Sudheer Dhoop, Mohammed Abu-Rumaileh, Wasef Sayeh, Sami Ghazaleh, Conner Lombardi, Manthanbhai Patel, Bisher Sawaf, Wade Lee-Smith, Adrian Zhou, Ali Nawras, Yaseen Alastal
{"title":"Efficacy and safety of full-thickness versus circular peroral endoscopic myotomy for treatment of achalasia: a systematic review and meta-analysis.","authors":"Sudheer Dhoop, Mohammed Abu-Rumaileh, Wasef Sayeh, Sami Ghazaleh, Conner Lombardi, Manthanbhai Patel, Bisher Sawaf, Wade Lee-Smith, Adrian Zhou, Ali Nawras, Yaseen Alastal","doi":"10.20524/aog.2025.0946","DOIUrl":"10.20524/aog.2025.0946","url":null,"abstract":"<p><strong>Background: </strong>Peroral endoscopic myotomy (POEM) is a treatment for esophageal achalasia with 2 variations in myotomy depth: full-thickness myotomy (FTM) and circular myotomy (CM). This systematic review and meta-analysis compares the efficacy and safety of these variations.</p><p><strong>Methods: </strong>Major health databases and registers, including Embase, MEDLINE and Cochrane were searched systematically. The primary outcome was clinical success, while secondary outcomes included change in achalasia severity scores, post-POEM gastroesophageal reflux disease (GERD) measures, procedural time, and adverse events. Meta-analysis was conducted using random-effects models, with risk ratios (RR) and mean differences (MD) calculated for dichotomous and continuous variables, respectively.</p><p><strong>Results: </strong>Nine observational studies compared FTM and CM in 1,203 patients. FTM was performed in more severe achalasia and demonstrated similar clinical success to CM (RR 1.01, 95% confidence interval [CI] 0.98-1.04; P=0.55; n=6) and procedural time (MD 3.49 min, 95%CI -2.79-9.78; P=0.28, <i>I</i> <sup>2</sup>=66%; n=3). FTM was associated with increased post-POEM GERD outcomes, post-POEM pain (RR 1.94, 95%CI 1.27-2.95; P=0.002; n=2), and length of stay (LOS) (MD 0.85 days, 95%CI 0.11-1.59; P=0.02; <i>I</i> <sup>2</sup>=0%; n=2); however, association with esophagitis disappeared when proton pump inhibitors use was accounted for (RR 1.68, 95%CI 0.89-3.16; P=0.11; <i>I</i> <sup>2</sup>=23%; n=4). CM was associated with higher rates of subcutaneous emphysema (RR 0.59, 95%CI 0.43-0.81; P=0.001; n=5).</p><p><strong>Conclusions: </strong>FTM and CM have comparable observed clinical efficacy and procedural time, with minimal differences in complications. FTM may be preferred in more severe achalasia and its association with post-POEM GERD may have been overestimated, but it may increase post-POEM pain and LOS.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"143-155"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690993","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}
Joanne D'Amato, Eliezer Zahra Bianco, Jade Camilleri, Emma Debattista, Pierre Ellul
{"title":"Hepatocellular carcinoma in Fontan-associated liver disease.","authors":"Joanne D'Amato, Eliezer Zahra Bianco, Jade Camilleri, Emma Debattista, Pierre Ellul","doi":"10.20524/aog.2025.0948","DOIUrl":"10.20524/aog.2025.0948","url":null,"abstract":"<p><p>Fontan-associated liver disease (FALD) is a significant complication in patients with Fontan palliation. The improved longevity following Fontan palliation has led to wider recognition of FALD and its association with hepatocellular carcinoma (HCC). This review examines the intricate link between FALD and HCC development, emphasizing the unique hemodynamic changes in Fontan circulation that promote hepatic congestion, fibrosis and cirrhosis, thereby facilitating carcinogenesis. The review comprehensively analyzes the existing literature, highlighting key risk factors, pathophysiological mechanisms, and diagnostic challenges in FALD-related HCC. While HCC incidence in FALD remains relatively low (1.5-5.0%), its higher mortality rate of 29.4% necessitates a thorough understanding of contributing factors and screening requirements. The management of FALD involves multidisciplinary approaches, addressing cardiac and hepatic aspects, with regular surveillance for liver disease progression and HCC using advanced imaging and biomarkers. Therapeutic considerations include interventions to manage hepatic congestion and fibrosis, although balancing these with the unique cardiac needs of Fontan circulation remains challenging. Interestingly, FALD management often mirrors that of other liver diseases, underscoring the need for tailored approaches. In severe cases, combined heart-liver transplantation offers a comprehensive solution for FALD-HCC. This review consolidates current knowledge on the epidemiology, pathogenesis and comprehensive management of HCC in the specific context of FALD, ultimately improving outcomes for this unique patient population.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"133-142"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691031","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}
Anastasia Katsoula, Olga Giouleme, Paschalis Paschos, Maria Toumpalidou, Maria Mainou, Konstantinos Malandris, Anna-Bettina Haidich, Apostolos Tsapas
{"title":"Patients' and gastroenterologists' preferences regarding outcomes and medication attributes in ulcerative colitis.","authors":"Anastasia Katsoula, Olga Giouleme, Paschalis Paschos, Maria Toumpalidou, Maria Mainou, Konstantinos Malandris, Anna-Bettina Haidich, Apostolos Tsapas","doi":"10.20524/aog.2025.0944","DOIUrl":"10.20524/aog.2025.0944","url":null,"abstract":"<p><strong>Background: </strong>Patients' and gastroenterologists' views on the relative importance of treatment outcomes and medication attributes for ulcerative colitis (UC) may differ. We aimed to explore which treatment outcomes and medication attributes are considered important by both for therapeutic decisions.</p><p><strong>Methods: </strong>Eight gastroenterologists and 23 patients with UC in Greece participated in semi-structured interviews and focus groups, respectively. The focus groups and interviews were audio-recorded, transcribed and coded, utilizing thematic analysis until data saturation was achieved.</p><p><strong>Results: </strong>Themes that were discussed included the impact of UC on daily life, UC-related outcomes, drug-related attributes and the patient-doctor relationship. Within these themes, disparities between the perspectives of gastroenterologists and patients were evident on 2 main issues. Gastroenterologists prioritized clinical remission and emphasized long-term objectives, such as mucosal healing, while patients focused on shorter-term outcomes, such as the early and sustained relief of symptoms. Regarding medication attributes, important factors for patients were primarily those that impacted their daily life, such as route of administration, dosage and the need for hospital visits. In contrast, gastroenterologists were more concerned about potential adverse events and non-responsiveness to treatment. There was a consensus regarding the importance of shared decision-making for UC management, emphasized by both patients and clinicians.</p><p><strong>Conclusions: </strong>Gastroenterologists mostly prioritize objective measures of remission, while patients mainly focus on factors related to their quality of life and overall well-being. Enhancing communication regarding different goals and expectations may strengthen the physician-patient relationship, ultimately resulting in better shared therapeutic decision-making.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"174-181"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691033","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}
Imen Jallouli, Michael Doulberis, Jannis Kountouras
{"title":"Primary biliary cholangitis: a summary of pathogenesis and therapies.","authors":"Imen Jallouli, Michael Doulberis, Jannis Kountouras","doi":"10.20524/aog.2025.0953","DOIUrl":"10.20524/aog.2025.0953","url":null,"abstract":"<p><p>Primary biliary cholangitis (PBC) is a progressive autoimmune liver disease characterized by chronic inflammation and destruction of interlobular bile ducts. Its pathogenesis involves a complex interplay of genetic predisposition, environmental triggers, and immune-mediated mechanisms, particularly T-helper cell activity, leading to bile duct damage. First-line therapy includes ursodeoxycholic acid (UDCA), which improves liver biochemistry and slows disease progression, with obeticholic acid (OCA) as an option for non-responders. Double and/or triple therapy, including UDCA, OCA, and fibrates, appears to be superior in achieving therapeutic benefits in UDCA-nonresponsive PBC patients. Emerging therapies, such as peroxisome proliferator-activated receptor-α agonists, biologics such as dacetuzumab and rituximab, and experimental approaches such as stem-cell therapy, offer promising advances in managing PBC. Liver transplantation remains a final treatment option for advanced cases.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"38 2","pages":"121-132"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691034","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}
Nicole Sciberras, Lara Miruzzi, Luke Bugeja, Adrienne Gatt, Suzanne Cauchi, Zane Attard, Pierre Ellul, Stefania Chetcuti Zammit
{"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}
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
{"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}
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
{"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}
Joseph Sleiman, Fadi F Francis, Nayantara Coelho-Prabhu, Jana G Hashash
{"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> <sup>2</sup>=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> <sup>2</sup>=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> <sup>2</sup>=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}