American Journal of Gastroenterology最新文献

{"title":"Safety and Efficacy of Endoscopic Retrograde Appendicitis Therapy for pediatric patients: A Single-Center Retrospective Study in Chinese Children.","authors":"Qiuyue Tu, Saif Ullah, Deliang Li, Lingjian Kong, Dan Liu, Ting Wei, Yajuan Li, Qingfen Zheng, Lixia Zhao, Hongwu Xin, Bingrong Liu","doi":"10.14309/ajg.0000000000003428","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003428","url":null,"abstract":"<p><strong>Objectives: </strong>Endoscopic retrograde appendicitis therapy (ERAT) is a new and non-invasive endoscopic technique originally developed by Liu in China for the management of acute appendicitis. While its safety and efficacy have been extensively validated in adult populations, evidence regarding its use in pediatric patients remains scarce. The aim of this study was to evaluate the clinical outcomes of ERAT in pediatric appendicitis.</p><p><strong>Methods: </strong>This retrospective study analyzed pediatric patients who underwent ERAT in our hospital between January 2019 and August 2022. Data collected included patient demographics, the success rate of ERAT, and the duration of hospital stay. Additionally, recurrence rates were assessed during the follow-up to evaluate the safety and long-term efficacy of the procedure.</p><p><strong>Results: </strong>A total of 73 patients were included in this study. Appendiceal intubation was successfully performed in 72/73 patients (98.63%). Among these patients, 72.22% of patients had appendiceal fecal stones or food residue, and the success rate of stone removal was 94.23%. Overall, clinical success rate of the procedure was 91.78%. The median procedure time was 22 minutes (IQR 15-36.5), and median postoperative hospital stay was 2 days (IQR 1-4). During the 1-year follow-up, 14.92% of the patients had recurrence appendicitis.</p><p><strong>Conclusions: </strong>ERAT appears to be a safe and effective alternative approach to treat appendicitis in pediatric patients, especially for obstructive appendicitis with appendicolith.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ALADDIN: A Machine Learning Approach to Enhance the Prediction of Significant Fibrosis or Higher in MASLD.","authors":"Naim Alkhouri, Terry Cheuk-Fung Yip, Laurent Castera, Marina Takawy, Leon A Adams, Nipun Verma, Juan Pablo Arab, Syed-Mohammed Jafri, Bihui Zhong, Julie Dubourg, Vincent L Chen, Ashwani K Singal, Luis Antonio Díaz, Nicholas Dunn, Rida Nadeem, Vincent Wai-Sun Wong, Manal F Abdelmalek, Zhengyi Wang, Ajay Duseja, Yousef Almahanna, Haya A Omeish, Junzhao Ye, Stephen A Harrison, Jessica Cristiu, Marco Arrese, Sage Robert, Grace Lai-Hung Wong, Amani Bajunayd, Congxiang Shao, Matthew Kubina, Winston Dunn","doi":"10.14309/ajg.0000000000003432","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003432","url":null,"abstract":"<p><strong>Introduction: </strong>The recent FDA-approval of resmetirom for treating metabolic dysfunction-associated steatohepatitis (MASH) in patients necessitates patient selection for significant fibrosis or higher (≥F2). No existing vibration-controlled transient elastography (VCTE) algorithm targets ≥F2.</p><p><strong>Methods: </strong>The ALADDIN study addressed this gap by introducing a machine-learning-based web calculator that estimates the likelihood of significant fibrosis using routine laboratory parameters with and without VCTE. Our study included a Training set of 827 patients, a Testing Set of 504 patients with biopsy-confirmed MASLD from six centers, and an External Validation Set of 1,299 patients from 9 centers. Five algorithms were compared using AUC in the Test Set: ElasticNet (EN), Random Forest (RF), Gradient Boosting Machines (GBM), XGBoost (XGB), and Neural Networks (NN). The top three (RF, GBM, and XGB) formed an ensemble model.</p><p><strong>Results: </strong>In the external validation set, the ALADDIN-F2-VCTE model, using routine laboratory parameters with VCTE (AUC 0.791, 95% CI: 0.764-0.819), outperformed VCTE alone (0.745, 95% CI 0.717-0.772, p<0.0001)FAST (0.710, 0.679-0.748, p<0.0001) and Agile-3 model (0.740, 0.710-0.770, p<0.0001) in terms of the AUC, Decision Curve Analysis, and calibration. The ALADDIN-F2-Lab model, using routine laboratory parameters without VCTE, achieved an AUC of 0.706 (95% CI: 0.668-0.749), outperfored Fibrosis-4 (FIB-4), steatosis-associated fibrosis estimator (SAFE), and LiverRisk scores.</p><p><strong>Conclusions: </strong>Along with the SAFE model developed to target significant fibrosis or higher, ALADDIN-F2-VCTE (https://aihepatology.shinyapps.io/ALADDIN1) uniquely supports a refined non-invasive approach to patient selection for resmetirom without the need for liver biopsy. Additionally, ALADDIN-F2-Lab (https://aihepatology.shinyapps.io/ALADDIN2) offers an effective alternative when VCTE is unavailable.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in gastroenterology service volumes and billing patterns associated with declining Medicare reimbursement.","authors":"Jonathan A Busam, Eric D Shah","doi":"10.14309/ajg.0000000000003436","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003436","url":null,"abstract":"<p><strong>Introduction: </strong>Efforts to control health spending within the United States have led to reductions in physician reimbursement. This study aims to elucidate the effects of such efforts on physician behavior and care access.</p><p><strong>Methods: </strong>For all gastrointestinal procedures, public Medicare datasets were reviewed to extract variables of interest, leveraging a t-test to assess significant change over time.</p><p><strong>Results: </strong>Between 2018 and 2022, there was a decrease in professional reimbursement (-18%) (p<0.01), procedure frequency (-11%) (p=0.04), and number of gastroenterologists performing each procedure (-7%) (p=0.04).</p><p><strong>Discussion: </strong>Within Medicare, decreasing procedural reimbursement is associated with decreased procedural volumes and fewer participating gastroenterologists.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of post-polypectomy colorectal cancer events and deaths.","authors":"Jiyue Qin, Ashley Earles, Mark Lamm, Hanin Yassin, Joshua Demb, Lin Liu, Samir Gupta","doi":"10.14309/ajg.0000000000003430","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003430","url":null,"abstract":"<p><strong>Objectives: </strong>Post-polypectomy colorectal cancers (PPCRCs) are diagnosed after a cancer-negative colonoscopy with polypectomy. Analyzing PPCRC characteristics informs prevention and early detection strategies. We investigated interval types and etiologies of PPCRCs using World Endoscopy Organization (WEO) guidelines.</p><p><strong>Methods: </strong>PPCRCs were identified in a retrospective cohort of U.S. Veterans who underwent colonoscopy with polypectomy 1999-2016. We classified PPCRCs into interval, non-interval type A, non-interval type B, defined as cancers diagnosed before, at, and after next recommended surveillance exam, respectively. A root cause analysis was conducted to determine the most plausible etiology.</p><p><strong>Results: </strong>We identified 396 PPCRC events and 90 PPCRC deaths over a median follow-up of 3.9 and 4.2 years, respectively. Among PPCRC events, 55% (95% CI: 50%, 60%) were interval, 12% (CI: 9%, 15%) non-interval type A and 33% (CI: 29%, 38%) non-interval type B. Interval cancers were more likely to be diagnosed at stage 4 than non-interval cancers (16% interval vs 2.1% non-interval A, 8.3% non-interval B, p = 0.003). Most interval cancers were due to possible missed lesions with adequate examinations (60%, CI: 53%, 66%), while most non-interval cancers were likely new CRCs (type A: 48%, CI: 34%, 62%; type B: 84%, CI: 77%, 90%). Similar results were found for PPCRC deaths.</p><p><strong>Conclusions: </strong>Most PPCRC events and deaths were diagnosed before the next recommended exam, largely due to procedural factors, underscoring the need to optimize quality of baseline colonoscopy and polypectomy. Many PPCRCs were diagnosed after recommended exam, suggesting the need to improve patient adherence to recommended surveillance intervals.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nature's cystenterostomy: Spontaneous pancreatico-colonic fistulae formation in infected pancreatic walled-off necrosis.","authors":"Khushboo Gala, Andrew C Storm","doi":"10.14309/ajg.0000000000003437","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003437","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colonoscopy-related adverse events in the 21st century: an updated systematic review and meta-analysis.","authors":"Xiu-He Lv, Qing Lu, Zi-Jing Wang, Zhu Wang, Jin-Lin Yang","doi":"10.14309/ajg.0000000000003429","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003429","url":null,"abstract":"<p><strong>Introduction: </strong>Colonoscopy is one of the most commonly performed endoscopic procedures and is generally considered low-risk. However, when adverse events (AEs) occur, they can present significant challenges in clinical practice. The aim of this study was to estimate the global incidence of colonoscopy-related AEs.</p><p><strong>Methods: </strong>We searched multiple databases for population-based studies reporting the incidence of colonoscopy-related AEs up to December 22, 2024. Meta-analyses were conducted for both gastrointestinal and non-gastrointestinal AEs. Subgroup analyses were performed based on factors including WHO region, publication year, sample size, data collection method, and study design.</p><p><strong>Results: </strong>Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% CI 4.19-6.34, I2=99%), bleeding (18.39; 95% CI 13.53-24.99, I2=100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2=93%); non-gastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2=100%), respiratory events (4.26; 95% CI 0.73-24.99, I2=100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2=74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias.</p><p><strong>Discussion: </strong>This comprehensive meta-analysis provides valuable insights into the global incidence of colonoscopy-related AEs and underscores the imperative need for continuous efforts to enhance the safety of this procedure.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an Entrustable Professional Activity for Intestinal Ultrasound in North America.","authors":"Illya Aronskyy, Jennifer C deBruyn, Rishika Chugh","doi":"10.14309/ajg.0000000000003435","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003435","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating for Celiac Disease in Patients on a Gluten-Free Diet: A Practical Approach.","authors":"Rishaan R Sharma, Claire L Jansson-Knodell, Dennis Kumral, Alberto Rubio-Tapia","doi":"10.14309/ajg.0000000000003434","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003434","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training and Performance of an Electrocardiogram-enabled Machine Learning Model for Detection of Advanced Chronic Liver Disease.","authors":"Puru Rattan, Joseph C Ahn, Beatriz Sordi Chara, Aidan F Mullan, Kan Liu, Zachi I Attia, Paul A Friedman, Alina Allen, Vijay H Shah, Patrick S Kamath, Peter A Noseworthy, Douglas A Simonetto","doi":"10.14309/ajg.0000000000003433","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003433","url":null,"abstract":"<p><strong>Introduction: </strong>Building on prior results, we hypothesized that an electrocardiogram (ECG)-enabled machine learning (ML) model could be used to detect advanced CLD.</p><p><strong>Methods: </strong>A cohort with CLD and 12-lead ECGs was matched with controls from electronic health records. A machine learning model was trained as a binary classifier.</p><p><strong>Results: </strong>There 12,930 CLD patients and 64,577 controls in the cohort. The model's discriminative ability to classify CLD showed an AUC 0.858 (95% CI: 0.850-0.866) and at the chosen threshold, CLD ECGs had 12 times higher odds of being classified as CLD (DOR 12.33, 95% CI: 11.16-13.63).</p><p><strong>Discussion: </strong>An ECG-enabled ML model affords great promise in identifying advanced CLD in low resource areas.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREVENTION OF ALCOHOL-ASSOCIATED LIVER DISEASE.","authors":"Robyn Burton, Lorenzo Leggio, Alexandre Louvet, Nick Sheron, Ashwani K Singal","doi":"10.14309/ajg.0000000000003427","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003427","url":null,"abstract":"<p><strong>Abstract: </strong>Alcohol-associated liver disease (ALD) is the leading cause of morbidity, disease adjusted life-years lost, and mortality worldwide. The significant burden and cost to the healthcare systems from ALD is largely preventable, given that alcohol use is the most important determinant of risk and severity of ALD. In this article, we will review the emerging evidence for public health policies (minimum unit price of alcohol, limiting or banning alcohol advertising), aiming to reduce the availability of alcohol at the population level (primary prevention), preventing ALD especially advanced form of cirrhosis in at risk individuals (secondary prevention), and improving liver outcomes and long-term survival in patients with advanced ALD of cirrhosis and / or alcohol-associated hepatitis (tertiary prevention). We will highlight the critical role of clinicians in promoting the public health policies, widespread screening for AUD and for ALD, and integrating liver with addiction care for patients with ALD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}