Annals of Gastroenterology最新文献

{"title":"Cytokine signatures in post-endoscopic retrograde cholangiopancreatography pancreatitis: a pilot study.","authors":"Jorge D Machicado, Peter J Lee, Stacey Culp, Kimberly Stello, Phil A Hart, Mitchell Ramsey, Adam Lacy-Hulbert, Cate Speake, Zobeida Cruz-Monserrate, B Joseph Elmunzer, David C Whitcomb, Georgios I Papachristou","doi":"10.20524/aog.2024.0922","DOIUrl":"10.20524/aog.2024.0922","url":null,"abstract":"<p><strong>Background: </strong>Following endoscopic retrograde cholangiopancreatography (ERCP), post-ERCP pancreatitis (PEP) is the most common complication. The host's innate immune response to periprocedural pancreatic injury is the hallmark of its pathogenesis. Investigating cytokine signatures associated with PEP and its risk factors can guide understanding of PEP immunopathogenesis.</p><p><strong>Methods: </strong>We conducted a single-center, prospective, observational pilot study in adults at high-risk for PEP. Seven serum cytokines relevant to early acute pancreatitis pathogenesis, angiopoietin-2, hepatocyte growth factor (HGF), interleukin-6 (IL-6), IL-8, monocyte chemotactic protein-1, resistin, and soluble tumor necrosis factor-α receptor 1, were measured in sera collected 2 h pre- and post-ERCP. Levels were compared among healthy controls and ERCP participants who either did or did not develop PEP. Heat maps were constructed to perform a multidimensional exploratory analysis that aimed to determine the cytokine signatures associated with PEP and its participant-related risk factors (female sex, young age, and obesity).</p><p><strong>Results: </strong>A total of 65 participants were enrolled (36 undergoing ERCP and 29 healthy controls). Eight of the 36 (22.2%) ERCP participants developed PEP. Baseline IL-8 levels measured before ERCP were elevated in participants who developed PEP (7.5 vs. 14.8 pg/mL, P=0.02), and most strongly upregulated in women under 40 years of age. HGF levels post-ERCP were higher in participants with PEP (738.0 vs. 556.6 pg/mL, P=0.04), and most strongly upregulated in obese participants.</p><p><strong>Conclusions: </strong>Pre-ERCP IL-8 and post-ERCP HGF are associated with the development of PEP. Findings from this pilot study can inform the design of translational work in the immunopathogenesis of PEP.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"734-741"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680642","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":"Prognosis after curative resection of non-metastatic pancreatic neuroendocrine tumors: a retrospective tertiary center study.","authors":"Thomas Hendrickx, Justine Vancanneyt, Jeroen Dekervel, Chris Verslype, Lukas Van Melkebeke, Filip Van Herpe, Halit Topal, Joris Jaekers, Christophe M Deroose, Vincent Vandecaveye, Gertjan Rasschaert","doi":"10.20524/aog.2024.0917","DOIUrl":"10.20524/aog.2024.0917","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic neuroendocrine tumors (pNETs) are rare tumors with heterogeneous outcomes. The aim of our study was to determine the long-term outcome, recurrence patterns, as well as the clinical and pathological factors that impact time-to-recurrence (TTR), recurrence-free survival (RFS), and overall survival (OS) in pNETs treated with curative surgery.</p><p><strong>Methods: </strong>Data for all patients who underwent radical surgery with curative intent for non-metastatic pNETs were obtained from a prospectively maintained database of the University Hospitals Leuven. Data from September 2002 until November 2021 were analyzed retrospectively. Patients with metastatic disease and/or neuro-endocrine carcinoma were excluded. Median follow-up time was calculated using the reverse Kaplan-Meier method. A Cox proportional hazards model was used to assess variables associated with recurrence.</p><p><strong>Results: </strong>The study included 128 patients. Only 8 patients (6.3%) had recurrent disease over a median follow up of 44.4 months (interquartile range [IQR] 29.8-74.7). The median TTR was 38.7 months (IQR 18.0-46.2). Univariate analysis showed that multiple endocrine neoplasia type 1 (MEN-1) and R1-status were statistically significant predictors for disease recurrence.</p><p><strong>Conclusions: </strong>In our series of patients treated with surgery for non-metastatic, well-differentiated pNETs, recurrence was low at 6.3%. MEN-1 and R1-status were predictors for recurrence in univariate analysis.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"758-764"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680627","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":"Endoscopic dilation of small-intestine strictures in Crohn's disease by balloon-assisted enteroscopy: a systematic review and meta-analysis.","authors":"Vishali Moond, Vikram Jeet Singh Gill, Sheza Malik, Ameya Kasture, Sandesh Parajuli, Suha Soni, Saurabh Chandan, Arkady Broder, Babu P Mohan, Douglas Adler","doi":"10.20524/aog.2024.0920","DOIUrl":"10.20524/aog.2024.0920","url":null,"abstract":"<p><strong>Background: </strong>Balloon-assisted enteroscopy (BAE) (both single- and double-balloon enteroscopy) has garnered attention in the treatment of small intestine strictures in patients with Crohn's disease (CD). This study aimed to evaluate the pooled clinical outcomes of BAE-mediated endoscopic dilation of small intestine strictures in patients with CD.</p><p><strong>Methods: </strong>We searched multiple databases for articles reporting outcomes following BAE for small intestinal strictures in patients with CD. Outcomes studied were pooled technical success, clinical success and adverse events. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied using <i>I</i> ² statistics.</p><p><strong>Results: </strong>We analyzed 26 studies, 9 prospective and 17 retrospective, involving 1570 patients. The pooled technical success rate of double-balloon enteroscopy was 87.6% (95% confidence interval [CI] 82.1-91.5; <i>I</i> ²=53%) and the pooled therapeutic success rate was 69.7% (95%CI 61.6-76.7; <i>I</i> ²=71%). The pooled major complications per procedure were 5.5% (95%CI 3.5-8.4; <i>I</i> ²=57%); the risk of bleeding was 2.5% (95%CI 1.4-4.2; <i>I</i> ²=28%), and the risk of perforation was 2.7% (95%CI 1.6-4.5; <i>I</i> ²=3%). The pooled rate of recurrence after the first dilation was 42.3% (95%CI 16.9-72.5; <i>I</i> ²=59%), and the rate of repeat endoscopic balloon dilation was 23.9% (95%CI 14.1%-37.5%; <i>I</i> ²=85%), while the pooled rate of repeat surgery was 25.3% (95%CI 11.8%-46.0%; <i>I</i> ²=44%].</p><p><strong>Conclusion: </strong>BAE is a good first line approach for patients with CD-induced strictures in an attempt to treat symptoms and potentially avoid surgery.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"682-694"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680657","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":"Hellenic Association for the Study of the Liver (HASL): revised clinical practice guidelines for autoimmune hepatitis.","authors":"George N Dalekos, George V Papatheodoridis, John Koskinas, Ioannis Goulis, Eirini I Rigopoulou, Dina Tiniakos","doi":"10.20524/aog.2024.0924","DOIUrl":"10.20524/aog.2024.0924","url":null,"abstract":"<p><p>Autoimmune hepatitis (AIH) is a rare liver disease, of unknown origin, characterized by considerable heterogeneity. AIH can affect both sexes, of all ages, ethnicities and races. The revised Clinical Practice Guidelines (CPGs) of the Hellenic Association for the Study of the Liver aim to provide updated guidance to clinicians. The diagnosis of AIH is based on clinicopathological characteristics, such as elevation of immunoglobulin G (IgG) levels, detection of autoantibodies, portal or lobular hepatitis at the histological level, absence of viral hepatitis markers, and a favorable response to immunosuppressive treatment. Clinical manifestations at onset vary, from no symptoms to the fulminant form of the disease. Aminotransferases and bilirubin levels also vary, while liver biopsy is a prerequisite to establish a firm diagnosis. Investigation for detection of autoantibodies is the cornerstone for diagnosis, if it is performed according to the CPGs. Treatment of AIH should aim towards the achievement of complete biochemical response (CBR; normalization of aminotransferases and IgG) no later than 6-12 months after treatment initiation, and also histological remission of the disease. All patients with active disease, irrespective of the presence of cirrhosis, should receive personalized and response-guided first-line induction treatment with predniso(lo)ne combined with mycophenolate mofetil or azathioprine. Treatment should be given for at least 3-5 years, and for at least 2 years after the achievement of CBR, while liver biopsy should be considered before treatment cessation. The updated CPGs also provide guidance for the management of difficult-to-treat patients, including those with variants and specific forms of AIH.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"623-654"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680659","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":"Meandering main pancreatic duct syndrome: a single-center cohort study and aggregated review.","authors":"Timothy Adam, Hannah Van Malenstein, Wim Laleman","doi":"10.20524/aog.2024.0901","DOIUrl":"10.20524/aog.2024.0901","url":null,"abstract":"<p><strong>Background: </strong>Meandering main pancreatic duct (MMPD) refers to an uncommon ductal variant of the normal smooth curvilinear course of the pancreatic duct. More specifically, MMPD is characterized by a hairpin (reverse Z-type) or loop (loop-type) turn in the pancreatic head. It has been suggested as a predisposing factor for the development of pancreatitis. Studies regarding treatment are scarce.</p><p><strong>Methods: </strong>We conducted a narrative review of the current literature regarding MMPD. Additionally, we present a cohort of 9 symptomatic patients treated endoscopically at our tertiary center.</p><p><strong>Results: </strong>Seven retrospective cohort studies and 4 case reports were included in our review. Only 1 study focuses on the clinical significance of MMPD and describes a positive association between MMPD and the onset of pancreatitis, especially recurrent acute pancreatitis. Only 1 case reports an endoscopic treatment. In our cohort of 9 MMPD patients, 7 did indeed present with recurrent acute pancreatitis. Endotherapy provided substantial regression of symptoms in 6 patients, all of whom had signs of ductal hypertension.</p><p><strong>Conclusions: </strong>Our review shows the scarcity of data regarding MMPD, especially concerning treatment, in the current literature. With our cohort, we not only hope to raise awareness of this often-neglected entity of recurrent acute pancreatitis, but also support the case for endotherapy for the first time in 9 symptomatic MMPD patients, especially in the presence of ductal hypertension.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"610-617"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138999","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":"Transcatheter arterial embolization for small-bowel bleeding: technical and clinical outcomes and risk factors for early recurrent bleeding.","authors":"Quinten Verhalleman, Marc Miserez, Annouschka Laenen, Lawrence Bonne, Eveline Claus, Jo Peluso, Alexander Wilmer, Geert Maleux","doi":"10.20524/aog.2024.0903","DOIUrl":"10.20524/aog.2024.0903","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the technical and clinical outcomes of transcatheter arterial embolization (TAE) in patients with acute small-bowel bleeding (SBB) and aimed to identify potential risk factors for early recurrent bleeding after TAE.</p><p><strong>Methods: </strong>Thirty-one patients with SBB managed with TAE between January 2006 and December 2021 were included. Technical and clinical success was defined as angiographic occlusion of the bleeding artery and disappearance of clinical or laboratory signs of persistent bleeding without major complications. Complications were classified according to the Society of Interventional Radiology's guidelines. Kaplan-Meier estimates assessed overall survival, and logistic regression models determined risk factors for clinical success and early rebleeding.</p><p><strong>Results: </strong>Technical and clinical success were achieved in 30/31 (97%) and 19 (61%), respectively. Early recurrent bleeding was present in 9 (29%) patients, and was treated by repeat embolization in 4 patients, conversion to surgery in 4, and comfort therapy in 1 patient. TAE-related small bowel ischemia requiring surgery was found in 2 (6.5%) patients. Thirty-day and in-hospital mortality were 19% (6/31) and 23% (7/31), respectively; overall 5-year estimated survival was 60%. Thrombocytopenia and elevated prothrombin time (PT)/activated partial thromboplastin time (aPTT) levels prior to TAE were identified as risk factors for clinical failure (P=0.0026 and P=0.027, respectively), and for residual or early recurrent bleeding (P<0.001 and P=0.01, respectively).</p><p><strong>Conclusions: </strong>TAE is safe and effective for managing severe SBB; however, early recurrent bleeding was found in nearly one third of patients. Thrombocytopenia and elevated PT/aPTT levels were risk factors for early recurrent bleeding.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"559-566"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139004","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":"Comparative efficacy of endoscopic ultrasound-guided biliary drainage versus endoscopic retrograde cholangiopancreatography as first-line palliation in malignant distal biliary obstruction: a systematic review and meta-analysis.","authors":"Shravya Reddy Ginnaram, Sudeep Nugooru, Dawood Tahir, Kara Devine, Ali Raza Shaikh, Pradeep Yarra, James Walter","doi":"10.20524/aog.2024.0912","DOIUrl":"10.20524/aog.2024.0912","url":null,"abstract":"<p><strong>Background: </strong>Malignant distal biliary obstruction (MDBO) is a challenging clinical condition commonly managed with endoscopic retrograde cholangiopancreatography (ERCP). However, endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative, especially in complex cases where ERCP fails or is deemed risky. This study aimed to compare the efficacy, safety and cost-effectiveness of EUS-BD vs. ERCP in the palliation of MDBO.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis, following PRISMA guidelines. Three databases were searched up to December 2023, including MEDLINE/PubMed, OVID and the Cochrane Central Register of Controlled Trials, for studies comparing EUS-BD with ERCP. Primary outcomes were technical and clinical success rates, while secondary outcomes included procedural times, hospital stay duration, 30-day mortality, reintervention rates, and adverse events such as pancreatitis.</p><p><strong>Results: </strong>Seven studies involving 1245 patients met the inclusion criteria. The meta-analysis revealed that EUS-BD had a technical success rate of 92%, compared to 85% for ERCP. Clinical success rates were similar for both EUS-BD and ERCP, at approximately 89%. EUS-BD was associated with a significantly lower incidence of pancreatitis (2% vs. 10% for ERCP).</p><p><strong>Conclusions: </strong>EUS-BD offers a viable and potentially superior alternative to ERCP for the primary palliation of MDBO, particularly in terms of technical success and a lower risk of pancreatitis. These findings support the adoption of EUS-BD in clinical settings equipped to perform this technique, though future research should focus on long-term outcomes and further economic analysis to solidify these recommendations.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"602-609"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139065","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":"Inflammatory bowel disease burden in the Middle East and North Africa Region: a comprehensive analysis of incidence, prevalence, and mortality from 1990-2019.","authors":"Saqr Alsakarneh, Mohamed Ahmed, Fouad Jaber, Mohammad Abuassi, Fadi H Mourad, Fadi F Francis, Kassem Barada, Rami Tfayli, Badr Al-Bawardy, Francis A Farraye, Jana G Hashash","doi":"10.20524/aog.2024.0909","DOIUrl":"10.20524/aog.2024.0909","url":null,"abstract":"<p><strong>Background: </strong>The epidemiology of inflammatory bowel disease (IBD) has changed rapidly in recent years. Objective data concerning the IBD burden in the Middle East and North Africa (MENA) region is limited. We aimed to provide a systematic report on the IBD burden in the MENA region. Additionally, we aimed to study the age- and sex-specific trends in IBD incidence, prevalence and mortality rates from 1990-2019.</p><p><strong>Methods: </strong>Using the Global Burden of Disease (GBD) 2019 Study Database, we investigated the changes in incidence, prevalence and mortality rate, and disability-adjusted life-years (DALYs), at a regional and country level between 1990 and 2019.</p><p><strong>Results: </strong>In 2019, there were 282,534 cases (95% confidence interval [CI] 239,506-334,478) of IBD in the MENA region (50.5% male). There was an overall increase in the incidence and prevalence rates of IBD in the MENA region from 1990 to 2019, while a simultaneous decrease in overall mortality rates was identified. Incidence rates were highest in Jordan, at 6.9 (95%CI 5.8-8.1) per 100,000, and lowest in Morocco, at 1.6 (95%CI 1.4-2) per 100,000. From 1990-2019, the incidence was found increased in males at a higher rate than in females. The age-standardized mortality rate decreased for both sexes by 24% from 1990-2019.</p><p><strong>Conclusion: </strong>The trends and geographic variations in IBD within the MENA region provide policymakers with vital information for making informed decisions in policy, research, and investment, thereby enabling the development of more effective strategies and better allocation of resources.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"527-535"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138998","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":"Assessing ChatGPT4 with and without retrieval-augmented generation in anticoagulation management for gastrointestinal procedures.","authors":"Sheza Malik, Himal Kharel, Dushyant S Dahiya, Hassam Ali, Hanna Blaney, Achintya Singh, Jahnvi Dhar, Abhilash Perisetti, Antonio Facciorusso, Saurabh Chandan, Babu P Mohan","doi":"10.20524/aog.2024.0907","DOIUrl":"10.20524/aog.2024.0907","url":null,"abstract":"<p><strong>Background: </strong>In view of the growing complexity of managing anticoagulation for patients undergoing gastrointestinal (GI) procedures, this study evaluated ChatGPT-4's ability to provide accurate medical guidance, comparing it with its prior artificial intelligence (AI) models (ChatGPT-3.5) and the retrieval-augmented generation (RAG)-supported model (ChatGPT4-RAG).</p><p><strong>Methods: </strong>Thirty-six anticoagulation-related questions, based on professional guidelines, were answered by ChatGPT-4. Nine gastroenterologists assessed these responses for accuracy and relevance. ChatGPT-4's performance was also compared to that of ChatGPT-3.5 and ChatGPT4-RAG. Additionally, a survey was conducted to understand gastroenterologists' perceptions of ChatGPT-4.</p><p><strong>Results: </strong>ChatGPT-4's responses showed significantly better accuracy and coherence compared to ChatGPT-3.5, with 30.5% of responses fully accurate and 47.2% generally accurate. ChatGPT4-RAG demonstrated a higher ability to integrate current information, achieving 75% full accuracy. Notably, for diagnostic and therapeutic esophagogastroduodenoscopy, 51.8% of responses were fully accurate; for endoscopic retrograde cholangiopancreatography with and without stent placement, 42.8% were fully accurate; and for diagnostic and therapeutic colonoscopy, 50% were fully accurate.</p><p><strong>Conclusions: </strong>ChatGPT4-RAG significantly advances anticoagulation management in endoscopic procedures, offering reliable and precise medical guidance. However, medicolegal considerations mean that a 75% full accuracy rate remains inadequate for independent clinical decision-making. AI may be more appropriately utilized to support and confirm clinicians' decisions, rather than replace them. Further evaluation is essential to maintain patient confidentiality and the integrity of the physician-patient relationship.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"514-526"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139063","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 effect of shortening vasoactive drug durations alongside endoscopic therapy in esophageal variceal bleeding: an updated systematic review and meta-analysis.","authors":"Sudheer Dhoop, Zohaib Ahmed, Conner Lombardi, Mohammed Abu-Rumaileh, Syeda Faiza Arif, Wasef Sayeh, Rayna Patel, Alborz Sherafati, Wade Lee-Smith, Mona Hassan","doi":"10.20524/aog.2024.0906","DOIUrl":"10.20524/aog.2024.0906","url":null,"abstract":"<p><strong>Background: </strong>The recommended duration of vasoactive drugs in esophageal variceal bleeding (EVB) spans 2-5 days. Prior meta-analyses of randomized trials include only a few studies that compared short vs. long vasoactive drug durations approximating this time range, including older management techniques, and only assessed variceal rebleeding at 5 days. We identified several additional randomized controlled trials (RCTs) assessing rebleeding at various durations, with updated management of EVB.</p><p><strong>Methods: </strong>We performed an updated systematic review and meta-analysis assessing the effect of shortening the vasoactive drug duration by 48-72 h. The primary outcome was rebleeding within 5 days. Secondary outcomes included rebleeding, mortality due to rebleeding, and all-cause mortality within 4-6 weeks (extended period) with subgroup analysis by vasoactive drug and type of endoscopic therapy. Length of stay, blood transfusion requirements and terlipressin-related adverse events were additional secondary outcomes.</p><p><strong>Results: </strong>Our comprehensive search strategy and screening process yielded 14 RCTs with 1060 patients (75.1% male): 7 trials used terlipressin, 4 octreotide, and 3 somatostatin. Shortened durations combined with band ligation led to similar rebleeding, with a trend towards less rebleeding when populations with more severe liver disease were excluded. There was greater rebleeding and mortality over an extended period when shorter durations were combined with sclerotherapy. Longer durations were associated with a longer hospital stay and, for terlipressin, more adverse events.</p><p><strong>Conclusions: </strong>Shorter vasoactive drug durations combined with band ligation in selected populations appear safe. Higher powered RCTs are needed, involving patients with different degrees of severity of EVB and liver disease.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"567-578"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139002","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}