Translational gastroenterology and hepatology最新文献

{"title":"The adoption of artificial intelligence assisted endoscopy in the Middle East: challenges and future potential","authors":"Ahmed El-Sayed, Sara Salman, Laith Alrubaiy","doi":"10.21037/tgh-23-37","DOIUrl":"https://doi.org/10.21037/tgh-23-37","url":null,"abstract":": The use of artificial intelligence (AI) in endoscopy has shown immense potential to enhance diagnostic accuracy, streamline procedures, and improve patient outcomes. There are potential uses in every field of endoscopy, from improving adenoma detection rate (ADR) in colonoscopy to reducing read time in capsule endoscopy or minimizing blind spots in gastroscopy. Indeed, some of these systems are already licensed and in commercial use across the world. In the Middle East, where healthcare systems are rapidly evolving, there is a growing interest in adopting AI technologies to revolutionise endoscopic practices. This article provides an overview of the advancements, potential opportunities and challenges associated with the implementation of AI in endoscopy within the Middle East region. Our aim is to contribute to the ongoing dialogue surrounding the implementation of AI in endoscopy and consider some of the factors that are particularly relevant in the Middle Eastern context, including the need to train the models for local populations, cost and training, as well as trying to ensure equity of access for patients. It provides valuable insights for healthcare professionals, policymakers, and researchers interested in leveraging AI to enhance endoscopic procedures, improve patient care, and address the unique healthcare needs of the Middle East population.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136094524","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":"Surgical management of pancreatic ductal adenocarcinoma: a narrative review","authors":"Elad Sarfaty, Nazanin Khajoueinejad, Makda G. Zewde, Allen T. Yu, Noah A. Cohen","doi":"10.21037/tgh-23-27","DOIUrl":"https://doi.org/10.21037/tgh-23-27","url":null,"abstract":"Background and Objective Pancreatic ductal adenocarcinoma (PDAC) is the third-leading cause of cancer-related death in the United States and is projected to become the second-leading cause of cancer-related death by 2030. Despite advances in systemic and radiation therapy, for patients with surgically resectable PDAC, complete surgical resection is the only potentially curative treatment option. The conduct of a safe, technically excellent pancreatectomy is essential to achieve optimal perioperative outcomes and long-term survival. In this narrative review, evidence from large, well-executed studies and clinical trials examining the technical aspects of pancreatectomy is reviewed. Methods A search was conducted in PubMed, Medline, and Cochrane Review databases to identify English-language randomized clinical trials, meta-analyses, and systematic reviews assessing surgical aspects of pancreatectomy for PDAC published between 2010 to 2023. Key Content and Findings We identified retrospective and prospective studies evaluating the technical aspects of surgery for PDAC. In this review, we evaluate data on surgical techniques of pancreatectomy for PDAC, including the role of minimally invasive techniques, extent of lymphadenectomy, reconstruction options after pancreatoduodenectomy, and the role of surgical drainage. Conclusions Surgical resection has a critical role in the treatment of operable PDAC. While pancreatic cancer surgery is an active area of research, conducting a technically excellent surgical resection maintains paramount importance for both oncological and perioperative outcomes. In this review, we summarize the latest evidence on surgical technique for operable PDAC.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136160581","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":"Image enhanced colonoscopy: updates and prospects-a review.","authors":"Dariush Shahsavari,&nbsp;Muhammad Waqar,&nbsp;Viveksandeep Thoguluva Chandrasekar","doi":"10.21037/tgh-23-17","DOIUrl":"https://doi.org/10.21037/tgh-23-17","url":null,"abstract":"<p><p>Colonoscopy has been proven to be a successful approach in both identifying and preventing colorectal cancer. The incorporation of advanced imaging technologies, such as image-enhanced endoscopy (IEE), plays a vital role in real-time diagnosis. The advancements in endoscopic imaging technology have been continuous, from replacing fiber optics with charge-coupled devices to the introduction of chromoendoscopy in the 1970s. Recent technological advancements include \"push-button\" technologies like autofluorescence imaging (AFI), narrowed-spectrum endoscopy, and confocal laser endomicroscopy (CLE). Dye-based chromoendoscopy (DCE) is falling out of favor due to the longer time required for application and removal of the dye and the difficulty of identifying lesions in certain situations. Narrow band imaging (NBI) is a technology that filters the light used for illumination leading to improved contrast and better visibility of structures on the mucosal surface and has shown a consistently higher adenoma detection rate (ADR) compared to white light endoscopy. CLE has high sensitivity and specificity for polyp detection and characterization, and several classifications have been developed for accurate identification of normal, regenerative, and dysplastic epithelium. Other IEE technologies, such as blue laser imaging (BLI), linked-color imaging (LCI), i-SCAN, and AFI, have also shown promise in improving ADR and characterizing polyps. New technologies, such as Optivista, red dichromatic imaging (RDI), texture and color enhancement imaging (TXI), and computer-aided detection (CAD) using artificial intelligence (AI), are being developed to improve polyp detection and pathology prediction prior to widespread use in clinical practice.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/d8/tgh-08-23-17.PMC10432234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10049173","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":"Systematic review with meta-analysis of transverse <i>vs.</i> vertical midline extraction incisional hernia risk following laparoscopic colorectal resections.","authors":"Amiya Ahsan,&nbsp;Hussameldin M Nour,&nbsp;Dimitra V Peristeri,&nbsp;Sameh Abogabal,&nbsp;Christie Swaminathan,&nbsp;Muhammad S Sajid","doi":"10.21037/tgh-22-75","DOIUrl":"https://doi.org/10.21037/tgh-22-75","url":null,"abstract":"<p><strong>Background: </strong>The aim of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.</p><p><strong>Methods: </strong>Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases, EMBASE, MEDLINE, PubMed and Cochrane Library were performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.</p><p><strong>Results: </strong>Twenty-five comparative studies (including 2 randomised controlled trials) on 10,362 patients fulfilled the inclusion criteria. There were 4,944 patients in the transverse incision group and 5,418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development (odds ratio =0.30, 95% CI: 0.19-0.49, Z=4.88, P=0.00001). However, there was significant heterogeneity (Tau²=0.97; Chi²=109.98, df=24, P=0.00004; I²=78%) among included studies. The limitation of the study is due to lack of RCTs, this study includes both prospective and retrospective studies along with 2 RCTs which makes the meta-analysis potentially biased in source of evidence.</p><p><strong>Conclusions: </strong>Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/c2/tgh-08-22-75.PMC10184032.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9841112","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":"Artificial intelligence in colonoscopy: where have we been and where should we go?","authors":"Babu P Mohan,&nbsp;Douglas G Adler","doi":"10.21037/tgh-23-25","DOIUrl":"https://doi.org/10.21037/tgh-23-25","url":null,"abstract":"© Translational Gastroenterology and Hepatology. All rights reserved. Transl Gastroenterol Hepatol 2023;8:23 | https://dx.doi.org/10.21037/tgh-23-25 The use of artificial intelligence (AI) in colonoscopy has gathered significant attention in recent years. Successful execution and publication of randomized trials have paved the way to Food and Drug Administration (FDA) approval of a handful of computer-vision based AI assistant tools in colonoscopy (1). However, it is yet to take a lead role as a helpful aid to the endoscopist on a day-today basis. Especially so in the private gastroenterology [gastrointestinal (GI)] practice setting where the majority of the population-based screening colonoscopies are performed (2). Although a good number of private practice settings in the US have tried some of the commercially available AI assistants in colonoscopy, most of them (to the best of our knowledge) have abandoned its ongoing use due to prolonged overall procedure time. A very important limitation in private GI practice. In fact, in a meta-analysis of six randomized controlled trials (RCTs) evaluating the use of real-time computer aided tools in colonoscopy, the withdrawal time was significantly greater in comparison to standard colonoscopy when AI was utilized (1). We should ensure that we all talk the same language when it comes to AI. AI encompasses every aspect of machine learning, where computer-based algorithms and softwares make tasks easier. A set of learning inputs are used to pre-train the system, and the system then generates outcome predictions on an unknown new data input. Computer vision is a branch of machine learning that is specific for identifying objects from an image or a video. Computer vision is the backbone of all ‘face-recognition’ technology, self-driving cars, and is also the concept that goes behind identifying polyps or pretty much anything of interest (like bleeding, or ulcers) in an image (whether it comes from a video capsule image, a colonoscopy image, or any endoscopy image). Convolutional neural networks (CNN) belong to deeplearning (a subset of machine learning) methods where the algorithms are connected by multiple arrays of ‘logisticregression’ connections or ‘nodes’. Only certain data detail at a specific numerical (to the decimal point in almost all cases) cut-off would get transmitted to the next level, so on and so forth to generate a final outcome, when all analyzed features of input data is broken up and evaluated through the CNN framework. With regards to colonoscopy and polyp detection, various terms have been used to describe the role of computer-aided systems, such as computer aided detection (CADe) and computer aided diagnosis (CADx). The difference in these terms is just the output parameter. Detection detects a polyp, whereas diagnosis characterizes the polyp (3). The machine learning algorithm is however agnostic to these terms. Randomized trials have, indeed, demonstrated better adenoma detection ra","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/23/dd/tgh-08-23-25.PMC10432228.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10040379","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":"Endoscopic mucosal resection: tips and tricks for gastrointestinal trainees.","authors":"Tessa Herman,&nbsp;Bryant Megna,&nbsp;Kumar Pallav,&nbsp;Mohammad Bilal","doi":"10.21037/tgh-23-23","DOIUrl":"https://doi.org/10.21037/tgh-23-23","url":null,"abstract":"<p><p>Endoscopic mucosal resection (EMR) is a minimally invasive, specialized endoscopic technique that is useful in resecting superficial gastrointestinal lesions that are unable to be removed by standard polypectomy. This is typically accomplished using a submucosal injection that lifts the lesion away from the muscularis propria to allow for safe resection of the polyp, either via piecemeal or <i>en bloc</i> resection. Over the years, several techniques exist to perform EMR including conventional EMR or hot EMR, cold EMR and underwater EMR. Despite its established advantages and safety over conventional techniques such as surgery, the adoption of endoscopic resection (and thus the education and training of gastroenterology trainees) is lagging. The goal of this article is to offer a comprehensive review of the basic principles of colonic EMR. We review the concepts of optical diagnosis including the various polyp classification systems available to determine the polyp morphology and histology. We also discuss the technical aspects of performing colonic EMR. We also outline the common adverse events associated with EMR including bleeding, perforation, postpolypectomy syndrome, and residual or recurrent polyps, and discuss preventative measures that can be taken to mitigate adverse events. Lastly, we offer practical tips for trainees who want to undertake EMR in their clinical practice.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/48/tgh-08-23-23.PMC10432230.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10040382","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":"Hepatic epithelioid hemangioendothelioma: is it actually \"indolent\"?","authors":"Alexander H Yang,&nbsp;Nathalie H Urrunaga","doi":"10.21037/tgh-22-82","DOIUrl":"https://doi.org/10.21037/tgh-22-82","url":null,"abstract":"© Translational Gastroenterology and Hepatology. All rights reserved. Transl Gastroenterol Hepatol 2022 | https://dx.doi.org/10.21037/tgh-22-82 Epithelioid hemangioendothelioma is a rare vascular tumor that was first described by Dail and Liebow involving the lung (1). It can arise in the liver, lung, and bone and has generally been thought to be an indolent lesion (2,3). Hepatic epithelioid hemangioendothelioma (HEHE), was first described by Ishak et al. in a case series (1). HEHE can involve the vasculature and extrahepatic involvement can be seen in 36.6% of patients (4). The etiology is unclear but there are reported associations with oral contraceptive use, alcohol consumption, liver trauma, sarcoidosis, Crohn’s disease, viral hepatitis, and vinyl chloride or asbestos exposure (4-7). Diagnosis incudes characteristic findings of target like lesion on magnetic resonance imaging (MRI) (8) and infiltrative epithelioid cell growth with Factor VIII Ag, CD34 and CD31 staining positive on biopsy (9). Treatment options include surgical resection, liver transplantation, chemotherapy and radiotherapy (4). In their recently published report, Dr. Ribeiro presented a case of rapidly progressing HEHE with delayed diagnosis (10). The authors used volumetric data from MRI showing a tumor percentage growth from 9% to 70% of liver, and a tumor growth of 964% over two years. The report is important in several aspects: it quantified the coalescence of nodules resulting in giant mass over time, as well as spreading to other organs, countering the preconception that HEHE is a slow-growing tumor, and tumor cells with transcription factor binding to IGHM enhancer 3 (TFE3) immunoreactivity indicating it as a case of recently described Yes1 associated transcriptional regulator (YAP1)-TFE3 fusion. The report also has important implications in terms of therapy: this patient underwent radiotherapy and sorafenib as surgery was not an option in multiorgan disease in the patient’s country. In terms of therapy options, surgical management is preferred when possible and it is associated with better survival (11). Liver resection is often the first choice for solitary tumors, however, due to the multifocal nature and presence of extrahepatic lesions, liver transplant has often been used. Two European series have reported liver transplantation for HEHE with rates of 5–10 years overall survival of 80.8–83% and 74–77.1% respectively (12,13). A third large retrospective series reported data from the United Network for Organ Sharing (UNOS) and reported a 5-year overall survival of 64% after liver transplantation for HEHE (14). In general, the rate of HEHE recurrence post liver transplant is of approximately 23.7% to 32% (12-14). The 5-year survival is significantly lower with chemotherapy (30%), or no treatment (4.5%) (4). Dr. Ribeiro’s report of rapid growing HEHE, highlights the importance of early recognition of HEHE and referral for treatment, including surgery or chemotherapy ","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/1b/tgh-08-22-82.PMC9813649.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10632885","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":"EndoFLIP assessment of pyloric sphincter in children: a single-center experience.","authors":"Mara Popescu,&nbsp;Emily White,&nbsp;Mohamed Mutalib","doi":"10.21037/tgh-22-58","DOIUrl":"https://doi.org/10.21037/tgh-22-58","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal complaints are common in children with neurodisabilities, vomiting, retching and poor feed tolerance are frequently reported. Endolumenal functional lumen imaging probe (EndoFLIP) is used to assess compliance and distensibility of the pylorus and can predict response to Botulinum Toxin in adult with gastroparesis. We aimed to review pyloric muscle measurements using EndoFLIP in children with neuromuscular disabilities and significant foregut symptoms and to assess the clinical response to intrapyloric Botulinum Toxin.</p><p><strong>Methods: </strong>Retrospective review of clinical notes of all children who underwent pyloric EndoFLIP assessment in Evelina London Children's Hospital from March 2019 to January 2022. EndoFLIP catheter was inserted at the time of endoscopy via existing gastrostomy tract.</p><p><strong>Results: </strong>A total of 335 measurement from 12 children were obtained, mean age 10.7±4.2 years. Measurements (pre and post Botox) were obtained with 20, 30 and 40 mL balloon volume. Diameter (6.5, 6.6), (7.8, 9.4) and (10.1, 11.2), compliance (92.3, 147.9), (89.7, 142.9) and (77, 85.4) mm³/mmHg, distensibility (2.6, 3.8), (2.7, 4.4) and (2.1, 3) mm²/mmHg and balloon pressure was (13.6, 9.6), (20.9, 16.2) and (42.3, 35) mmHg. Eleven children reported clinical symptom improvement after Botulinum Toxin injection. Balloon pressure was positively correlated to diameter (r=0.63, P<0.001).</p><p><strong>Conclusions: </strong>Children with neurodisabilities who present with symptoms suggestive of poor gastric emptying do have a low pyloric distensibility and poor compliance. EndoFLIP via existing gastrostomy tract is quick and easy to perform. Intrapyloric Botulinum Toxin appears to be safe and effective in this cohort of children leading to clinical and measurements improvement.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/22/tgh-08-22-58.PMC10184029.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9488779","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":"Impact of pre-operative transjugular intrahepatic portosystemic shunt on post-operative outcomes following non-transplant surgeries in patients with decompensated cirrhosis.","authors":"Pragnesh Patel,&nbsp;Malcolm Irani,&nbsp;Edward A Graviss,&nbsp;Duc T Nguyen,&nbsp;Eamonn M M Quigley,&nbsp;David W Victor","doi":"10.21037/tgh-21-133","DOIUrl":"https://doi.org/10.21037/tgh-21-133","url":null,"abstract":"<p><strong>Background: </strong>Patients with cirrhosis have a high risk for morbidity and mortality in relation to abdominal surgery. Despite improvements in surgical techniques and intensive care, major abdominal surgery still remains a challenge. Major factors determining short- and long-term survival and perioperative complications in this patient population include severity of liver dysfunction, degree of portal hypertension (PHTN), and the presence of related complications such as ascites. Elective transjugular intrahepatic portosystemic shunt (TIPS) placement prior to surgery has been reported to improve perioperative outcomes, but available data is limited to case reports and small case series. We aimed to determine the impact of elective TIPS placement on perioperative outcomes after abdominal-pelvic surgeries in patients with cirrhosis.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients who underwent elective TIPS and compared these patients with a cohort of cirrhotic patients who underwent any abdominal surgeries without TIPS placement. The primary outcomes were mortality at 30 days and 1 year following surgery. Other post-operative outcomes compared between the two groups, included: blood loss, worsening ascites, wound leak, infections, encephalopathy, liver decompensation, and length of hospitalization.</p><p><strong>Results: </strong>Among 38 patients with cirrhosis who underwent abdominal surgery, 20 patients underwent pre-operative elective TIPS placement. Demographic characteristics of the two groups were comparable including age, gender, and body mass index (BMI). The median age was 62 years with a male predominance (62.5%). Both groups had similar etiologies of cirrhosis with hepatitis C virus (HCV) (34.2%) being most common. The most frequent indications for surgery were strangulated hernia (50%) in the TIPS group and acute cholecystitis (55.6%) in the non-TIPS group. Mean pre-TIPS hepato-venous portal gradient (HVPG) was 16.5 mmHg and mean post-TIPS HVPG was 7.0 mmHg. Mortality at 1 month was not statistically different between the groups (20% <i>vs.</i> 5.6%, respectively, P=0.19). The 1-year mortality was also not statistically different between the two groups (20% <i>vs.</i> 11.1%, P=0.36).</p><p><strong>Conclusions: </strong>We found no statistically significant difference in mortality or rate of post-operative complications between patients who received pre-operative TIPS and those who did not in our age-matched cohort.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/00/tgh-08-21-133.PMC9813646.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10619504","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":"A comparison of magnetic resonance elastography (MRE) to biomarker testing for staging fibrosis in non-alcoholic fatty liver disease (NAFLD).","authors":"Joseph M Kaplan,&nbsp;Jamil Alexis,&nbsp;Gregory Grimaldi,&nbsp;Mohammed Islam,&nbsp;Stephanie M Izard,&nbsp;Tai-Ping Lee","doi":"10.21037/tgh-22-27","DOIUrl":"https://doi.org/10.21037/tgh-22-27","url":null,"abstract":"<p><strong>Background: </strong>Non-alcoholic fatty liver disease (NAFLD) is the world's most prevalent chronic liver disease. In advanced stages, it is associated with significant morbidity and mortality. Magnetic resonance elastography (MRE) and scoring panels Fibrosis-4 (FIB-4) and NAFLD Fibrosis Score (NFS) are useful noninvasive alternatives to liver biopsy for fibrosis staging. Our study aimed to determine how well MRE corresponds with both FIB-4 and NFS at different stages of fibrosis.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients age ≥18 with NAFLD as their only known liver disease who underwent MRE within six months of a lab draw. MRE stratified patients into fibrosis stages using kPa values. FIB-4 categorized patients as Advanced Fibrosis Excluded, Further Investigation Needed or Advanced Fibrosis Likely. NFS categorized them as F0-2, Indeterminate or F3-4. MRE fibrosis staging was compared to FIB-4 and NFS for both ruling out advanced fibrosis and identifying advanced fibrosis/cirrhosis.</p><p><strong>Results: </strong>Overall, 193 patients met inclusion criteria. Our statistical analysis included calculating positive predictive values (PPVs) and negative predictive values (NPVs), which are the proportions of positive and negative fibrosis screening results that correspond to positive and negative MRE results respectively. NPV for FIB-4 (0.84) and NFS (0.89) in the 'rule out advanced fibrosis' category signify that 84% and 89% of respective biomarker scores correspond to MRE in early stage disease. The PPV for FIB-4 and NFS in the 'identify advanced fibrosis/cirrhosis' category signify 63% and 72% of respective biomarker scores correspond to MRE in late stage disease.</p><p><strong>Conclusions: </strong>FIB-4 and NFS scores indicating little to no fibrosis correspond extremely well with MRE, while scores suggesting advanced fibrosis/cirrhosis correspond less convincingly. MRE shows promise as an effective alternative to liver biopsy, however our study suggests FIB-4 and NFS alone may be sufficient for fibrosis staging, particularly in early stage NAFLD.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/2b/tgh-08-22-27.PMC9813653.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10619506","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}