Annals of Gastroenterology最新文献

{"title":"Age of onset of inflammatory bowel disease is the strongest risk factor for the development of malignancy.","authors":"Nicole Sciberras, Lara Miruzzi, Luke Bugeja, Adrienne Gatt, Suzanne Cauchi, Zane Attard, Pierre Ellul, Stefania Chetcuti Zammit","doi":"10.20524/aog.2025.0952","DOIUrl":"10.20524/aog.2025.0952","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a multifactorial inflammatory disorder of the gastrointestinal system that impairs the patient's quality of life. Its presentation includes a spectrum of symptoms that may also be secondary to IBD complications, such as malignancy. On the other hand, immunosuppressive treatment to maintain remission also carries a risk of malignancy, which can cause patients distress due to the risk/benefit balance of IBD control and malignancy.</p><p><strong>Methods: </strong>In this nationwide retrospective study, we aimed to elucidate which patient and treatment factors have the greatest impact on the development of malignancy in IBD patients. Statistical analysis was performed on patient factors, including treatment types, and nominal regression analysis was carried out to assess the effects of multiple risk factors on the incidence of malignancy in patients with IBD.</p><p><strong>Results: </strong>Age at diagnosis of IBD correlated significantly with malignancy development, as did the diagnosis of ulcerative colitis. IBD patients diagnosed with malignancy had an older age of onset of IBD than those who did not develop malignancy. Sex, treatment type, treatment duration, and extent or location of disease did not correlate significantly with malignancy development.</p><p><strong>Conclusion: </strong>We conclude that age of onset of IBD plays the greatest role in malignancy development, whilst immunosuppressive treatment is not a significant risk factor.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"182-186"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690927","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":"Use of nailfold capillaroscopy for the early diagnosis of systemic sclerosis in patients with primary biliary cholangitis.","authors":"Daniele Crescenzi, Daniele Balducci, Marta Mazzetti, Denise Menghini, Chiara Gelardi, Veronica Pedini, Cristina Mezzanotte, Giuseppe Tarantino, Antonio Benedetti, Maria Giovanna Danieli, Marco Marzioni, Luca Maroni","doi":"10.20524/aog.2025.0949","DOIUrl":"10.20524/aog.2025.0949","url":null,"abstract":"<p><strong>Background: </strong>Primary biliary cholangitis (PBC) is a cholestatic autoimmune disease and is often associated with systemic sclerosis (SSc). The prevalence of SSc in PBC patients ranges from 1-22% and the diagnosis is often delayed. The aim of this study was to evaluate the role of nailfold capillaroscopy (NFC) for early SSc diagnosis in PBC patients.</p><p><strong>Methods: </strong>In this monocentric, cross-sectional study, NFC was performed in 56 PBC patients. Raynaud's phenomenon (RP) was assessed in each patient. Patients with major NFC abnormalities and those with a scleroderma pattern were screened for SSc-specific antibodies. The SSc diagnosis was established using the 2013 American College of Rheumatology and European League Against Rheumatism (ACR/AULAR) and Very Early Diagnosis Of Systemic Sclerosis (VEDOSS) criteria.</p><p><strong>Results: </strong>NFC abnormalities were found in 31 patients (55%): 11 (20%) presented minor abnormalities, 17 (30%) had major abnormalities and 3 (5%) presented a scleroderma pattern. RP was found in 12 patients. Two patients with a scleroderma pattern were newly diagnosed with SSc. All patients newly diagnosed with SSc presented RP. No patient without RP was diagnosed with SSc.</p><p><strong>Conclusions: </strong>Performing NFC in PBC patients can help anticipate the SSc diagnosis. RP should always be checked in PBC patients and should be an indication to perform NFC for early SSc diagnosis. A diagnostic algorithm is proposed.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"187-194"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690421","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":"Treatment patterns and outcomes in hepatocellular carcinoma: Real-world experience in Greece from the retrospective OPAL study.","authors":"John Koskinas, Spyridon Pantzios, Melanie Deutsch, Emmanuel Koullias, Alexandra Alexopoulou, Hariklia Kranidioti, Elisavet Michailidou, Ioannis Goulis, Ioanna Papagiouvanni, Ioannis Koutroubakis, Dimitrios Samonakis, Ioannis Drygiannakis, Eleni Magafouraki, Evdokia Tsaliki, Spilios Manolakopoulos, Ioannis Elefsiniotis, Georgios Papatheodoridis","doi":"10.20524/aog.2025.0950","DOIUrl":"10.20524/aog.2025.0950","url":null,"abstract":"<p><strong>Background: </strong>Newer advances involving immunotherapies are changing the hepatocellular carcinoma (HCC) landscape. In the multinational OPAL study, we described the characteristics of patients with HCC during 2014-2021 in Greece.</p><p><strong>Methods: </strong>This was a retrospective chart review study of adults (alive/dead) with newly diagnosed HCC between 2014-2021.</p><p><strong>Results: </strong>Of 406 patients, 37.7%, 33.0%, 25.9% and 3.4% had Barcelona Clinic Liver Cancer (BCLC) stage 0/A, B, C and D, respectively. Common etiologies were hepatitis B virus (32.9%), alcohol use (31.6%), hepatitis C virus (27.6%), and metabolic dysfunction-associated steatotic liver disease (26.3%); viral+non-viral: 15.5%. The first treatment was resection, embolization, ablation, systemic therapy and transplant, in 35.5%, 30.7%, 22.9%, 3.3% and 0.7% of BCLC-0/A; 14.9%, 48.5%, 9.0%, 15.7% and 0% of BCLC-B; and 4.8%, 18.1%, 3.8%, 49.5% and 0% of BCLC-C patients; 7.2%, 11.9% and 23.8% of patients in the respective BCLC groups remained untreated. Tyrosine-kinase inhibitor monotherapy was the commonest systemic therapy (76.7%). Among BCLC-0/A, BCLC-B, and BCLC-C patients, median progression-free survival was 15.8, 8.0 and 3.2 months, and overall survival (OS) was 45.7, 21.8 and 7.9 months from treatment initiation, respectively. Among BCLC-D patients, median OS was 3.4 months from HCC diagnosis. By multivariate Cox regression analysis, hepatitis B virus etiology (P=0.016) and Eastern Cooperative Oncology Group performance status ≥1 (P=0.015) were independent factors associated with poorer OS among BCLC-C patients.</p><p><strong>Conclusion: </strong>Real-life clinical practice in Greece is aligned with European guidelines, while poor clinical outcomes underscore the need for implementation of new therapies.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"195-207"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691036","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":"All you need to know about the overlap between primary sclerosing cholangitis and inflammatory bowel disease.","authors":"Joseph Sleiman, Fadi F Francis, Nayantara Coelho-Prabhu, Jana G Hashash","doi":"10.20524/aog.2025.0945","DOIUrl":"10.20524/aog.2025.0945","url":null,"abstract":"<p><p>Primary sclerosing cholangitis (PSC) is a progressive auto-inflammatory condition of the biliary ducts clinically characterized by painless cholestasis and jaundice. Histologically, the typical findings in PSC are periductal fibrosis with inflammation, bile duct proliferation, and ductopenia. These hallmarks eventually develop into end-stage liver disease requiring liver transplantation (LT), although the latency between diagnosis and LT is variable among patients. PSC is the leading indication for LT among patients with autoimmune liver disease. The interplay of PSC and inflammatory bowel disease (IBD) is intricate and poorly understood, as exemplified by the ongoing debate as to whether these are 2 distinct diseases or a complex 2-sided manifestation of the same disease spectrum. A true pathophysiological pathway has not been pinpointed, which explains the current lack of disease-specific therapies approved for this entity. This review summarizes our current knowledge about the epidemiology, pathophysiology, clinical presentation and management of PSC. We will also elucidate the relationship between PSC and IBD, specifically regarding the LT and pouchitis subpopulations.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"107-120"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690934","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":"Early versus late drainage of pancreatic necrotic fluid collections: a systematic review and meta-analysis.","authors":"Shivanand Bomman, Andrew Canakis, Muaaz Masood, Jagpal S Klair, Rodrigo Alvarez, Arunkumar Muthusamy, Shruti Chandra, Avin Aggarwal, Hemanth Gavini, Rajesh Krishnamoorthi","doi":"10.20524/aog.2025.0955","DOIUrl":"10.20524/aog.2025.0955","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing pancreatitis can be complicated by necrotic fluid collections (NFCs). International guidelines recommend waiting 4 weeks for the collection to mature before interventional management. With the advances in endoscopic drainage, the need to delay drainage by 4 weeks is unclear. We aimed to compare early drainage (ED: <4 weeks) vs. late drainage (LD: ≥4 weeks) of NFCs.</p><p><strong>Methods: </strong>Literature searches through multiple databases were performed to identify studies that investigated outcomes of ED vs. LD of NFCs. Our primary outcome was the complication rate among these groups. The secondary outcomes included the number of patients requiring subsequent necrosectomies, and mortality.</p><p><strong>Results: </strong>We identified 9 studies with 855 patients (320 ED and 535 LD). The complication rates (rate ratio 1.060, 95% confidence interval [CI] 0.79-1.42; P=0.69; <i>I</i> ²=51.61) and the number of patients requiring subsequent necrosectomies (odds ratio [OR] 2.15, 95% CI 0.86-5.35; P=0.099; <i>I</i> ²=79.81) were similar in both groups. Mortality was slightly higher in the ED group (OR 1.94, 95%CI 1.05-3.59; P=0.033; <i>I</i> ²=0).</p><p><strong>Conclusions: </strong>Our study suggests that ED can be performed if needed in carefully selected patients without an increase in complications or subsequent necrosectomies. However, mortality was slightly higher compared to LD. A multidisciplinary team approach is necessary for considering ED.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"221-229"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690960","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 removal of proximally migrated pancreatic duct stents: a case series and literature review.","authors":"Sachin Hosahally Jayanna, Nikhil Bush, Ravi Sharma, Rajesh Gupta, Surinder Singh Rana","doi":"10.20524/aog.2025.0954","DOIUrl":"10.20524/aog.2025.0954","url":null,"abstract":"<p><strong>Background: </strong>Proximal migration of pancreatic stents is an uncommon but significant problem that poses risks of pain and pancreatitis. It is often a challenging situation for endoscopists, necessitating surgical retrieval in 10% of cases.</p><p><strong>Method: </strong>A 10-year retrospective review was performed of stent removal procedures performed at a tertiary care center in northern India between January 2010 and December 2019.</p><p><strong>Results: </strong>Sixteen patients (mean age 39.52 years, 13 [81.25%] males) with proximally migrated pancreatic stents (PMPSs) were studied. Thirteen (81.25%) patients had a dilated pancreatic duct (PD) and 3 (18.75%) had a non-dilated PD. In the majority of patients, the PMPSs were located at the genu (50%), while 62% were 10 cm in length. Three (18.75%) patients had fragmented stents, whereas the remaining 13 (81.25%) had intact stents <i>in situ</i>. Complete retrieval of the PPMS and stent fragments was possible in 12 (75%) patients, with grasping forceps being used in the majority (50%). In patients with fragmented stents and difficult locations (n=3), pancreatoscopy-assisted techniques resulted in the retrieval of the stent or fragments. PMPSs could not be retrieved in 3 patients: all these failures were during the study period when a SpyGlass pancreatoscope was not available in our unit. Two patients (12.5%) reported post-procedural pain that responded to intravenous analgesics.</p><p><strong>Conclusions: </strong>Endoscopic retrieval of proximally migrated stents, using a combination of techniques and accessories, is safe and effective. Pancreatoscopy increases the success rates. Surgery is rarely required for stent removal.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"230-236"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690998","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":"Forty-five-year trends in intra- and extrahepatic cholangiocarcinoma: sex- and race-based insights.","authors":"Rajamanuri Medha, Pannala Sai Shanmukha Sreeram, Obada Daaboul, Dar Sophia, Sundar Rahul, Johnson Adejoke, Cheema Ayesha, Tufail Muhammad Umer, Arshad Hafiz Muhammad Sharjeel","doi":"10.20524/aog.2025.0951","DOIUrl":"10.20524/aog.2025.0951","url":null,"abstract":"<p><strong>Background: </strong>A comprehensive review of 45-year trends in intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC) in the United States has not been published. Given their rising incidence, our study aimed to analyze trends in incidence and survival, comparing ICC and ECC.</p><p><strong>Methods: </strong>We extracted a 45-year dataset (1975-2020) from the Surveillance, Epidemiology, and End Results database. Age-adjusted incidence rates were calculated using SEERStat®. Annual Percent Change (APC) was estimated via weighted least squares. Relative survival (1- and 5-year) was calculated using the Ederer II method and compared across sexes and races.</p><p><strong>Results: </strong>A significant rise in ICC and ECC incidence was observed in both sexes (APC 3.71 for ICC vs. 6.16 for ECC; P<0.001). In females, ECC incidence increased more than ICC (APC 5.96 vs. 4.09, P<0.05), whereas males showed a fluctuating ECC trend and a steady ICC rise. Survival rates significantly improved across all races and sexes (P<0.05). ICC survival rose from 17.45% to 41.41% (1-year) and 2.83% to 10.99% (5-year), while ECC increased from 30.33% to 41.12% (1-year) and 5.96% to 10.44% (5-year). Among white and other-race females, ECC showed less improvement than ICC. Black individuals lacked statistically significant data.</p><p><strong>Conclusions: </strong>Our study highlights disparities in ICC and ECC incidence, with higher rates in males, but better survival for ECC in males and ICC in females. The underrepresentation of Black individuals warrants further study to explore contributing factors such as risk, access to care, and treatment.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"214-220"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691018","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 role of intraductal ultrasound in endoscopic biliary brushing for sampling in patients with malignant biliary strictures: a bicentric retrospective study.","authors":"Jianxiang Wang, Zhuqiong Lu, Guangwen Chen, Zhenyang Shen, Junjun Wang, Jiangfeng Hu, Xinjian Wan, Hongcheng Sun, Haiming Zheng, Xiaobo Cai","doi":"10.20524/aog.2025.0942","DOIUrl":"10.20524/aog.2025.0942","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic biliary brushing is the first line modality for sampling in patients with indeterminate biliary stricture (BS); however, its sensitivity is limited. Endoscopic intraductal ultrasound (IDUS) is also a useful approach for the diagnosis of biliary malignancies. However, whether IDUS can guide the sampling by biliary brushing has not been reported.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent endoscopic retrograde cholangiopancreatography for BS in 2 tertiary care hospitals and assessed the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of IDUS and brush cytology.</p><p><strong>Results: </strong>The study involved 530 patients with BS, including 333 in the IDUS group and 197 in the non-IDUS group. Both groups exhibited similar baseline characteristics. The diagnostic ability of IDUS imaging was as follows: sensitivity 70.7%, specificity 82.4%, PPV 81.5%, NPV 72.0%, and accuracy 76.3%. Brush cytology alone demonstrated an overall sensitivity of 45.2%, with specificity 98.2%, PPV 97.2%, NPV 56.0%, and accuracy 67.2%. The sensitivity was similar in patients with or without IDUS, whereas it was significantly higher in patients with biliary mucosal invasion indicated by IDUS (55.1% vs. 30.3%, P=0.003).</p><p><strong>Conclusion: </strong>Although IDUS cannot improve the detection rate of biliary brushing for malignancy, it helps identify patients with malignant BS to be sampled more easily by brushing.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"208-213"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691035","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":"Early rebleeding rate following endoscopic treatment of colonic diverticular bleeding: a systematic review and meta-analysis.","authors":"Isha Delaleeuwe, Jennifer Aoun, Hendrik Reynaert, Paraskevas Gkolfakis, Pierre Eisendrath","doi":"10.20524/aog.2025.0940","DOIUrl":"10.20524/aog.2025.0940","url":null,"abstract":"<p><strong>Background: </strong>Various endoscopic treatment options are available for managing colonic diverticular bleeding (CDB). We conducted a systematic review and meta-analysis to assess the effectiveness of these endoscopic interventions in achieving hemostasis in patients with CDB, focusing on early rebleeding rate (ERR) within 30 days.</p><p><strong>Methods: </strong>A systematic literature search of the PubMed and Cochrane Library databases was performed for articles published between January 2008 and December 2023. Studies evaluating endoscopic clipping, with or without epinephrine injection, endoscopic band ligation (EBL) and endoscopic snare ligation (EDSL) in the treatment of CDB were included. The primary outcome was the overall pooled ERR following successful hemostasis. Secondary outcomes addressed ERRs associated with various hemostatic endoscopic techniques, and pooled ERRs for both direct and indirect clipping methods. Results are presented as pooled rates and odds ratio (OR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Sixteen studies were included, comprising 1435 patients with definite CDB of whom 1273 received endoscopic hemostatic treatment. Overall pooled ERR was 14.73% (95%CI 9.33-20.14%). Pooled ERRs were 9.83% (95%CI 7.41-12.26%) in the EBL/EDSL group and 22.32% (95%CI 12.48-32.16%) in the endoscopic clipping group (P=0.02). A subgroup analysis of the clipping group showed a significant difference between the pooled ERRs favoring direct clipping: 12.04% (95%CI 3.06-21.02%) vs. 27.74% (95%CI 18.34-37.14%), P=0.02. The measured effect favors direct over indirect clipping in reducing early rebleeding episodes: OR 0.45, 95%CI 0.24-0.85; P=0.01.</p><p><strong>Conclusion: </strong>In the management of patients presenting with CDB, EBL/EDSL and direct clipping showed significantly lower ERRs compared to indirect clipping.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 1","pages":"41-50"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969326","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":"Peroral endoscopic myotomy (Z-POEM) versus flexible endoscopic septotomy (FES) for treatment of Zenker's diverticulum: does either make the cut? A systematic review and meta-analysis of outcomes.","authors":"Sahib Singh, Saurabh Chandan, Jay Bapaye, Himmat S Brar, Abdul Mohammed, Lena L Kassab, Ishfaq Bhat, Shailender Singh, Amol Bapaye, Dennis Yang","doi":"10.20524/aog.2024.0934","DOIUrl":"10.20524/aog.2024.0934","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic treatments of symptomatic Zenker's diverticulum (ZD) include flexible endoscopic septotomy (FES) and, more recently, peroral endoscopic myotomy (Z-POEM). Data comparing these techniques are limited. We conducted a meta-analysis evaluating FES vs. Z-POEM for symptomatic ZD.</p><p><strong>Methods: </strong>Multiple databases were searched from inception to September 2024. Our primary outcomes were clinical and technical success. Secondary outcomes included adverse events, length of hospital stay (LOS), procedure time, and recurrence. A random-effects model was used, and outcomes were represented as pooled rates, relative risk (RR) and standardized mean difference (SMD), along with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Seven studies with 580 patients (Z-POEM=274, FES=306) were included. Mean age ranged from 68.9-74.9 years. The diverticulum size was not statistically different between the 2 groups: SMD -3.78 (-11.68 to 4.12), P=0.35. The pooled technical success was similar for Z-POEM and FES: RR 0.99 (95%CI 0.96-1.02; <i>I</i> ²=0%); P=0.4. Clinical success rate was significantly higher for Z-POEM compared to FES: RR 1.11 (95%CI 1.04-1.18; <i>I</i> ²=16%); P=0.001. There were no statistically significant differences between the 2 treatment modalities in pooled rate of recurrence, adverse events, LOS or procedural time.</p><p><strong>Conclusions: </strong>Our analysis shows that Z-POEM and FES in the treatment of symptomatic ZD are both associated with high technical success and a good safety profile, and have comparable procedural times and rates of recurrence. Z-POEM may offer higher rates of clinical success at follow up.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 1","pages":"20-27"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969273","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}