in the field of Gastroenterology in Spain, have among their core objectives the continuous improvement of clinical practice, the training of specialists, and the promotion of diagnostic and therapeutic tools that contribute to higher quality, more efficient, and patient-centered healthcare. As a guarantor of the professional development of specialists, SEPD also acts as a technical liaison with health authorities, advocating for the recognition of competencies based on scientific evidence and real healthcare needs. Likewise, AEED is committed to advancing the use of ultrasound techniques, as well as research and training in ultrasound techniques. Both societies consider it essential to establish clinical ultrasound as a core competency of the gastroenterologist. This need arises from a clinical and educational reality strongly supported by scientific evidence, the current regulatory framework, and accumulated experience in other countries and specialties. In this context, SEPD and AEED issue this position statement to reinforce the role of clinical ultrasound as an essential skill of the digestive system specialist. This position is not driven by corporate interests but by an academic, responsible vision that serves patients and the healthcare system. It is further justified by growing scientific evidence, regulatory and training support, and the urgent need to ensure equal access to this technique in all Gastroenterology departments across the country, avoiding unjustified inequalities between regions or hospitals. It also seeks to address organizational gaps where ultrasound remains restricted to other specialties, even when the overall care of the patient lies with the gastroenterologist.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":"554-556"},"PeriodicalIF":4.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252483","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":"Strain ratio vs strain histogram for the elastographic evaluation of non-calcific chronic pancreatitis (CP) ‒ A prospective, single-centre, comparative study.","authors":"Yessica Domínguez Novoa, J Enrique Domínguez-Muñoz, José Lariño Noia, Patricia Míguez-Sánchez, Julio Iglesias-García","doi":"10.17235/reed.2025.11504/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11504/2025","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnosis of chronic pancreatitis (CP) at early stages remains challenging. Endoscopic ultrasound (EUS) guided strain elastography (SE) has improved the diagnostic yield of CP. Aim of our study was to evaluate the diagnostic yield of SE quantification methods, strain ratio (SR) and strain histogram (SH), in detecting non-calcific CP.</p><p><strong>Methods: </strong>Prospective, comparative study including patients undergoing EUS-guided SE for non-calcific CP evaluation. Procedures were performed with linear echoendoscopes. Number of EUS criteria according to Rosemont classification were evaluated. SH analysis targeted a pancreatic body area, while SR compared this area (A) to a soft extrapancreatic reference area (B), with B/A as the final ratio. Data are shown as percentages and mean (95%CI) and analyzed using ANOVA, linear regression and Spearman test. Diagnostic accuracy of SR and SH were evaluated using the Rosemont classification as reference. STARD criteria for studies was followed.</p><p><strong>Results: </strong>284 patients were included (mean age 49.8 years, range 17-85; 142 males). Among them, 43 (15.1%) had a normal pancreas, 110 (38.7%) had indeterminate findings, and 131 (46.1%) had suggestive CP findings. A SR>2.42 showed 91.7% sensitivity and 88.1% specificity (ROC=0.968). An SH<116.1 demonstrated 88.0% sensitivity and 97.7% specificity (ROC=0.964). EUS criteria correlated with pancreatic fibrosis severity by SR (r=0.785, p<0.0001) and SH (r=-0.742, p<0.0001). Age correlated with EUS criteria (r=0.127, p=0.03), but not with SE.</p><p><strong>Conclusions: </strong>The quantification of the degree of pancreatic fibrosis by SR and SH during pancreatic EUS-guided SE exhibit high diagnostic accuracy for CP and are not influenced by age.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186121","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":"Uncommon cause of fecal impaction: rectal phytobezoar due to seeds.","authors":"Carme Grande-Moreillo, Sara Fuentes-Carretero, Florencia Venturini, Adrianna Machinena","doi":"10.17235/reed.2025.11481/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11481/2025","url":null,"abstract":"<p><p>Currently, the need for manual disimpaction of fecalomas under general anesthesia is exceptional, as this condition is usually managed orally with polyethylene glycol (PEG)-based laxatives. However, in certain cases, manual extraction becomes necessary. The aim of this article is to describe the case of a child with a rectal phytobezoar caused by sunflower seeds, in whom oral disimpaction was ineffective, requiring manual extraction under general anesthesia in the operating room. A systematic review of cases published between 1980 and 2018 concluded that manual extraction under general anesthesia is the treatment of choice for rectal seed bezoars, as it minimizes patient discomfort.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186571","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":"A case of bleeding from gastric antral vascular ectasia treated by endoscopic submucosal dissection.","authors":"Guoqiang Zhang, Zhenguo Qiao, Gang Wei, Zhiyong Zhu, Yaping Wang","doi":"10.17235/reed.2025.11521/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11521/2025","url":null,"abstract":"<p><p>A case of bleeding from gastric antral vascular ectasia (GAVE) treated by resecting both the mucosa and submucosa using ESD in two separate sessions after failure of APC, it has satisfactory treatment effects and no further recurrence.Our case revealed that ESD may become a new better therapeutic method for GAVE.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186634","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":"FROM RECOMMENDATIONS TO PRACTICE: TRACKING THE NATIONAL ROLLOUT OF COMPREHENSIVE HEPATITIS DIAGNOSIS IN SPAIN.","authors":"Joaquín Cabezas, Antonio Aguilera, Federico García García, Raquel Domínguez-Hernández, Araceli Casado Gómez, Nataly Espinoza-Cámac, Miguel Ángel Casado, Javier Crespo","doi":"10.17235/reed.2025.11496/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11496/2025","url":null,"abstract":"<p><strong>Introduction: </strong>The comprehensive diagnosis of viral hepatitis is an advance towards its elimination, but not all Spanish hospitals performed this diagnosis in 2022. Our objective was to evaluate the situation of the comprehensive diagnosis after the publication of the guidelines and evaluate the degree of implementation in the centers that responded to both surveys.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted among 79 hospitals that had participated in the initial survey. They were reinvited to respond via Google Forms (sent 23/12/2024).</p><p><strong>Results: </strong>The response rate was 91% (72/79). Compared to the previous year, reflex testing increased by 3%, with notable increases for HBV (33%), HCV (2%), HDV (45%) and dual HBV-HDV (79%). Anti-HDV and HDV-RNA testing increased by 18% and 21%, respectively. Alerts to specialist physicians rose by 24.1% for HBV and 52.9% for HDV. Automated appointment systems and referral mechanisms also expanded. HAV testing was integrated in 38% of centers, HIV testing in 50%, and STI testing in 56%.</p><p><strong>Conclusions: </strong>Awareness and implementation of integrated diagnostics, particularly for hepatitis D, have improved. Nonetheless, further progress is needed to ensure broader coverage and to contribute towards WHO elimination goals.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186659","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":"Results of a hepatitis C microelimination project in an addiction treatment center.","authors":"Elisa Del Pilar Rodríguez Seguel, Ricardo Ruiz Pérez, Enrique Pérez-Godoy Díaz, María Del Carmen Lozano Domínguez, Álvaro Giráldez Gallego, Trinidad Desongles Corrales, María Teresa Ferrer Ríos, José Manuel Sousa Martín, Juan Manuel Pascasio Acevedo","doi":"10.17235/reed.2025.11495/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11495/2025","url":null,"abstract":"<p><strong>Background: </strong>Patients on opioid substitution therapy constitute a collective with a high burden of hepatitis C and candidate to interventions aimed to microelimination.</p><p><strong>Aims: </strong>To analyze the baseline prevalence of both previous contact and/or active infection patients, measure the response to current treatment provided through a simplified circuit and estimate the impact of this intervention on reduction of proportion of viremic population.</p><p><strong>Methods: </strong>People affiliated in an addiction treatment center was subjected to an in situ diagnostic sequence using a saliva serological screening and viremia quantification with dry blood spot test. Viremic patients were linked to care and treatment was administered in the first single appointment with pan-genotypic direct-acting antivirals. The McNemar test was used to compare proportions of active infection before and after intervention.</p><p><strong>Results: </strong>With a participation of 99.2%, seroprevalence for hepatitis C was 44.6% (115/258) while active infection was present in a 20.9% of seropositive people (24/115). The response rate to treatment was 54.2% by intention-to-treat and 61.9% by per-protocol analysis. Successfully treating of 13 patients allowed to estimate a global reduction of active infection rate from 9.3% to 4.3% (p=0.0002), for a theorical scenario with no reinfections. By adjusting for the known reinfection rates, the prevalence of active infection also decreased a 4.2% for people with assumed no recent drug use (p=0.0074), but no changes were found for estimates in patients with supposed recent drug use (p=0.2632).</p><p><strong>Conclussions: </strong>Focused efforts targeted to this high-risk group, including both screening and treatment initiatives, can potentially reduce the prevalence of active hepatitis C infections.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186702","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":"Ultrasound-guided liver biopsy of focal lesions ‒ Comparison between direct and coaxial techniques.","authors":"Rafael Varela Ponte, Enrique Flores Ríos, Nieves Martínez Lago, José Martín Carreira","doi":"10.17235/reed.2025.11543/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11543/2025","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrasound-guided liver biopsy is an essential tool for the histological diagnosis of focal hepatic lesions. Both direct and coaxial puncture techniques are widely used in clinical practice, although comparative evidence regarding diagnostic performance and safety remains limited.</p><p><strong>Material and methods: </strong>We conducted a retrospective, single-center study including 295 consecutive ultrasound-guided liver biopsies of focal lesions performed between December 2012 and February 2018. The primary objective was to compare diagnostic adequacy between coaxial and direct techniques. Secondary objectives were to assess sample adequacy (number of cores obtained) and complication rates. Diagnostic adequacy was classified as satisfactory, insufficient, or failed biopsy. Complications were classified according to Society of Interventional Radiology (SIR) criteria.</p><p><strong>Results: </strong>A total of 278 patients (64.1% male; median age, 69 years) were included. The coaxial technique was associated with higher diagnostic adequacy (92.8% vs. 89.4%; p = 0.014) and greater sample adequacy (mean cores: 3.6 vs. 2.7; p <0.001), with no significant differences in complication rates (2.6% vs. 4.2%; p = 0.683). In multivariate analysis, the coaxial technique remained an independent predictor of diagnostic adequacy (OR 2.45; 95% CI: 1.12-5.37; p = 0.024).</p><p><strong>Conclusions: </strong>Ultrasound-guided percutaneous liver biopsy is a safe and effective technique for the evaluation of focal hepatic lesions. The coaxial technique improves diagnostic adequacy and sample yield without increasing complication rates, supporting its preferential use in clinical practice.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186575","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":"Relative Fat Mass and Constipation in U.S. Adults: A Cross-Sectional Study of 11,380 Participants From NHANES 2005-2010.","authors":"Min Lv, Xiaxi Wu, Wei Wang","doi":"10.17235/reed.2025.11391/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11391/2025","url":null,"abstract":"<p><p>Background Constipation is a common gastrointestinal disorder closely associated with obesity. Relative Fat Mass(RFM) is a newer anthropometric index that offers a more precise reflection of body fat distribution than traditional methods. Despite its advantages, the potential link between RFM and the likelihood of experiencing constipation has not been thoroughly examined. This study was therefore designed to explore the association between RFM and constipation Methods Data were obtained from the 2005-2010 cycles of the National Health and Nutrition Examination Survey (NHANES). Constipation was defined using the Bristol Stool Form Scale and questionnaire responses. Weighted multivariable logistic regression models were employed to evaluate the association between RFM and constipation. Propensity score matching (PSM) was used to balance baseline covariates between groups. Analyses were conducted both before and after PSM to test the robustness of the findings. Smooth curve fitting and threshold effect analyses were conducted to explore potential nonlinear relationships. Subgroup analyses and interaction tests were used to assess possible heterogeneity across different population strata. Results A total of 11,380 participants were included in the final analysis, among whom 1,206 were classified as having constipation. Logistic regression revealed that in the fully adjusted model, each one-unit increase in RFM was associated with a 2.9% reduction in the odds of constipation (OR = 0.971, 95%CI: 0.956-0.986, p = 0.0011). Furthermore, PSM analyses confirmed the robustness of the results. The inverse association between RFM and constipation was more pronounced among individuals aged > 45 years, those with hypertension, and those who did not consume alcohol (all p for interaction < 0.05). Smooth curve fitting and threshold effect analysis indicated a nonlinear relationship, with an inflection point at an RFM of 36.06. Conclusion Our study suggests a significant inverse association between RFM and constipation. Further prospective studies are warranted to validate this relationship.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":"117 ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186623","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":"Hybrid percutaneous-endoscopic necrosectomy for large walled-off pancreatic necrosis: an observational feasibility study.","authors":"Elena Tenorio González, Nada El-Domiaty, Emilia Ragot, Tom Boeken, Hadrien Alric, Alessandro Di Gaeta, Aurelien Saltel, Guillaume Perrod, Laetitia Paulmier-Clee, Christophe Cellier, Enrique Pérez-Cuadrado-Robles","doi":"10.17235/reed.2025.11510/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11510/2025","url":null,"abstract":"<p><strong>Background and aim: </strong>Although direct endoscopic necrosectomy (DEN) by transgastric approach is accurate and enough in most patients presenting with infected walled-off necrosis (WON), some of them with very large and/or distal collections may need further therapies such as percutaneous endoscopic necrosectomy. Percutaneous hybrid necrosectomy (PHN) represents a new approach in these cases, combining the use of surgical clamps through the percutaneous fistula and a transgastric or percutaneous endoscopic guidance. The aim was to analyze the impact of this innovative multidisciplinary technique on selected patients with WON.</p><p><strong>Methods: </strong>This is an observational single-center study. All consecutive patients presenting with large WON who underwent PHN in 2019-2023 were included. A classification in early (<3 previous DEN) or late PHN (≥3) was defined. The primary outcome was the clinical success, defined as symptom relief with WON complete resolution. The secondary aims were the time to WON resolution and the adverse event (AE) rate.</p><p><strong>Results: </strong>Of 51 patients presenting with WON, 15 (mean age: 59±12.7, 80% male) underwent DEN combined with PHN and were included. The median number DEN sessions were two. Overall, most patients required only one single PHN procedure (n=9, 60%) during an interval time of 8 days (range: 2-14). Clinical success was obtained in 14 cases (93.3%). The time to WON resolution was lower in patients with an early PHN strategy (13 vs. 30 days, p=0.024). The overall per-procedure AE rate was 10.5% during a median follow-up of 6.5 months (range: 3-49), with no procedure-related mortality.</p><p><strong>Conclusions: </strong>PHN under transgastric or percutaneous guidance represents a new minimally invasive and collaborative approach for selected patients with large WON. A low number of procedures is needed to achieve clinical success in a shorter time.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186632","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":"Evaluation of adverse events following endoscopic peroral myotomy (POEM) for achalasia ‒ Implications for feasibility of same-day discharge.","authors":"Anna Calm, Andrea Avella, Sofía Dall'Oglio, Raquel Muñoz-González, Maria Gloria Bonet, Claudia Thatiana Vertiz, Mónica Rodríguez, Adria Escudero, Enrique Moret, Anna Pèlach, Luis Wong, Eugeni Domènech, Vicente Moreno, Ingrid Marín, Hugo Uchima","doi":"10.17235/reed.2025.11535/2025","DOIUrl":"https://doi.org/10.17235/reed.2025.11535/2025","url":null,"abstract":"<p><strong>Background: </strong>Although hospitalization for peroral endoscopic myotomy (POEM) performance is standard practice, emerging evidence suggests it may not be essential.</p><p><strong>Objective: </strong>We aimed to determine the proportion of patients eligible for same-day-discharge after POEM procedure and assess readmission rates by analysing adverse events (AE).</p><p><strong>Methods: </strong>Patients with achalasia who underwent POEM procedure in a single centre from June 2019 to July 2023 were included. Demographic, clinical, and endoscopic data were retrospectively collected, focusing on AE within 30 days. AE were graded using the AGREE classification and events not requiring major medical intervention or suspension of the procedure were classified as incidents, whereas AE graded  grade II were considered indicative of hospitalization.</p><p><strong>Results: </strong>Among 76 patients, 29 (38%) experienced at least one incident, including superficial mucosal injury (42.4%), intraprocedural bleeding (30.3%), bronchoaspiration (15.2%) and pneumoperitoneum (12.1%). Grade I AE (pain/nausea) occurred in 50 patients (65.7%), while 10 (13.2%) had  grade II AE. In the univariate analysis, bronchoaspiration and intratunnel fibrosis were associated with the development of  grade II AE, but only bronchoaspiration remained significantly associated in the multivariate analysis (p=0.007; OR 61.12, CI 95% 3.06-1219.86). Two patients (2.9%) would have required readmission.</p><p><strong>Conclusions: </strong>Most of the  grade II AE in patients undergoing POEM occur and can be predicted intraoperatively, suggesting that most patients could be safely discharged on the same day. Mild AE are common but mostly manage within 8 hours post-procedure, making inpatient care unnecessary. However, prospective studies are required to validate the clinical safety and practicality of this approach.</p>","PeriodicalId":21342,"journal":{"name":"Revista Espanola De Enfermedades Digestivas","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186661","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}