Saudi Journal of Gastroenterology最新文献

{"title":"Peroral endoscopic myotomy (POEM) for achalasia in the Middle East: The type of myotomy matters.","authors":"Bahtiyar Muhammedoğlu","doi":"10.4103/sjg.sjg_167_23","DOIUrl":"https://doi.org/10.4103/sjg.sjg_167_23","url":null,"abstract":"Sir, Achalasia is a rare disease, that negatively affects human life with progressive dysphagia.[1] The Chicago Classification and the introduction of the peroral endoscopic myotomy (POEM) procedure (PP) into clinical practice revolutionized the treatment of achalasia.[2] The main goal of current therapeutic modalities is to reduce lower esophageal sphincter (LES) pressure.[3] Recently, Al Lehibi et al. examined 67 patients with achalasia where 95.5% achieved Eckardt scores of ≤3 at ≥3 months after the procedure.[3] It is important to determine myotomy according to the achalasia type, but as the authors stated, 10 cm in types I–II and 12 cm in type III may not be sufficient. It should be noted that in another study, good results were obtained when performing a myotomy with an average of 14.4 cm.[4] Similarly, long myotomy in the PP in patients with type III achalasia (16 vs 8 cm) is associated with better clinical outcomes.[5] The length of myotomy distal to the gastroesophageal junction (GEJ) is important in achalasia. Adequate gastric myotomy has been shown to prevent recurrent dysphagia in achalasia cases. Traditionally, the length of gastric myotomy varies from 2 to 3 cm.[6] İn the study by Al Lehibi et al, we believe that the myotomy was short, which is performed up to 2 cm distal to the GEJ. The authors did not specify what type of myotomy they performed in their study, but several randomized trials and systematic reviews have confirmed that the orientation of myotomy (anterior or posterior), has no substantial impact on the outcomes of POEM.[6] However, Al Lehibi et al. did not state whether selective circular myotomy or full‐thickness myotomy was performed in their study. In addition, the rate of pneumoperitoneum was relatively high (32.8%) during PP, which may be related to the general anesthesia‐related positive pressure ventilation utilized to prevent adverse events of CO2. Sometimes, it is necessary to pause the POEM for a while to prevent CO2 from leaking into the various tissue planes.[7] Generally, air leaks resolve spontaneously and a chest tube should be inserted when severe pneumothorax develops. In essence, POEM is a safe procedure for the treatment of achalasia. Myotomy length should be determined according to achalasia type and distal segment involvement. It may require redo POEM in the case of recurrent disease or esophagectomy in the case of the sigmoid esophagus.","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/17/SJG-29-199.PMC10358800.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9839173","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":"Urinary coproporphyrins as a diagnostic biomarker of Dubin-Johnson syndrome in neonates: A diagnostic pathway is proposed.","authors":"Abdulrahman Al-Hussaini,&nbsp;Ali Asery,&nbsp;Omar Alharbi","doi":"10.4103/sjg.sjg_480_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_480_22","url":null,"abstract":"<p><strong>Background: </strong>Dubin-Johnson syndrome (DJS) presents during the neonatal period with a phenotype that overlaps with a broad list of causes of neonatal cholestasis (NC), which makes the identification of DJS challenging for clinicians. We conducted a case-controlled study to investigate the utility of urinary coproporphyrins (UCP) I% as a potential diagnostic biomarker.</p><p><strong>Methods: </strong>We reviewed our database of 533 cases of NC and identified 28 neonates with disease-causing variants in ATP-binding cassette-subfamily C member 2 (ABCC2) gene \"Cases\" (Study period 2008-2019). Another 20 neonates with cholestasis due to non-DJS diagnoses were included as \"controls.\" Both groups underwent UCP analysis to measure CP isomer I percentage (%).</p><p><strong>Results: </strong>Serum alanine aminotransferase (ALT) levels were within the normal range in 26 patients (92%) and mildly elevated in 2 patients. ALT levels were significantly lower in neonates with DJS than in NC from other causes (P < 0.001). The use of normal serum ALT levels to predict DJS among neonates with cholestasis had a sensitivity of 93%, specificity 90%, positive predictive value (PPV) 34%, and negative predictive value (NPV) 99.5%. The median UCPI% was significantly higher in DJS patients [88%, interquartile range (IQR) 1-IQR3, 84.2%-92.7%] than in NC from other causes [67%, (IQR1-IQR3, 61%-71.5%; Confidence interval 0.18-0.28; P< 0.001)]. The use of UCPI% >80% to predict DJS had a sensitivity, specificity, PPV, and NPV of 100%.</p><p><strong>Conclusion: </strong>Based on the results from our study, we propose sequencing of the ABCC2 gene in neonates with normal ALT, presence of cholestasis and UCP1% >80%.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/72/SJG-29-183.PMC10358799.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206730","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 Saudi Gastroenterology Association guidelines for quality indicators in gastrointestinal endoscopic procedures.","authors":"Fahad Alsohaibani,&nbsp;Hesham Aljohany,&nbsp;Abdul Hakim Almakadma,&nbsp;Ahmed Hamed,&nbsp;Resheed Alkhiari,&nbsp;Emad Aljahdli,&nbsp;Majid Almadi","doi":"10.4103/sjg.sjg_391_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_391_22","url":null,"abstract":"<p><p>The quality and safety of gastrointestinal endoscopy varies considerably across regions and facilities worldwide. In this field, quality management has traditionally focused on individual performance of endoscopists, with most indicators addressing process measures and limited evidence of improvement in health outcomes. Indicators of quality can be classified according to their nature and sequence. The various professional societies and organizations have proposed many systems of indicators, but a universal system is necessary so that healthcare professionals are not overburdened and confused with a variety of quality improvement approaches. In this paper, we propose guidelines by the Saudi Gastroenterology Association pertaining to quality in endoscopic procedures aiming to improve the awareness of endoscopy unit staff toward important quality indications to enhance and standardize quality of care provided to our patients.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4b/b6/SJG-29-148.PMC10358793.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9838571","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":"Incidence and clinical characteristics of pediatric inflammatory bowel disease in Oman.","authors":"Tawfiq Taki Al Lawati,&nbsp;Yusriya Al Rawahi,&nbsp;Al Qasim Al Bahlani,&nbsp;Adawiya Al Jamei,&nbsp;Dafalla Ramatalla,&nbsp;Omar I Saadah","doi":"10.4103/sjg.sjg_473_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_473_22","url":null,"abstract":"<p><strong>Background: </strong>Pediatric inflammatory bowel disease (PIBD) has been documented all over the world, and there is now a large body of clinical, pathological, and treatment knowledge and protocols in place in many countries. There is currently limited knowledge on the prevalence and pathology of PIBD in Omani population. The aim of this study is to report the incidence and clinical features of PIBD in Oman.</p><p><strong>Methods: </strong>This was a retrospective, cross-sectional, multicenter study carried out on all children <13 years of age between January 1, 2010 and December 31, 2021.</p><p><strong>Results: </strong>Fifty-one children were identified, 22 males (43.1%) and 29 females (56.9%), who were mostly from the Muscat region of Oman. The median incidence in the country was 0.57 (confidence interval [CI]: 0.31-0.64) per 10⁵ children for inflammatory bowel disease (IBD), 0.18 (CI: 0.07-0.38) per 10⁵ children for ulcerative colitis (UC), and 0.19 (CI: 0.12-0.33) per 10⁵ children for Crohn's disease (CD). There was a significant increase in the incidence of all PIBD types after the year 2015. Bloody diarrhea was the most common symptom, followed by abdominal pain. Perianal disease affected nine children (40.9%) with CD.</p><p><strong>Conclusion: </strong>The incidence of PIBD in Oman is lower than in some neighboring Gulf countries but similar to that of Saudi Arabia. An alarming upward trend was noted from the year 2015. Large-scale population-based studies are required to investigate the possible causes of this increasing incidence.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/e8/SJG-29-177.PMC10358796.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9902276","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":"Exploring treatment of inflammatory bowel disease with infliximab in the Middle East and Northern Africa: An analysis of the HARIR observational cohort study.","authors":"Othman Alharbi,&nbsp;Waleed Hamed,&nbsp;Osama Salem,&nbsp;Catherine Taylor,&nbsp;Ahmed Besar,&nbsp;Mohamed Sharaf","doi":"10.4103/sjg.sjg_434_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_434_22","url":null,"abstract":"<p><strong>Background: </strong>In 2017, inflammatory bowel disease, including Crohn's disease (CD) and ulcerative colitis (UC) affected more than 6.8 million people worldwide, with increased incidence in newly industrialized countries. Although treatment options were previously limited to symptom reduction, current approaches benefit from disease-modifying biologics. In this study, we aimed to explore disease characteristics, treatment, and outcomes of patients with CD or UC treated with infliximab or golimumab in routine clinical practice in the Middle East and Northern Africa.</p><p><strong>Methods: </strong>HARIR was a prospective, observational, multicenter study (NCT03006198), in patients who were treatment naïve or who received two or fewer biologic agents. Observed data from routine clinical practice were presented descriptively.</p><p><strong>Results: </strong>Data from 86 patients enrolled from five countries (Algeria, Egypt, Kuwait, Qatar, and Saudi Arabia) were analyzed, 62 with CD and 24 with UC. All patients received infliximab. Clinically meaningful efficacy data were observed only for the CD group (up to Month 3) due to limited patient numbers. Crohn's Disease Activity Index (CDAI) scores at Month 3 indicated a positive response to treatment (reduced score of ≥70 and ≥25% compared with baseline) for 14/48 (29.2%) patients; notably, 28/52 (53.8%) patients had CDAI score <150 at baseline. Rates of serious and severe adverse events (AEs) were low in both groups. The most common AEs were gastrointestinal disorders.</p><p><strong>Conclusion: </strong>Infliximab treatment was well tolerated in this Middle Eastern and Northern African population, and a clinical response was observed for 29.2% of CD patients. Limited accessibility to biologics and concomitant treatments restricted study conduct.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/8e/SJG-29-164.PMC10358795.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206731","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 preoperative total parenteral nutrition on the surgical complications of Crohn's disease: A retrospective cohort study.","authors":"Thamer A Bin Traiki,&nbsp;Sulaiman A Alshammari,&nbsp;Nadia A Aljomah,&nbsp;Monirah M Alsalouli,&nbsp;Esraa S Altawil,&nbsp;Maha-Hamadien Abdulla,&nbsp;Noura S Alhassan,&nbsp;Khayal A Alkhayal","doi":"10.4103/sjg.sjg_425_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_425_22","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is associated with malnutrition, an independent risk factor for surgical morbidity and mortality in more than 65% of patients, with a significant impact on disease outcomes. In this single-center retrospective cohort study, we aimed to investigate the impact of total parenteral nutrition (TPN) on the surgical outcomes of patients with CD.</p><p><strong>Methods: </strong>This study included patients with CD who underwent abdominal surgery. We compared patients who received preoperative total parenteral nutrition (TPN group) to those who did not (non-TPN group). Prolonged oral intolerance, albumin level <30 g/L, and body mass index <18.5 were the main indications for TPN. We evaluated postoperative surgical complications in both groups.</p><p><strong>Results: </strong>Between January 2010 and October 2018, 169 eligible patients underwent abdominal surgery. The TPN and non-TPN groups included 40 and 129 patients, respectively. The mean albumin level was significantly lower in the TPN group (P = 0.013). Laparoscopic surgery was performed in 76.9% of the patients, with a conversion rate of 11.6%. Infectious and non-infectious complications developed in 8.9% and 16% of patients, respectively. Surgical complications were comparable between the groups (P >0.05).</p><p><strong>Conclusions: </strong>Despite oral intake intolerance and severe disease in the TPN group, the surgical complications were comparable between the groups.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d8/22/SJG-29-158.PMC10358801.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845181","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":"Let food be thy medicine….","authors":"Htar Htar Hlaing,&nbsp;Lisa Mary Sharkey","doi":"10.4103/sjg.sjg_180_23","DOIUrl":"https://doi.org/10.4103/sjg.sjg_180_23","url":null,"abstract":"Although Hippocrates probably never stated the exact words that are often attributed to him (let food be thy medicine, and medicine be thy food), he did consider nutrition as an integral part of a doctor’s armamentarium. Perioperative nutrition support should be at the forefront of every surgeon’s mind, especially as many conditions requiring surgery are naturally associated with a catabolic state and a high risk of nutritional deficiencies, including inflammatory bowel disease (IBD). There have been significant advances in the medical management of IBD over the past 20 years; however, many patients with Crohn’s disease (CD) still require surgery. The prevalence of malnutrition has been reported as high as 82.8% in patients with active CD[1] and that of sarcopenia to be up to 70%,[2] and these are associated with increased frequency and severity of postoperative complications.[3]","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/ee/SJG-29-145.PMC10358794.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9839174","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":"Gut virome profile in healthy Saudi children.","authors":"Mohammad I El Mouzan,&nbsp;Asaad A Assiri,&nbsp;Ahmed A Al Sarkhy,&nbsp;Mona M Alasmi","doi":"10.4103/sjg.sjg_444_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_444_22","url":null,"abstract":"<p><strong>Background: </strong>The role of viruses is well known in health and disease. The aim of this report was to describe the profile of viruses in the gut of healthy Saudi children.</p><p><strong>Methods: </strong>In 20 randomly selected school age children from Riyadh, stool samples were collected in cryovials and stored at -80° C. At the time of analysis, the samples were sent by express mail in a temperature-controlled container to the laboratory in the USA, Viral DNA was isolated and shotgun metagenomic sequencing was performed. The abundance of each organism was expressed as an average relative percentage across the viral phylogenetic tree from phyla to species.</p><p><strong>Results: </strong>The median age of the children was 11.3 (range 6.8-15.4) years, and 35% were males. Caudovirales were the most abundant bacteriophage order (77%) and Siphoviridae, Myoviridae, and Podoviridae families predominated, accounting for 41%, 25%, and 11%, respectively. Among the viral bacteriophage species, the most abundant were the Enterobacteria phages.</p><p><strong>Conclusion: </strong>The profile and abundance of the gut virome in healthy Saudi children reveal important differences from the literature. Further studies from different populations with larger sample sizes are needed to understand the role of gut viruses in the pathogenesis of disease in general and in the response to fecal microbiota therapy in particular.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/e5/SJG-29-171.PMC10358797.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206728","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":"Combining serum uric acid and fatty liver index to improve prediction quality of nonalcoholic fatty liver disease.","authors":"Yajie Ding,&nbsp;Zongzhe Tang,&nbsp;Minxian Wang,&nbsp;Min Wang,&nbsp;Ru Zhang,&nbsp;Liuxin Zhang,&nbsp;Mengting Zhang,&nbsp;Qing Guan,&nbsp;Jie Wang","doi":"10.4103/sjg.sjg_484_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_484_22","url":null,"abstract":"<p><strong>Background: </strong>The significant association between serum uric acid (SUA) and nonalcoholic fatty liver disease (NAFLD) is well documented. In this report, we tested the hypothesis that SUA might improve the widely studied fatty liver index (FLI) to predict NAFLD.</p><p><strong>Methods: </strong>A cross-sectional study was performed in a community of Nanjing, China. The population data on sociodemographics, physical examinations, and biochemical tests were collected from July to September 2018. The associations of SUA and FLI with NAFLD were analyzed using linear correlation, multiple linear regressions, binary logistic analyses, and area under receiver-operating characteristic curve (AUROC).</p><p><strong>Results: </strong>A total of 3,499 people were included in this study, of which 36.9% had NAFLD. The prevalence of NAFLD increased with the increase of SUA levels (all P <.05). Logistic regression analyses revealed that SUA was significantly associated with an increased risk of NAFLD (all P <.001). The NAFLD predictive value after combining SUA with FLI was superior to FLI, especially in females (AUROC_{SUA + FLI} = 0.911 vs. AUROC_FLI = 0.903, P <.05). The reclassification of NAFLD also significantly improved, based on net reclassification improvement (0.053, 95% confidence interval [CI]: 0.022-0.085, P <.001) and integrated discrimination improvement (0.096, 95% CI: 0.090-0.102, P <.001). A regression formula of this combined algorithm was proposed as: The novel formula = 0.032* waist circumference + 0.303* body mass index + 1.301* natural logarithm of triglyceride + 0.478* natural logarithm of glutamyl transpeptidase + 0.002* SUA- 18.823. At the cutoff value of 13.3, the sensitivity and specificity of this model were 89.2% and 78.4%, respectively.</p><p><strong>Conclusions: </strong>SUA level was positively associated with NAFLD prevalence. A new formula combining SUA with FLI may serve as a better indicator to predict NAFLD compared to FLI, especially in females.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/cc/SJG-29-191.PMC10358798.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9851075","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":"Predictors of biliary atresia outcome: Saudi National Study (2000 - 2018).","authors":"Mohammed Abanemai,&nbsp;Mohammed AlEdreesi,&nbsp;Ahmed Al Sarkhy,&nbsp;Omar I Saadah,&nbsp;Homoud Alhebbi,&nbsp;Razan Bader,&nbsp;Maher Alhatlani,&nbsp;Hana Halabi,&nbsp;Ahmed Aladsani,&nbsp;Sami Wali,&nbsp;Talal Alguofi,&nbsp;Fahad Alsayed,&nbsp;Amira NasserAllah,&nbsp;Ahmed Almehmadi,&nbsp;Afnan Qurban,&nbsp;Muhammed Salman Bashir,&nbsp;Aisha Alamri,&nbsp;Abdulrahman Al-Hussaini","doi":"10.4103/sjg.sjg_512_22","DOIUrl":"https://doi.org/10.4103/sjg.sjg_512_22","url":null,"abstract":"<p><strong>Background: </strong>Outcomes in biliary atresia (BA) have been well-documented in large national cohorts from Europe, North America, and East Asia. Understanding the challenges that preclude success of the Kasai portoenterostomy (KPE) is the key to improve the overall outcomes of BA and implementing intervention strategies. Here, we analyzed the data from the Saudi national BA study (204 BA cases diagnosed between 2000 and 2018) to identify the prognostic factors of BA outcomes.</p><p><strong>Methods: </strong>One hundred and forty-three cases underwent KPE. Several prognostic factors (center case load, congenital anomalies, serum gamma-glutamyl transferase, use of steroids, ascending cholangitis post-operatively, and degree of portal fibrosis at time of KPE) were investigated and correlated with the primary outcomes of interest: 1) success of KPE (clearance of jaundice and total serum bilirubin <20 mmol/l after KPE), 2) survival with native liver (SNL), and 3) overall survival.</p><p><strong>Results: </strong>Use of steroids after KPE was associated with clearance of jaundice, 68% vs. 36.8% in the BA cases that did not receive steroids (P = 0.013; odds ratio 2.5) and a significantly better SNL rate at 2 - and 10-year of 62.22% and 57.77% vs. 39.47% and 31.57%, respectively (P = 0.01). A better 10-year SNL was observed in centers with caseload <1/year (group 1) as compared to centers that performed ≥1/year (group 2) [45.34% vs. 26.66%, respectively; P = 0.047]. On comparison of the 2 groups, cases in group 1 had KPE at significantly earlier age (median 59.5 vs. 75 days, P = 0.006) and received steroids after KPE more frequently than group 2 (69% vs. 31%, P < 0.001). None of the remaining prognostic variables were identified as being significantly related to BA outcome.</p><p><strong>Conclusion: </strong>Steroids use post-KPE predicted clearance of jaundice and better short- and long-term SNL. There is a need to establish a national BA registry in Saudi Arabia aiming to standardize the pre- and post-operative clinical practices and facilitate clinical and basic research to evaluate factors that influence BA outcome.</p>","PeriodicalId":48881,"journal":{"name":"Saudi Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41149543","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}