Annals of Gastroenterology最新文献

{"title":"Predictors of a need for cholangioscopy-guided electrohydraulic lithotripsy in the management of difficult common bile duct stones.","authors":"Dionysios Kogias, Nikolaos Kafalis, Vaia Karapepera, Vasileios Papadopoulos, Georgios Kouklakis","doi":"10.20524/aog.2026.1026","DOIUrl":"10.20524/aog.2026.1026","url":null,"abstract":"<p><strong>Background: </strong>While standard endoscopic methods effectively clear most common bile duct stones, complex cases require specialized management. This study compared the effectiveness of cholangioscopy-guided electrohydraulic lithotripsy (EHL) against conventional techniques for treating difficult common bile duct stones (DBS).</p><p><strong>Methods: </strong>This retrospective study included 436 patients who underwent endoscopic retrograde cholangiopancreatography between April 2020 and April 2024. Demographic, laboratory and procedural data were recorded. Categorical regression identified predictors for EHL, and classification tree analysis was used to develop a prioritization algorithm.</p><p><strong>Results: </strong>Among patients with DBS (305/436, 70%), conventional methods succeeded in 28.9% (88/305). Endoscopic papillary large balloon dilation followed failed first-line techniques in 115 cases, with a 21.7% success rate. EHL was used in 192 patients, achieving a 98.4% success rate. Multivariate analysis showed that DBS (P<0.001), absence of wedged stones in the ampulla of Vater (P<0.001), and small papillae (P=0.002) were strong independent predictors for EHL use, with DBS being the most significant.</p><p><strong>Conclusions: </strong>DBS, absence of wedged stones in Vater and small papillae are key predictors of the need for cholangioscopy-guided EHL. Given its high success rate and comparable safety profile, EHL should be considered an early-line treatment in selected cases.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"32-39"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083927","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":"Adherence of Greek gastroenterologists to established quality indicators in gastrointestinal endoscopy.","authors":"Georgios Axiaris, Alexandros Ioannou, Konstantina Dimopoulou, Stavros P Papadakos, Panagiotis Baxevanis, Margarita Papatheodoridi, Xenofon Tsamakidis, Georgios Tziatzios, Ioannis S Papanikolaou, Konstantinos Triantafyllou, Spyridon Michopoulos, Kalliopi Panagiotopoulou, Konstantina D Paraskeva","doi":"10.20524/aog.2026.1090","DOIUrl":"10.20524/aog.2026.1090","url":null,"abstract":"<p><strong>Background: </strong>Quality assessment is a priority in gastroenterology. Data on adherence to endoscopy quality standards in Greece remain limited. This study examined Greek gastroenterologists' compliance with endoscopic quality indicators.</p><p><strong>Methods: </strong>This survey collected data on the quality of upper and lower gastrointestinal endoscopy in Greece. Hellenic Society of Gastroenterology members were invited to complete an electronic survey that included validated endoscopic quality indicators.</p><p><strong>Results: </strong>In total, 164 gastroenterologists participated, of whom 107 (65%) were male. Gastroscopy duration was not recorded by 116 (71%), whereas 102 (62%) used photodocumentation. Use of Prague and Los Angeles classifications was high (156/95% and 159/97%). Complications were recorded by 103 (63.58%) after gastroscopy and 90 (55.56%) after colonoscopy. In colonoscopy, 140 (90.85%) used the Boston Bowel Preparation Scale and 158 (96.34%) achieved cecal intubation. An adenoma detection rate >25% was achieved by 117 (71.78%), and 103 (62.8%) used the Paris classification. Overall compliance with upper and lower endoscopy quality indicators was 87 (53%) and 75 (46%), respectively. Multivariate analysis showed that experience (odds ratio [OR] 2.25, 95% confidence interval [CI] 1-5.06; P=0.049), video recording (OR 2.55, 95%CI 1.23-5.28; P=0.012), and high-resolution endoscope use (OR 2.92, 95%CI 1.39-6.09; P=0.004) were associated with better compliance during upper endoscopy. For lower endoscopy significant predictors included video recording (OR 2.20, 95%CI 1.11-4.33; P=0.023), age (OR 4.33, 95%CI 1.67-11.24; P=0.003) and high-resolution endoscope use (OR 2.67, 95%CI 1.34-5.3; P=0.005).</p><p><strong>Conclusion: </strong>In this survey, discrepancies were observed in Greek endoscopists' compliance with endoscopic quality indicators, underscoring the need for further improvement.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 5","pages":"571-580"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672851","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":"Safety and diagnostic accuracy of ultrasound-assisted percutaneous liver biopsy in pediatric patients: a retrospective single-center study.","authors":"Maria Rogalidou, Aglaia Zellos, Kalliopi Stefanaki, Amalia Patereli, Konstantina Dimakou, Paraskevi Galina, David Oikonomopoulos, Alexandra Papadopoulou","doi":"10.20524/aog.2026.1088","DOIUrl":"10.20524/aog.2026.1088","url":null,"abstract":"<p><strong>Background: </strong>Liver biopsy remains essential for diagnosing and managing pediatric liver diseases, despite advances in noninvasive techniques. However, data on the current indications, diagnostic yield, and safety of ultrasound-assisted percutaneous liver biopsy in children are limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 60 pediatric patients who underwent ultrasound-assisted percutaneous liver biopsy at Agia Sofia Children's Hospital between January 2018 and September 2025. Data collected included demographics, laboratory values, biopsy indications, histopathology and complications. Biopsies were performed under anesthesia using an 18-G Tru-Cut needle with real-time ultrasound guidance. Hemoglobin and hematocrit were measured pre-procedure and at 4 and 24 h post-procedure. Specimen adequacy was assessed by core length and number of complete portal tracts (CPTs).</p><p><strong>Results: </strong>The mean patient age was 8.6 years (range 1 month to 17 years), with weights from 2.9-65 kg. Indications included persistent hypertransaminasemia, cholestasis, autoimmune and metabolic liver disease, and post-transplant evaluation. Mean biopsy length was 1.12 cm (range 0.5-2 cm), with a mean of 11 CPTs (range 4-17). Histopathology revealed autoimmune hepatitis (AIH) in 38.3%, AIH with primary sclerosing cholangitis in 13.3% of patients with inflammatory bowel disease, and other diagnoses in the remainder. No major complications or postprocedural bleeding occurred. Hemoglobin and hematocrit remained stable, and all specimens were adequate for histologic assessment.</p><p><strong>Conclusions: </strong>Ultrasound-assisted percutaneous liver biopsy with an 18-G needle is safe, and yields sufficient tissue for diagnosis in pediatric patients. It continues to be indispensable for the definitive diagnosis, staging, and management of diverse liver diseases in children.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 5","pages":"581-587"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672911","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":"Dietary supplement based on dihydromyricetin in metabolic dysfunction-associated steatotic liver disease: a double-blind, placebo-controlled, randomized clinical trial.","authors":"Εlisavet Michailidou, Stavros P Papadakos, Εleni Κoukoulioti, Sofia Paraskevopoulou, Maria Μela, Paraskevi Fytili, Panagiota Ioannidou, Εvangelos Cholongitas, Κonstantinos Τriantafyllou, George V Papatheodoridis","doi":"10.20524/aog.2026.1019","DOIUrl":"10.20524/aog.2026.1019","url":null,"abstract":"<p><strong>Background: </strong>Despite its increasing prevalence, effective treatment options for metabolic dysfunction-associated steatotic liver disease (MASLD) are limited. We assessed the efficacy of a dietary supplement containing dihydromyricetin (DHM) in MASLD.</p><p><strong>Methods: </strong>Adult MASLD patients were randomized to receive a dietary supplement containing DHM (300 mg/day), vitamins C/E and choline (group A), or identical placebo (group B) for 12 months. Patients were assessed every ≤6 months for clinical and laboratory parameters and liver stiffness measurements (LSM).</p><p><strong>Results: </strong>Fifty-five patients were randomized to group A (n=28) or B (n=27), but 9 patients (group A/B=2/7) were withdrawn early for personal reasons. Median liver enzymes decreased at 6 or 12 months only in group A. Group A compared to B patients achieved higher 12-month rates of combined alanine aminotransferase (ALT)/γ-glutamyl transpeptidase (GGT) normalization (35% vs. 5%, P=0.028). Only in group A, glucose, glycated hemoglobin and total/low density lipoprotein mean levels had declined significantly at 6 and/or 12 months, whereas median liver stiffness measurements (LSM) were lower than baseline at both 6 and 12 months. In multivariate analysis, group A was the only factor associated with ALT/GGT normalization (P=0.038). Generalized estimating equation analysis revealed a significant treatment by time interaction for 12-month combined ALT/GGT normalization only in group A (P=0.021).</p><p><strong>Conclusions: </strong>The 6/12-month use of DHM supplement seems to result in improvements in liver enzymes and LSM, as well as in diabetes and lipid parameters in MASLD patients. Therefore, the use of such a supplement in MASLD needs further evaluation.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"54-62"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083903","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":"Serum anti-integrin αvβ6 autoantibodies for diagnosis of primary sclerosing cholangitis: a systematic review and meta-analysis.","authors":"Stavros P Papadakos, Stamatina Vogli, Alexandra Argyrou, Antonios Chatzigeorgiou, Andreas Koutsoumpas, Jiannis Vlachogiannakos, George V Papatheodoridis","doi":"10.20524/aog.2026.1025","DOIUrl":"10.20524/aog.2026.1025","url":null,"abstract":"<p><strong>Background: </strong>Currently, there is no noninvasive serological marker for primary sclerosing cholangitis (PSC). Serum anti-integrin αvβ6 autoantibodies were recently suggested as potential diagnostic PSC biomarkers. We conducted a systematic review and meta-analysis to evaluate their diagnostic performance, the influence of concomitant inflammatory bowel disease (IBD), and differentiation from other cholestatic liver diseases.</p><p><strong>Methods: </strong>PubMed, Embase, Cochrane Library and Web of Science databases were systematically searched for studies assessing the diagnostic value of serum anti-αvβ6 autoantibodies in PSC. Pooled sensitivity, specificity, diagnostic odds ratio and area under the summary receiver operating characteristic curve (AUC) were calculated using a bivariate random-effects model. Subgroup analyses were performed based on IBD status and differentiation from other cholestatic liver diseases.</p><p><strong>Results: </strong>Four studies including 1294 subjects (398 PSC patients and 896 controls) were analyzed. The pooled sensitivity and specificity of anti-αvβ6 autoantibodies for PSC diagnosis were 62.3% and 87.3%, respectively (AUC: 0.76). The specificity increased to 96% (AUC: 0.86) in PSC without IBD, while it decreased to 71% (AUC: 0.67) in PSC with IBD. For the differentiation of PSC from other cholestatic liver diseases, anti-αvβ6 autoantibodies had pooled sensitivity 81% and specificity 95% (AUC: 0.90).</p><p><strong>Conclusions: </strong>Serum anti-αvβ6 autoantibodies exhibit moderate sensitivity and high specificity for PSC diagnosis, especially in differentiation from other cholestatic diseases. Their clinical utility as a noninvasive diagnostic biomarker is promising and warrants validation in larger, multicenter prospective studies to establish their role in routine clinical practice.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"40-47"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083909","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":"Is common variable immunodeficiency associated with diverticulitis? A matched cohort study.","authors":"Zaid Ansari, Akram Ahmad, Tasneem Jamal Al-Din, Effa Zahid, Ritu Channagiri, Fernando Castro, Asad Ur Rahman","doi":"10.20524/aog.2026.1084","DOIUrl":"10.20524/aog.2026.1084","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the likelihood of acute diverticulitis and its severity in patients with common variable immunodeficiency (CVID) compared to matched controls among those who presented to the emergency room and underwent computed tomography (CT) imaging for abdominal pain.</p><p><strong>Methods: </strong>This was a multicenter, retrospective study comparing adult patients with a diagnosis of CVID, who had CT imaging for abdominal pain between the years 2015-2024, to a control cohort of adult patients without CVID. Mann-Whitney <i>U</i> and chi-square tests were performed to compare baseline characteristics between cases and controls. Mantel-Haenszel tests and conditional logistic regression were used to evaluate associations between CVID, diverticulitis and selected variables.</p><p><strong>Results: </strong>A total of 1392 patients were included in the analysis (696 with CVID and 696 without CVID). Of these patients, 72% were female, 96% were white, their median age was 57 years, and their median body mass index was 27.8 kg/m². CVID was associated with lower odds of diverticulitis (odds ratio [OR] 0.41, 95% confidence interval 0.27-0.63; P<0.001). There was no difference between the rates of complicated diverticulitis. Among patients with CVID who were diagnosed with diverticulitis, 51.4% (vs. 45%, OR 1.27, 95%CI 0.57-2.81; P=0.563) required inpatient treatment, 22.9% required surgical intervention (vs. 16.5%, OR 1.50, 95%CI 1.50 (0.56-4.04); P=0.418), and 31.4% (vs. 24.1%, OR 1.45, 95%CI 0.60-3.49; P=0.411) had recurrent diverticulitis.</p><p><strong>Conclusion: </strong>Patients with CVID presenting to the emergency department have lower odds of acute diverticulitis among those who underwent CT imaging for abdominal pain.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 5","pages":"614-618"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672907","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":"Bezlotoxumab for prevention of <i>Clostridioides difficile</i> recurrence in patients with inflammatory bowel disease: a retrospective multicenter experience.","authors":"Christian Karime, Tarek Odah, Jana G Hashash, Darrell S Pardi, Sahil Khanna, Francis A Farraye","doi":"10.20524/aog.2026.1029","DOIUrl":"10.20524/aog.2026.1029","url":null,"abstract":"<p><strong>Background: </strong>Bezlotoxumab can reduce recurrent <i>Clostridioides difficile</i> infection (rCDI); however, data from patients with inflammatory bowel disease (IBD) are limited. Since rCDI is common in IBD, we assessed the efficacy of bezlotoxumab for rCDI prevention in patients with and without IBD.</p><p><strong>Methods: </strong>Adults who received bezlotoxumab for CDI were identified. Clinical variables and adverse events were collected during a minimum follow-up of 1 year. The primary outcome was rCDI, classified at 4 time intervals (30, 60, 90 days, and 1 year).</p><p><strong>Results: </strong>Of the 70 patients identified, 34 patients had IBD. Most patients (88.6%) had ≥2 prior CDI episodes (interquartile range [IQR] 1-4). Bezlotoxumab was commonly combined with vancomycin (61.4%) or fidaxomicin (42.9%), which did not differ between patients with and without IBD. Following bezlotoxumab, the 1-year rCDI rate was 28.6% (median 65 days, IQR 32.8-158.3), while the 30-, 60- and 90-day rCDI rates were 5.7%, 12.9% and 22.9%, respectively. Patients with IBD had comparable rCDI rates to non-IBD patients, including at 30 (5.9% vs. 5.6%, P>0.99), 60 (17.6% vs. 8.3%, P=0.30), and 90 days (20.6% vs. 13.9%, P=0.54), and 1 year (32.4% vs. 25.0%, P=0.60). A history of colorectal surgery or vancomycin exposure was more common among patients with IBD and rCDI. Adverse events occurred in 6 patients (8.6%), most commonly heart failure exacerbation.</p><p><strong>Conclusions: </strong>The rCDI rate following bezlotoxumab was similar in patients with and without IBD. In patients with IBD, a history of colorectal surgery or prior vancomycin exposure was more common among those who experienced rCDI.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"114-122"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083947","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 impact of depression, anxiety and stress on self-care in inflammatory bowel disease: a systematic review.","authors":"Simone Amato, Alessio Lo Cascio, Francesca Iannuzzi, Michela Cocco, Nicoletta Orgiana, Antonio Maria D'Onofrio, Giovanni Camardese, Franco Scaldaferri, Marco Sguanci, Daniele Napolitano","doi":"10.20524/aog.2026.1024","DOIUrl":"10.20524/aog.2026.1024","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, compromises both physical and psychological health. High levels of stress, anxiety, and depression are common yet often overlooked, negatively impacting treatment adherence and self-care. This review examines how psychological factors influence self-care behaviors in IBD and explores strategies to improve disease management. Following PRISMA guidelines and registered on PROSPERO (CRD42024575631), this systematic review applied the PICO model to identify studies involving IBD patients, self-care interventions, and outcomes related to depression, anxiety and stress. A comprehensive search was conducted in PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, APA PsycInfo and Google Scholar (October-December 2024). JBI tools were used to assess risk of bias, and evidence was graded using the framework established by the Oxford Centre for Evidence-Based Medicine. Data extraction and synthesis were performed using structured tables and graphs. IBD patients frequently experience psychological distress that impairs self-care and quality of life. Depression is associated with low self-efficacy and maladaptive coping, while anxiety reduces treatment adherence, particularly in younger patients. Stress contributes to disease management difficulties, reinforcing the need for integrated psychological support. Psychological distress in IBD patients significantly affects self-care behaviors. Incorporating mental health support into standard care may enhance adherence, disease control, and overall well-being.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"11-22"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12850693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083970","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":"Electroencephalography in hepatic encephalopathy: diagnostic and prognostic applications across the disease spectrum.","authors":"Georgios Vakadaris, Konstantinos Arvanitakis, Georgios Kalopitas, Eleni Theocharidou, Parmenion P Tsitsopoulos, Georgios Germanidis","doi":"10.20524/aog.2026.1094","DOIUrl":"10.20524/aog.2026.1094","url":null,"abstract":"<p><p>Hepatic encephalopathy (HE) represents a neuropsychiatric continuum arising from cirrhosis and portosystemic shunting, where metabolic toxicity, neuroinflammation and impaired cerebral autoregulation progressively disrupt cortical network function. Minimal hepatic encephalopathy (MHE), its first and not overt stage, has been recognized as a major cause of impaired quality of life and has been associated with reduced functioning and heightened risk of progression to overt HE and mortality. Current diagnostic tools, primarily psychometric tests, capture only clinical manifestations, and lack the ability to directly examine neuronal dysfunction. Electroencephalography (EEG) provides a real-time tool to quantify brain activity, allowing the identification of subtle neural alterations long before clinical symptoms appear. Quantitative EEG (qEEG) indices, such as reduced mean dominant frequency, increased slow-wave activity and disrupted spectral ratios, consistently reflect early cognitive impairment in studies, and are correlated with liver disease severity and neurological performance. These markers not only enhance the early diagnosis of MHE, but also carry important prognostic implications: several EEG parameters have independently predicted future progression of the disease, hospitalization and mortality, and may enhance established risk models when integrated into multicomponent indices such as model for end-stage liver disease (MELD)-EEG. Collectively, evidence suggests that EEG could be used as a multidimensional and objective assessment of neural dysfunction that complements psychometric, biochemical, and imaging-based methods. Our study aimed to examine the diverse electrophysiological findings clarifying the diagnostic and prognostic importance of EEG-based markers, and to examine their possible role in early diagnosis, risk stratification and future clinical applications for patients with HE.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 5","pages":"497-508"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672857","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":"Efficacy and safety of bipolar energy-based therapy for hemorrhoids: a systematic review.","authors":"Renuka Verma, Kyaw Min Tun, Kamleshun Ramphul, Banreet Singh Dhindsa, Douglas G Adler","doi":"10.20524/aog.2026.1022","DOIUrl":"10.20524/aog.2026.1022","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhoids arise from dilated vessels in the submucosal layer of the anorectal canal. Hemorrhoids are responsible for 4 million office and emergency visits annually in the US. Hemorrhoidal energy therapy (HET) is a novel nonsurgical, bipolar energy-based instrument for treating hemorrhoids. It has multiple benefits, such as requiring only a single session for resolution of symptoms, and minimizing heat-related collateral damage. However, there are limited data regarding the effectiveness and adverse events of HET. We performed the first systematic review to evaluate the efficacy and safety of HET in the treatment of internal hemorrhoids.</p><p><strong>Methods: </strong>A comprehensive search was performed from major databases to identify studies that investigated HET to treat hemorrhoids. The primary outcomes were technical success and clinical success. The secondary outcomes were total adverse events and individual adverse events, such as postprocedural bleeding and incontinence.</p><p><strong>Results: </strong>Eight studies with 512 patients were included in the meta-analysis. The average age was 55.6 years, and the majority of patients were female. Most patients presented with grade I and grade II hemorrhoids. The HET demonstrated technical and clinical success rates of 100% and 86.1%, respectively. All adverse events were determined to be mild, according to the ASGE lexicon, except for 1 case of perianal hematoma that required hospitalization.</p><p><strong>Conclusion: </strong>Our study demonstrates that HET is an effective and safe treatment for grade I and II internal hemorrhoids.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"39 1","pages":"99-103"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12881760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140599","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}