Annals of Gastroenterology最新文献

{"title":"Endoscopic ultrasonography-guided gastroenterostomy for malignant and benign gastric outlet obstruction: a systematic review and meta-analysis.","authors":"Raffaele Manta, Angelo Zullo, Vincenzo De Francesco, Marco Spadaccini, Cesare Hassan, Luigi Gatta","doi":"10.20524/aog.2025.0989","DOIUrl":"10.20524/aog.2025.0989","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent has been proposed as a treatment for patients with gastric outlet obstruction (GOO). We performed a systematic review and meta-analysis to compute the technical success, clinical success and complication rates of EUS-GE in treating GOO due to either neoplastic or benign diseases.</p><p><strong>Methods: </strong>The literature search was conducted in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials, from inception until January 23, 2025, according to the PRISMA and MOOSE statement guidelines. The primary objective was to assess both technical and clinical success. A secondary outcome was to rate the adverse events.</p><p><strong>Results: </strong>Data from 39 studies involving 2845 patients were analyzed. The pooled technical success rate was 95.1%, and the procedure was successful in 95.3% and 95.1% of patients with malignant or benign diseases, respectively. Clinical success was achieved in 93.5% of all patients where the procedure had technical success, and in 93.1% and 94.4% of those treated for malignant and benign conditions, respectively. The overall rate of adverse events was 18.5%, including perforation (4.4%), bleeding (2.7%), stent migration (1.4%), stent closure (3.3%), infection (4.4%), and fistula (2.3%). The procedure-related mortality was 1.4%.</p><p><strong>Conclusion: </strong>EUS-GE appears to be a viable approach for the treatment of GOO patients, for both malignant and benign diseases, with favorable outcomes and an acceptable safety profile.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"554-563"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038846","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":"Evaluating spleen volume in inflammatory bowel disease.","authors":"Konstantinos C Mpakogiannis, Fotios S Fousekis, Viktoria-Efthymia C Mpakogianni, Ioanna Nefeli Mastorogianni, Konstantinos H Katsanos","doi":"10.20524/aog.2025.0993","DOIUrl":"10.20524/aog.2025.0993","url":null,"abstract":"<p><p>Crohn's disease (CD) and ulcerative colitis (UC), known as inflammatory bowel disease (IBD), are characterized by immune system dysregulation. The spleen holds a primary role in systemic inflammation and immune responses. Splenic involvement or splenomegaly in IBD patients may result from secondary causes, such as portal hypertension, myeloproliferative diseases, amyloidosis, splenic abscesses or granulomas. Current research on the direct association between IBD and spleen volume (SV) has expanded significantly. In CD, SV is predominantly increased, and is associated with worsen clinical outcomes. Successful treatment with infliximab often leads to a reduction in the elevated SV. Patients with UC often present spleens with invariant SV, or smaller spleens than those observed in CD, as UC typically affects a more limited part of the gastrointestinal tract compared to CD. However, reduction of SV in UC can also indicate relapsing pancolitis. Recent genetic data also suggest that an increased SV serves as a potential risk factor for the development of IBD, emphasizing the possible bidirectional causal relationship between IBD and SV. Shared pathogenic pathways, including intestinal immune activation, tumor necrosis factor-α activation, bowel toxin absorption and lymphatic tissue involvement, might explain the splenic and intestinal immune dysfunction. Thus, the measurement of SV and its adjustment for body mass index or weight, factors that affect the spleen size, may serve as a potential indicator for IBD monitoring, predicting disease-related flares and complications, and evaluating the response to current biologics. Nonetheless, further insights into the underlying pathogenic pathways linking SV and IBD are considered imperative.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"465-471"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038879","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":"Impact of overt and subclinical hepatogenous diabetes and metformin treatment on circulatory function, renal function and hemodynamics, inflammatory activity, and prognosis in patients with cirrhosis and ascites.","authors":"Ilias Tsiakas, Maria Kosmidou, Grigorios Despotis, Dimitrios Biros, Spiridon Tsiouris, Xanthi Xourgia, Lampros Lakkas, Georgios S Markopoulos, Eleni Bairaktari, Georgios Kolios, Haralampos Milionis, Georgios Kalambokis","doi":"10.20524/aog.2025.0990","DOIUrl":"10.20524/aog.2025.0990","url":null,"abstract":"<p><strong>Background: </strong>Hepatogenous diabetes (HD) is common in advanced cirrhosis. The oral glucose tolerant test (OGTT) is frequently diagnostic, as fasting blood glucose (FBG) may be normal. We investigated the impact of FBG- and OGTT-diagnosed HD, and metformin treatment, on circulatory function, renal function and perfusion, and inflammatory activity in patients with cirrhosis and ascites. Also, long-term prognosis of HD under metformin/metformin-based treatment was assessed.</p><p><strong>Methods: </strong>Mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR) as MAP/CO ratio, plasma renin activity (PRA), plasma aldosterone, glomerular filtration rate (GFR), renal blood flow (RBF), and plasma levels of lipopolysaccharide-binding protein (LBP), tumor-necrosis factor-α (TNF-α) and interleukin-6 were evaluated at baseline in patients with and without HD, and after 6 months of metformin treatment for newly diagnosed HD.</p><p><strong>Results: </strong>Compared to OGTT-HD (n=34) and no-HD (n=37), FBG-HD patients (n=35; newly-diagnosed, n=13) had significantly lower SVR (P=0.02/P=0.01), GFR (P=0.01/P=0.008) and RBF (P=0.02/P=0.01), and significantly higher CO (P=0.04/P=0.03), PRA (P=0.009/P=0.006), and levels of LBP (P=0.01/P=0.008) and TNF-α (P=0.03/P=0.02). Initiation of metformin in OGTT-HD and FBG-HD patients induced significant increases in SVR (P=0.02/P=0.04), GFR (P=0.02/P=0.04) and RBF (P=0.04/P=0.05), and significant decreases in PRA (P=0.02/P=0.03) and LBP (P=0.02/P=0.04). Three-year survival in OGTT-HD was significantly higher than in FBG-HD (75.3% vs. 55.3%; P=0.03) and similar to no-HD (81.7%).</p><p><strong>Conclusions: </strong>Circulatory function and renal function and perfusion are aggravated by FBG-HD compared to OGTT-HD or no-HD, possibly because of greater inflammatory activity, while they improve significantly after metformin treatment. Early treatment of HD with metformin may improve prognosis.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"545-553"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038885","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":"Reassessing <i>Clostridioides difficile</i> trends and racial disparities.","authors":"Rebecca Parry","doi":"10.20524/aog.2025.0984","DOIUrl":"10.20524/aog.2025.0984","url":null,"abstract":"","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"577"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038913","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":"The effects of empagliflozin on diuresis and natriuresis in patients with type 2 diabetes mellitus and liver cirrhosis.","authors":"Christos Siafarikas, Chris J Kapelios, Margarita Papatheodoridi, Evangelos Cholongitas, Theodoros Androutsakos, John Vlachogiannakos, Nikolaos Tentolouris, George Papatheodoridis","doi":"10.20524/aog.2025.0992","DOIUrl":"10.20524/aog.2025.0992","url":null,"abstract":"<p><strong>Background: </strong>We investigated the short-term diuretic and natriuretic effect of empagliflozin, a sodium-glucose linked transporter 2 inhibitor, in patients with cirrhosis and type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>This was a prospective, single-arm study including 30 patients with T2DM and cirrhosis (Child-Pugh class A/B). Participants received empagliflozin 10 mg for 15 days while continuing their standard treatment. Clinical and biochemical parameters, and urinary samples, using 24-h urine collection, were recorded before and after treatment. Twenty-seven patients continued empagliflozin for 6 months and were assessed for glycemic control and renal function.</p><p><strong>Results: </strong>Empagliflozin increased median daily urine volume by 475 mL (P=0.010) and fractional sodium excretion (FE_Na) by 16% at day 15 (P=0.030), but the 8 mmol/L increase in 24-h sodium excretion was not significant. Empagliflozin also reduced body weight (-0.8 kg, P<0.001) and systolic blood pressure (-4 mmHg, P=0.029). Glycemic control remained unremarkable at day 15, but improved at 6 months (baseline vs. 6 months: fasting glucose 146 vs. 116 mg/dL, P=0.016; glycosylated hemoglobin 6.2% vs. 6%, P=0.011). Compared to baseline (89.1±20.6 mL/min/1.73m², estimated glomerular filtration rate declined numerically but not statistically significantly at day 15 (85.2±21.8, P=0.056 and at 6 months (82.8±23.7, P=0.035. No serious adverse events were noticed.</p><p><strong>Conclusions: </strong>Up to 6 months' empagliflozin administration in patients with cirrhosis and T2DM seems safe and increases urine output and FE_Na, but its impact on renal function requires further investigation. Larger randomized controlled trials are needed to confirm its long-term efficacy and safety in this setting.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"537-544"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038918","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":"Device failures and patient-related adverse events with small bowel capsule endoscopy: a 20-year MAUDE database analysis.","authors":"Eric S Tatro, Sherif E Elhanafi, Douglas G Adler, Andrew C Stuart, Marc J Zuckerman","doi":"10.20524/aog.2025.0988","DOIUrl":"10.20524/aog.2025.0988","url":null,"abstract":"<p><strong>Background: </strong>Small bowel capsule endoscopy (SBCE) is a critical tool in the evaluation of small bowel bleeding, detection of small bowel neoplasms and diagnosing Crohn's disease. The object of this study was to examine device failures (DF) and patient-related adverse events (PRAE) in SBCE, including those involving the patency capsule system, using user-generated reports from the US Food and Drug Administration's (FDA) Manufacturer and User facility Device Experience (MAUDE) database.</p><p><strong>Method: </strong>We analyzed post marketing surveillance data for SBCE data for all of the SBCE systems from the FDA's MAUDE database from January 2000 until December 2023.</p><p><strong>Results: </strong>A total of 352 reports were obtained during the study period, pertaining to the following SBCE systems, in descending order of frequency: Pillcam SB^® system, Pillcam^® Patency Capsule, Endocapsule^®, CapsoCam^® and MiroCam^®. The vast majority pertained to the Pillcam^® and Pillcam^® Patency system: a total of 307 medical device reports with 398 DFs and 569 PRAEs. The most reported DFs were entrapment of the device (n=212, 53.2%), failure to transmit record (n=38, 9.5%), and failure to record (n=35, 8.7%). The most commonly reported PRAEs were a foreign body retained in the patient (n=140, 24.6%), unintentional exposure to radiation (n=104, 18.2%), and unintended exposure to anesthesia (n=58, 10.2%).</p><p><strong>Conclusions: </strong>Findings from the MAUDE database regarding SBCE devices provide valuable information on DFs and PRAEs. This knowledge can help operators optimize patient selection and reduce patient risk.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"497-504"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039074","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":"Effectiveness of upadacitinib in ulcerative colitis patients with prior tofacitinib exposure: a systematic review and meta-analysis.","authors":"Fariha Hasan, Ayesha Liaquat, Ahmed Raza, Zain Ali Nadeem, Fatima Farooqi, Hassam Ali, Dushyant Singh Dahiya, Zeina Issa, Bhanu Siva Mohan Pinnam, Saqr Alsakarneh, Islam Mohamad, Gursimran S Kocchar","doi":"10.20524/aog.2025.0991","DOIUrl":"10.20524/aog.2025.0991","url":null,"abstract":"<p><strong>Background: </strong>Upadacitinib, a selective Janus kinase (JAK) inhibitor, is a recently approved therapy for moderate-to-severe ulcerative colitis (UC). Limited data are available on its efficacy in patients previously exposed to tofacitinib, a non-selective JAK inhibitor. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of upadacitinib in UC patients with prior tofacitinib treatment.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and Cochrane Library were queried for studies evaluating the effectiveness of upadacitinib in UC patients with prior tofacitinib treatment. Primary outcomes included clinical remission, steroid-free clinical remission (SFCR), and clinical response. Secondary outcomes were the mean decrease in fecal calprotectin, and adverse events. Statistical analyses were performed using R, calculating pooled proportions with 95% confidence intervals (CI) for dichotomous outcomes and mean differences with 95%CI for continuous outcomes using a random-effects model.</p><p><strong>Results: </strong>Five studies, with 127 patients, were included in the final analysis. Upadacitinib increased pooled clinical remission rates by 57% (95%CI 0.32-0.80), SFCR rates by 52% (95%CI 0.26-0.78), and clinical response rates by 75% (95%CI 0.44-0.96). Upadacitinib reduced mean fecal calprotectin levels by 597.59% (95%CI 350.94-844.324). Adverse events, such as headache, acne vulgaris, rash, nasopharyngitis and infections, were reported in 34% of patients (95%CI 0.11-0.62).</p><p><strong>Conclusions: </strong>Our meta-analysis indicates that upadacitinib may be an effective treatment for patients with prior tofacitinib exposure, demonstrating significant clinical remission, SFCR, and clinical response. Larger clinical trials are needed to establish long-term outcomes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"511-518"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038849","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":"Effectiveness of prophylactic pancreatic stents in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients: a 16-year comprehensive study.","authors":"Gregorios Paspatis, Ioannis Psaroudakis, Magdalini Velegraki, Maria Fragaki, Despoina-Eleni Arna, George Tribonias, Evangelos Voudoukis, Angeliki Theodoropoulou, Gregorios Chlouverakis, Emmanouil Vardas","doi":"10.20524/aog.2025.0996","DOIUrl":"10.20524/aog.2025.0996","url":null,"abstract":"<p><strong>Background: </strong>Cannulation of the common bile duct (CBD) during endoscopic retrograde cholangiopancreatography (ERCP) can be technically challenging, especially when repeated unintended pancreatic duct cannulation occurs. We evaluated the effectiveness of prophylactic pancreatic stent (PS) placement in preventing post-ERCP pancreatitis (PEP) under such conditions. This is the first comprehensive study of its kind conducted in Greece, and one of the few in Europe.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent their first ERCP between January 1, 2008, and March 1, 2024, and received a PS after inadvertent pancreatic duct cannulation on 3 or more attempts. From 2015 onward, rectal diclofenac was administered to all patients as a preventive measure for PEP.</p><p><strong>Results: </strong>In a total of 6080 ERCP procedures, 421 patients met the inclusion criteria (46.1% male; mean age 67.8±15.8 years). The most common indications were choledocholithiasis (57.7%), malignant obstruction (26.6%), and benign CBD strictures (5.7%). Successful CBD cannulation during the initial session was achieved in 86.4% of cases. Additional techniques included transpancreatic sphincterotomy (2.6%) and needle-knife precut (1.4%). A second ERCP was performed in 7.8% of cases, achieving successful CBD cannulation in all. PEP occurred in 4.9% of patients, with severe cases accounting for only 0.7%. PEP was significantly more frequent in women (P=0.001), while diclofenac did not significantly reduce its incidence (P=0.4). There were 3 deaths, 1 related to PEP (0.2%).</p><p><strong>Conclusion: </strong>PS placement effectively reduces severe PEP risk following difficult CBD cannulation and supports high success rates in repeat ERCP, while diclofenac showed no significant additional benefit.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"570-576"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039096","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":"Managing inflammatory bowel disease in patients receiving cancer-associated chemotherapy and beyond.","authors":"Courtenay Ryan-Fisher, Stefan Thorarensen, Ruchir Paladiya, Haleh Vaziri","doi":"10.20524/aog.2025.0998","DOIUrl":"10.20524/aog.2025.0998","url":null,"abstract":"<p><p>Managing patients with inflammatory bowel disease (IBD) and a current or previous history of cancer is becoming increasingly common. This scoping review aims to provide an up-to-date overview of the available literature on the management of IBD in cancer patients, including those in remission and those undergoing active cancer treatment. This scoping review was conducted, using PubMed, EMBASE and Scopus, to identify studies on IBD management in adult patients with active or prior malignancy, published between January 2019 and July 2024. Search terms included \"inflammatory bowel disease\" and \"malignancy\". Thirty-three studies met the criteria for inclusion; most were retrospective cohort studies. Seventeen studies analyzed incident risk of new or recurrent malignancy after starting IBD medications in patients with prior cancer. Most of these studies suggest a limited risk of cancer recurrence after restarting IBD medications. The remaining studies looked at IBD patients receiving active cancer therapy, assessing the risk of IBD relapse and/or the side effects of cancer therapy in IBD patients. Most IBD patients treated with cytotoxic chemotherapy did not experience relapse of IBD activity during therapy. However, those on either hormonal chemotherapies or immune checkpoint inhibitors were more likely to experience IBD relapse, although the data are inconsistent. This review highlights the limited cancer recurrence risk associated with IBD therapies in cancer patients. Individualized, multidisciplinary approaches are essential for managing IBD in patients with a history of cancer. Future research should prioritize large-scale prospective studies to guide IBD and cancer management.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"472-487"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038875","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":"Trends and outcomes of endoscopic ultrasound-guided drainage and pancreatic necrosectomy for acute necrotizing pancreatitis.","authors":"Osayande Osagiede, Andrea Gomez Pons, Bhaumik Brahmbhatt, Vivek Kumbhari, Frank Lukens","doi":"10.20524/aog.2025.0987","DOIUrl":"10.20524/aog.2025.0987","url":null,"abstract":"<p><strong>Background: </strong>Use of endoscopic ultrasound (EUS)-guided interventions has resulted in an expanding domain of non-surgical endoscopic methods for treating acute necrotizing pancreatitis (ANP). We examined the current trends and outcomes of EUS-guided drainage and endoscopic necrosectomy in the United States.</p><p><strong>Methods: </strong>This observational retrospective study used the Nationwide Inpatient Sample database (2016-2020) to identify adult patients with ANP who underwent endoscopic necrosectomy, based on ICD-10-CM codes. Univariate and multivariate logistic regression, and linear models were used to examine the outcomes of ANP in patients who underwent endoscopic necrosectomy in comparison to patients who had no such interventions.</p><p><strong>Results: </strong>Among 11,212 ANP cases identified, 493 (4.4%) underwent endoscopic necrosectomy. The patients' mean age was 49.6 years and they were predominantly male (66.8%). There was a steady increase in ANP admissions (542 to 3180) and endoscopic necrosectomy (0% to 5.8%) from 2016-2020. Endoscopic intervention had lower odds for systemic inflammatory response syndrome (P=0.038), but higher odds for venous thromboembolism (P=0.006). Hospital costs (P<0.001), charges (P<0.001), and length of hospital stay (LOS) (P<0.001) were greater for patients with endoscopic intervention. Procedural adverse events were rare (5.9%), and were associated with significantly greater LOS (P=0.004), higher hospital costs (P=0.018) and charges (P=0.004), but no difference in mortality (P=0.899).</p><p><strong>Conclusions: </strong>Endoscopic necrosectomy for ANP increased from 2016-2020 and was associated with low risk for adverse events or mortality, but greater LOS and costs compared to conservative non-interventional management. Further research is required to optimize patient selection and address the economic implications.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 5","pages":"564-569"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038832","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}