Annals of Gastroenterology最新文献

{"title":"Infliximab trough levels among patients with inflammatory bowel disease in correlation with infliximab treatment escalation: a cross-sectional study from a Greek tertiary center.","authors":"Afroditi Orfanidou, Konstantinos Katsanos, Theodoros Voulgaris, Aristeidis Kofinas, Maria Veatriki Christodoulou, Maria Konstandi, Dimitrios Christodoulou","doi":"10.20524/aog.2024.0926","DOIUrl":"10.20524/aog.2024.0926","url":null,"abstract":"<p><strong>Background: </strong>Infliximab monitoring correlates with improved outcomes in inflammatory bowel disease (IBD). We aimed to evaluate the association between serum infliximab trough levels (TLs) and therapeutic outcomes in Greek patients with Crohn's disease (CD) or ulcerative colitis (UC).</p><p><strong>Methods: </strong>This cross-sectional study included consecutive adult patients with IBD receiving intravenous infliximab maintenance therapy at a Greek tertiary center. Therapeutic outcomes assessed were clinical remission (CR), steroid-free clinical remission (SFCR), biochemical remission (BR: C-reactive protein <5 mg/L), and combined (steroid-free and biochemical) remission (SFCBR).</p><p><strong>Results: </strong>Seventy-seven patients participated (62.3% with CD, 16.8% on concomitant immunomodulators), with a mean infliximab infusion duration of 5.1±4.6 years. Forty-seven (61%) patients underwent treatment escalation. Infliximab mean TLs were 7.2±4.9 μg/mL, correlating only with treatment escalation (9.7 vs. 3.6 μg/mL, P<0.001). CR was achieved in 88.3% of patients, SFCR in 80.5%, BR in 62.3%, and SFCBR in 55.8%. In a subgroup analysis, for patients without treatment escalation, higher mean TLs were significantly associated with BR (4.2 vs. 0.8 μg/mL, P=0.020) and SFCBR (4.3 vs. 1.5 μg/mL, P=0.035). In receiver operating characteristic analysis, TLs predicted SFCBR (P=0.016) with good accuracy (area under the curve [AUC] 0.768, 95% confidence interval [CI] 0.584-0.952), with an optimal TL cutoff at 3.4 μg/mL. For patients with treatment escalation, TLs predicted SFCBR (P=0.018) with fair accuracy (AUC 0.653, 95%CI 0.527-0.755), with an optimal TL cutoff at 11 μg/mL.</p><p><strong>Conclusions: </strong>Infliximab TLs correlate with treatment escalation. Higher infliximab TLs may predict combined remission among patients with treatment escalation.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"674-681"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680667","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":"Real-world outcomes of collaborative surgery for gastrointestinal tumors by endoscopists and surgeons: a single-center retrospective analysis of 131 patients.","authors":"Kazutoshi Higuchi, Osamu Goto, Nobuyuki Sakurazawa, Atsuko Sakanushi, Koji Sakamoto, Akira Matsushita, Nobutoshi Hagiwara, Akihisa Matsuda, Toshihiko Hoashi, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Eriko Koizumi, Jun Omori, Naohiko Akimoto, Ryuji Ohashi, Hidehisa Saeki, Kimihiro Okubo, Hiroshi Yoshida, Katsuhiko Iwakiri","doi":"10.20524/aog.2024.0921","DOIUrl":"10.20524/aog.2024.0921","url":null,"abstract":"<p><strong>Background: </strong>Collaborative surgery by both endoscopists and surgeons is considered effective for providing less invasive local resection of gastrointestinal tumors, to offset the limitations of either pure endoscopic treatments or surgical intervention. The clinical outcomes of collaborative surgery were evaluated to investigate the feasibility and safety of this approach.</p><p><strong>Methods: </strong>In this single-center retrospective observational study, we collected data from consecutive patients who underwent collaborative surgery for lesions located from the laryngopharynx to the anus. The completeness of collaboration, technical success, procedure time, postoperative hospitalization period, and occurrence of adverse events were analyzed.</p><p><strong>Results: </strong>Collaboration surgery was performed for 134 lesions (33 laryngopharyngeal, 2 esophageal, 89 gastric, 8 duodenal and 2 recto-anal) in 131 patients. Collaboration completeness was achieved in 129 lesions (96%). <i>En bloc</i> resection and pathological R0 resection of lesions were achieved in 127 (95%) and 124 (93%) lesions, respectively. The mean procedure time was 188 min. The mean time of discharge was the 11^th postoperative day. Five patients (4%) developed relevant postoperative adverse events.</p><p><strong>Conclusions: </strong>These results indicate that collaborative surgery by endoscopists and surgeons was feasible and safe, and may contribute to providing less invasive treatment than conventional surgery. Collaborative surgery is worth considering as a flexible and reliable surgical option, when cooperation may outperform either treatment alone.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"699-707"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680629","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":"Clinical evolution of gallstones following percutaneous cholecystostomy in patients with severe acute calculous cholecystitis: a single-center analysis of 102 cases.","authors":"Ram Ragatha, Ibraheem Khalil, Rebecca Jones, Antonio Manzelli, Alex Reece-Smith, Yunli Ou, Shahjehan Wajed, Davide Di Mauro","doi":"10.20524/aog.2024.0915","DOIUrl":"10.20524/aog.2024.0915","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous cholecystostomy (PC) is effective in controlling sepsis in patients with severe acute calculous cholecystitis (ACC). The long-term treatment of this group is still debated. We aimed to assess the clinical evolution of gallstones after severe ACC and the outcomes of laparoscopic cholecystectomy (LC) and conservative management, following PC.</p><p><strong>Methods: </strong>This was a retrospective analysis of the rate of readmissions due to recurrent biliary disease and all-cause mortality in subjects who underwent a PC for severe ACC. We compared results between patients who underwent interval LC and those who received conservative management. Readmissions and late mortality were assessed using the Kaplan-Meier method and multivariate regression analysis.</p><p><strong>Results: </strong>A total of 102 patients were included, of whom 30 underwent interval LC and 72 PC only. Overall, 51.6% were readmitted with recurrent biliary events and the rate did not differ between groups (P=0.583). The probability of recurrent gallstone events was higher in the first 30 weeks after PC; in the surgical cohort, 77.8% of them developed before LC. Late deaths occurred in 46.2% of patients: 13.3% LC vs. 61.9% conservative (P<0.001). Three years after PC, the estimated survival was 75% LC vs. 38% conservative (P=0.014). High-grade comorbidities and severity of ACC were positive predictors of all-cause mortality (P=0.004 and P=0.027), whereas LC was a negative predictor (P=0.003).</p><p><strong>Conclusions: </strong>Recurrent biliary events were common following PC for ACC. Interval LC was associated with lower rates of readmissions and all-cause late mortality.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 6","pages":"718-725"},"PeriodicalIF":2.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680640","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":"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}