JGH Open最新文献

{"title":"The Epidemiology of Ascites in a Multi-Ethnic Asian Population","authors":"Ram Prasad Sinnanaidu,&nbsp;Kumaraganapathy Poobalan,&nbsp;Aswinderjeet Singh Balwan Singh,&nbsp;Kishvan Nair,&nbsp;Anushya Vijayananthan,&nbsp;Sanjiv Mahadeva","doi":"10.1002/jgh3.70111","DOIUrl":"https://doi.org/10.1002/jgh3.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Ascites is a common condition seen by clinicians in secondary care. Data on the epidemiology of ascites in Asians is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A retrospective case record review was performed in this large, referral institution between January 2016 and December 2019. Clinical and epidemiological data of adult (age &gt; 18 years) patients with ascites, identified from the Radiology database, were obtained from this institutions' electronic medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 838 patients (median age 59.77 ± 14.46 years, 56% males, ethnicity: Chinese 41.9%, Malay 34.8%, Indian 22.7%) were included in the study. Malignancy (28.9%) and liver cirrhosis (27.9%) were the most common etiology of ascites. Most of the malignant etiology of ascites were due to female-related (breast and ovarian) and gastrointestinal (colon, liver, pancreatic, bile duct) cancer. Liver cirrhosis-related ascites was mostly due to metabolic-associated fatty liver disease (MASLD, 35.5%) and hepatitis B infection (20.5%). An increased age (&gt; 40 years) was associated with all causes of ascites. The etiology of ascites varied with ethnicity as follows: the most common cause of ascites was malignancy (37.6%) among ethnic Chinese, heart failure (20.5%) in ethnic Malays and chronic liver disease (43.7%) in ethnic Indians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Malignancy and liver cirrhosis are the leading cause of ascites in a multi-ethnic Asian population. Demographic factors, particularly ethnicity, have a strong influence on the etiology of ascites.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additional Stem Resection for Control of Massive Bleeding After Polypectomy for a Pedunculated Colonic Polyp","authors":"Shima Mimura,&nbsp;Kazuhiro Kozuka,&nbsp;Yui Kinouchi,&nbsp;Yukiko Koyama,&nbsp;Toshiharu Funaki,&nbsp;Takuma Yamashita,&nbsp;Akihiro Kondo,&nbsp;Minoru Oshima,&nbsp;Keiichi Okano,&nbsp;Hideki Kobara","doi":"10.1002/jgh3.70117","DOIUrl":"https://doi.org/10.1002/jgh3.70117","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Polypectomy-associated bleeding is the most frequent complication of colorectal polypectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 82-year-old woman underwent polypectomy after an endoloop was placed in a pedunculated polyp in the sigmoid colon. However, the endoloop dislodged, causing massive bleeding from the stem surface. Furthermore, the bleeding vessel could not be identified because of the narrow resection surface and the presence of thrombus and hemorrhage. Therefore, several clips were removed, and polypectomy was performed again on the resection stem to open the resection surface wider and identify the bleeding vessels. Finally, the responsible arterial vessel appeared, leading to complete hemostasis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The additional stem resection may be a novel method for detecting uncontrolled bleeding after polypectomy for colorectal pedunculated polyps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Retinol-Binding Protein in Predicting Mortality in Patients With Chronic Liver Disease","authors":"Yuki Utakata,&nbsp;Takao Miwa,&nbsp;Tatsunori Hanai,&nbsp;Masashi Aiba,&nbsp;Shinji Unome,&nbsp;Kenji Imai,&nbsp;Yohei Shirakami,&nbsp;Koji Takai,&nbsp;Masahito Shimizu","doi":"10.1002/jgh3.70087","DOIUrl":"https://doi.org/10.1002/jgh3.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Rapid turnover proteins (RTPs), including retinol-binding protein (RBP), prealbumin, and transferrin, are useful in evaluating dynamic nutritional status. This study aimed to investigate the relationship between serum RTP levels and mortality in patients with chronic liver disease (CLD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated 341 patients with CLD admitted between October 2011 and December 2021. Those with RBP levels below 2.7 mg/dL for males and 1.9 mg/dL for females were included in the low RBP group. Factors associated with mortality and low RBP were evaluated using the Cox proportional hazard regression and logistic regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of the included patients was 67 years, and 48% were male. The median model for end-stage liver disease (MELD) score was 8 points, and the median RBP, prealbumin, and transferrin levels were 1.5 mg/dL, 11 mg/dL, and 227 mg/dL, respectively. During a median observational period, 23% of the patients died. Multivariate analysis showed that the RBP level (hazard ratio, 0.62; 95% confidence interval [CI], 0.46–0.81) was independently associated with mortality, while prealbumin and transferrin were not. Additional analysis revealed that male sex (odds ratio, 8.62; 95% CI, 2.56–29.00) and albumin level (odds ratio, 0.10; 95% CI, 0.04–0.26) were significantly associated with the low RBP levels in patients with CLD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The serum RBP level is a dynamic biomarker associated with mortality in patients with CLD, independent of liver functional reserve, and it may be a useful indicator for nutritional intervention in these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Friable Rectal Neuroendocrine Tumor Complicated by Hemorrhagic Shock: A Rare Case Report and Review of the Literature","authors":"Yazan Abboud,&nbsp;Imran Qureshi,&nbsp;Ayham Khrais,&nbsp;Alexander Le,&nbsp;Param Patel,&nbsp;Ozlem Fidan Ozbilgin,&nbsp;Sima Vossough-Teehan","doi":"10.1002/jgh3.70112","DOIUrl":"https://doi.org/10.1002/jgh3.70112","url":null,"abstract":"<p>Rectal neuroendocrine tumors (NETs) are rare neoplasms that are usually asymptomatic and diagnosed incidentally. There are limited data on the presentation and management of high-grade poorly differentiated large friable rectal NETs. We report the first case of an 87-year-old male who presented with chronic diarrhea and subsequently had severe hematochezia complicated by hemorrhagic shock and cardiac arrest and was diagnosed with a 7-cm high-grade friable rectal NET. Our case sheds light on the need to consider NETs in cases of chronic diarrhea and on the importance of endoscopy-guided biopsy in the diagnosis and categorization, which can guide management.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal Exposures in Pancreatic Cancer Incidence: Insights From Mendelian Randomization Studies","authors":"Ashraf Mohamadkhani,&nbsp;Reza Ghanbari,&nbsp;Ramin Shakeri,&nbsp;Mohammad Ali Mohammadkhani,&nbsp;Akram Pourshams","doi":"10.1002/jgh3.70105","DOIUrl":"https://doi.org/10.1002/jgh3.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Pancreatic cancer, marked by its high lethality and poor 5-year survival rate, requires a thorough understanding of its risk factors and etiological mechanisms. In this review, we collected the latest findings from Mendelian randomization (MR) studies to identify potential causal factors for pancreatic cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method and Results</h3>\u0000 \u0000 <p>The present analysis encompasses MR studies on the gut and oral microbiomes, non-malignant phenotypes, blood metabolites, immune cells, and chronic inflammation. Specific gut and oral microbiome species have been identified as potential causal factors for pancreatic cancer, some with protective effects, and others increasing the risk. The review also highlights causal associations between obesity, type 2 diabetes, and pancreatic cancer, as well as the impact of blood metabolites and immune cell phenotypes on disease risk. Additionally, it investigates the causal effects of inflammatory bowel disease, showing a significant risk increase associated with Crohn's disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These insights emphasize the need for interdisciplinary research and personalized medicine to enhance prevention and treatment strategies for pancreatic cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Metal Stents Versus Plastic Stents for Treatment of Walled-Off Pancreatic Necrosis: A Systematic Review and Meta-Analysis","authors":"Yousaf Zafar,&nbsp;Muhammad Umer Sohail,&nbsp;Zainab Siddiqua Ibrahim,&nbsp;Ruqiat Masooma Batool,&nbsp;Ifrah Ansari,&nbsp;Syed Zaeem Ahmed,&nbsp;Muhammad Saad,&nbsp;Eliza Aisha,&nbsp;Saad Ahmed Waqas,&nbsp;Muhammad Ovais Sohail,&nbsp;Faisal Bukeirat,&nbsp;Shou Jiang Tang,&nbsp;Raheel Ahmed","doi":"10.1002/jgh3.70109","DOIUrl":"https://doi.org/10.1002/jgh3.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Walled-off necrosis (WON) is a potentially fatal condition best treated endoscopically with metal or plastic stents. This study compares the clinical outcomes of these stents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PubMed and Cochrane were searched for trials comparing metal and plastic stents for WON. Primary outcomes were clinical and technical success.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven studies with 230 metal stent patients and 226 plastic stent patients were included. Metal stents showed significantly shorter procedure times (SMD -0.80, 95% CI: -1.25 to −0.34), better 4-week clinical success (OR 1.94, 95% CI: 1.00 to 3.77), and higher procedure costs (SMD 1.38, 95% CI: 0.56 to 2.20). No significant differences were observed in hospital stay (SMD -0.05, 95% CI: -0.35 to 0.25), technical success (OR 1.45, 95% CI: 0.22 to 9.43), clinical success (OR 1.13, 95% CI: 0.54 to 2.39), interventions (SMD -0.02, 95% CI: -0.34 to 0.29), need for necrosectomy (RR 1.10, 95% CI: 0.59 to 2.04), necrosectomy sessions (SMD 0.35, 95% CI: -0.42 to 1.11), need for percutaneous drainage (RR 0.82, 95% CI: 0.36 to 1.85), stent migration (RR 0.88, 95% CI: 0.29 to 2.66), bleeding (RR 0.97, 95% CI: 0.53 to 1.75), WON recurrence (RR 1.66, 95% CI: 0.70 to 3.92), treatment failure (death) (RR 0.75, 95% CI: 0.37 to 1.53), disconnected pancreatic duct (RR 0.93, 95% CI: 0.79 to 1.11), and total cost (SMD -0.02, 95% CI: -0.29 to 0.26).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Metal stents offer shorter procedure time and better 4-week clinical success, although at a higher cost, with most clinical outcomes showing no significant differences between stent types.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malnutrition and Associated Factors Among Patients With Cirrhosis at a Tertiary Care Center in Addis Ababa Ethiopia: An Ordinal Logistic Regression Analysis","authors":"Metages Damtie Melaku,&nbsp;Aklog Almaw Yigzaw,&nbsp;Yoseph Gebremedhin Kassie,&nbsp;Mulugeta Wondmu Kedimu,&nbsp;Henok Bahru Wodajeneh,&nbsp;Binyam Melese Getahun,&nbsp;Denekew Tenaw Anley,&nbsp;Melaku Mekonen Agidew,&nbsp;Edgeit Abebe Zewde","doi":"10.1002/jgh3.70107","DOIUrl":"10.1002/jgh3.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cirrhosis is an irreversible stage of liver damage that decreases the ability of the liver to store and metabolize nutrients. Malnutrition is a common problem in patients with cirrhosis and increases the risk of mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to assess malnutrition and associated factors among patients with cirrhosis at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was conducted at Tikur Anbessa Specialized Hospital. All patients with cirrhosis who were admitted to the hospital from August to November were included. Royal Free Hospital Global Assessment tool (RFH-GA) was used to assess nutritional status. Data were entered in Epi-data software version 4.6.0.2 and analyzed with STATA version 17/MP. Ordinal logistic regression analysis was fitted to determine factors associated with nutritional status. Statistical significance was declared at <i>p</i> value &lt; 0.05.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of moderate malnutrition and severe malnutrition were 36.67% and 14.29%, respectively. Patients with ascites were five times at a higher risk of being severely malnourished (AOR = 5.08; 95% CI = 2.66–9.67). The odds of severe malnutrition decrease by 0.35 times for patients without a history of previous hospitalization (AOR = 0.35; 95% CI = 0.18–0.68). The odds of being in the higher category of nutritional status (severe malnutrition) are 10 times higher for patients with hepatic encephalopathy (AOR = 10.43; 95% CI = 4.66–23.31). As the level of creatinine blood urea nitrogen (Cr-BUN) increases, the risk of malnutrition increases by 2.57 times (AOR = 2.57; 95% CI = 1.02–5.78).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Malnutrition is high among cirrhotic patients at Tikur Anbessa Specialized Hospital. Ascites, history of hospitalization, Cr-BUN, and hepatic encephalopathy are significant predictors of malnutrition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Peritoneal Biopsy Diagnose Atypical Cases of Familial Mediterranean Fever?: A Case Report","authors":"Yousef Alsaffaf,&nbsp;Ahmed Aldolly,&nbsp;Mahmoud Shokfa,&nbsp;Ahmad Alnahhas","doi":"10.1002/jgh3.70108","DOIUrl":"10.1002/jgh3.70108","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Familial Mediterranean Fever (FMF) is a prevalent inherited monogenic autoinflammatory disease that predominantly affects populations from the Mediterranean basin. It is typically characterized by the recurrence of fever episodes and abdominal pain accompanied by recurrent short-lived inflammatory attacks that usually resolve spontaneously within 1–3 days. It is uncommon to see ascites with large amounts of peritoneal fluid as a manifestation of FMF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 36-year-old Arab female presented with generalized abdominal pain and bloating. No family history of FMF. Analysis of peritoneal fluid identified low-grade ascites. A CT scan was performed, which did not reveal any suspicious lesions. Laparoscopic surgery was undertaken to rule out the differential diagnoses and obtain a peritoneal biopsy, even though the periton had a normal visual appearance. Histopathological examination of the biopsy specimens was compatible with a diagnosis of FMF, after other differential diagnoses were ruled out. The patient showed significant improvement within a month of taking colchicine. The ascites resolved progressively and completely, affirming the FMF diagnosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The occurrence of chronic ascites in a patient requires the consideration of FMF among the differential diagnoses. A diagnosis of FMF can also be suspected through a peritoneal biopsy, which may be sufficient for diagnosis without the need for genetic testing. Additionally, the patient's response to colchicine therapy can be considered for confirmation, as demonstrated in our case. Future research should focus on considering the inclusion of peritoneal biopsy among the diagnostic criteria for FMF particularly in cases with non-specific presentations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 2","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of a 6-Month Placement of a Fully Covered Self-Expanding Metallic Stent for Refractory Benign Biliary Stricture: A Multicenter Prospective Study","authors":"Tomohisa Iwai,&nbsp;Mitsuhiro Kida,&nbsp;Kazuya Sugimori,&nbsp;Hiroaki Shigoka,&nbsp;Takaaki Matsumoto,&nbsp;Masashi Ijima,&nbsp;Haruo Miwa,&nbsp;Kosuke Okuwaki,&nbsp;Masafumi Watanabe,&nbsp;Kai Adachi,&nbsp;Akihiro Tamaki,&nbsp;Taro Hanaoka,&nbsp;Junro Ishizaki,&nbsp;Chika Kusano","doi":"10.1002/jgh3.70103","DOIUrl":"10.1002/jgh3.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Managing benign biliary stricture endoscopically is complicated and challenging. This study aimed to evaluate the safety and efficacy of a 6-month placement of a fully covered self-expanding metallic stent for refractory benign biliary stricture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-two patients with refractory benign biliary stricture (13 with chronic pancreatitis and 9 without) were recruited from five higher tertiary care centers. All patients received a planned 6-month fully covered self-expanding metallic stent placement. Primary outcomes included clinical success, technical success of stent removal, adverse events, and stricture recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 21 cases (one case was excluded owing to malignant findings), fully covered self-expanding metallic stent placement was successful in all cases, with contralateral bile duct plastic stents used in three patients and stents remaining in place for 6 months in 16 of 21 patients. Distal stent migration occurred in three cases, two of which had resolved strictures. Adverse events were observed in 19.0% of patients: one case of severe cholangitis, two cases of mild cholangitis, and one case of hyperplasia formation. No stent-induced pancreatitis or cholecystitis occurred. All stents were removed successfully, and the treatment success rate was 85%. One patient experienced recurrent stricture 6.5 months post-stent removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A six-month placement of a modified fully covered self-expanding metallic stent effectively improved strictures and minimized stent-induced Adverse events in patients with refractory benign biliary stricture.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>UMIN ID: UMIN000025027</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elderly Onset Primary Intestinal Lymphangiectasia—A Rare Case","authors":"Li-Han Goh,&nbsp;Madhavan Manoharan,&nbsp;Khean-Lee Goh","doi":"10.1002/jgh3.70102","DOIUrl":"10.1002/jgh3.70102","url":null,"abstract":"<p>Primary intestinal lymphangiectasia (PIL) is a rare protein-losing gastroenteropathy characterized by diffuse or localized ectasia of the enteric lymphatics, which can be accompanied by lymphatic abnormalities in other parts of the body. This condition results in hypoalbuminemia, hypogammaglobulinemia, and lymphopenia due to the abnormal leakage of lymphatic fluid into the gastrointestinal tract. As there are no specific serological or radiological tests available, the gold standard for diagnosing intestinal lymphangiectasia is endoscopic examination with histopathological examination of intestinal biopsy specimens. We present a rare case of primary intestinal lymphangiectasia in a 62-year-old Chinese woman who presented with a six-month history of lethargy, persistent diarrhea, and progressive weight loss. Gastroscopy and colonoscopy were performed, and biopsies revealed dilated intestinal lymphatics with broadened villi in the small intestine. Secondary causes of intestinal lymphangiectasia were ruled out, confirming the diagnosis of PIL. The patient was treated with a high-protein, low-fat diet supplemented with medium-chain triglycerides, resulting in significant clinical improvement.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11754540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}