Annals of Gastroenterology最新文献

{"title":"Inflammatory bowel disease burden in the Middle East and North Africa Region: a comprehensive analysis of incidence, prevalence, and mortality from 1990-2019.","authors":"Saqr Alsakarneh, Mohamed Ahmed, Fouad Jaber, Mohammad Abuassi, Fadi H Mourad, Fadi F Francis, Kassem Barada, Rami Tfayli, Badr Al-Bawardy, Francis A Farraye, Jana G Hashash","doi":"10.20524/aog.2024.0909","DOIUrl":"10.20524/aog.2024.0909","url":null,"abstract":"<p><strong>Background: </strong>The epidemiology of inflammatory bowel disease (IBD) has changed rapidly in recent years. Objective data concerning the IBD burden in the Middle East and North Africa (MENA) region is limited. We aimed to provide a systematic report on the IBD burden in the MENA region. Additionally, we aimed to study the age- and sex-specific trends in IBD incidence, prevalence and mortality rates from 1990-2019.</p><p><strong>Methods: </strong>Using the Global Burden of Disease (GBD) 2019 Study Database, we investigated the changes in incidence, prevalence and mortality rate, and disability-adjusted life-years (DALYs), at a regional and country level between 1990 and 2019.</p><p><strong>Results: </strong>In 2019, there were 282,534 cases (95% confidence interval [CI] 239,506-334,478) of IBD in the MENA region (50.5% male). There was an overall increase in the incidence and prevalence rates of IBD in the MENA region from 1990 to 2019, while a simultaneous decrease in overall mortality rates was identified. Incidence rates were highest in Jordan, at 6.9 (95%CI 5.8-8.1) per 100,000, and lowest in Morocco, at 1.6 (95%CI 1.4-2) per 100,000. From 1990-2019, the incidence was found increased in males at a higher rate than in females. The age-standardized mortality rate decreased for both sexes by 24% from 1990-2019.</p><p><strong>Conclusion: </strong>The trends and geographic variations in IBD within the MENA region provide policymakers with vital information for making informed decisions in policy, research, and investment, thereby enabling the development of more effective strategies and better allocation of resources.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"527-535"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing ChatGPT4 with and without retrieval-augmented generation in anticoagulation management for gastrointestinal procedures.","authors":"Sheza Malik, Himal Kharel, Dushyant S Dahiya, Hassam Ali, Hanna Blaney, Achintya Singh, Jahnvi Dhar, Abhilash Perisetti, Antonio Facciorusso, Saurabh Chandan, Babu P Mohan","doi":"10.20524/aog.2024.0907","DOIUrl":"10.20524/aog.2024.0907","url":null,"abstract":"<p><strong>Background: </strong>In view of the growing complexity of managing anticoagulation for patients undergoing gastrointestinal (GI) procedures, this study evaluated ChatGPT-4's ability to provide accurate medical guidance, comparing it with its prior artificial intelligence (AI) models (ChatGPT-3.5) and the retrieval-augmented generation (RAG)-supported model (ChatGPT4-RAG).</p><p><strong>Methods: </strong>Thirty-six anticoagulation-related questions, based on professional guidelines, were answered by ChatGPT-4. Nine gastroenterologists assessed these responses for accuracy and relevance. ChatGPT-4's performance was also compared to that of ChatGPT-3.5 and ChatGPT4-RAG. Additionally, a survey was conducted to understand gastroenterologists' perceptions of ChatGPT-4.</p><p><strong>Results: </strong>ChatGPT-4's responses showed significantly better accuracy and coherence compared to ChatGPT-3.5, with 30.5% of responses fully accurate and 47.2% generally accurate. ChatGPT4-RAG demonstrated a higher ability to integrate current information, achieving 75% full accuracy. Notably, for diagnostic and therapeutic esophagogastroduodenoscopy, 51.8% of responses were fully accurate; for endoscopic retrograde cholangiopancreatography with and without stent placement, 42.8% were fully accurate; and for diagnostic and therapeutic colonoscopy, 50% were fully accurate.</p><p><strong>Conclusions: </strong>ChatGPT4-RAG significantly advances anticoagulation management in endoscopic procedures, offering reliable and precise medical guidance. However, medicolegal considerations mean that a 75% full accuracy rate remains inadequate for independent clinical decision-making. AI may be more appropriately utilized to support and confirm clinicians' decisions, rather than replace them. Further evaluation is essential to maintain patient confidentiality and the integrity of the physician-patient relationship.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"514-526"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of shortening vasoactive drug durations alongside endoscopic therapy in esophageal variceal bleeding: an updated systematic review and meta-analysis.","authors":"Sudheer Dhoop, Zohaib Ahmed, Conner Lombardi, Mohammed Abu-Rumaileh, Syeda Faiza Arif, Wasef Sayeh, Rayna Patel, Alborz Sherafati, Wade Lee-Smith, Mona Hassan","doi":"10.20524/aog.2024.0906","DOIUrl":"10.20524/aog.2024.0906","url":null,"abstract":"<p><strong>Background: </strong>The recommended duration of vasoactive drugs in esophageal variceal bleeding (EVB) spans 2-5 days. Prior meta-analyses of randomized trials include only a few studies that compared short vs. long vasoactive drug durations approximating this time range, including older management techniques, and only assessed variceal rebleeding at 5 days. We identified several additional randomized controlled trials (RCTs) assessing rebleeding at various durations, with updated management of EVB.</p><p><strong>Methods: </strong>We performed an updated systematic review and meta-analysis assessing the effect of shortening the vasoactive drug duration by 48-72 h. The primary outcome was rebleeding within 5 days. Secondary outcomes included rebleeding, mortality due to rebleeding, and all-cause mortality within 4-6 weeks (extended period) with subgroup analysis by vasoactive drug and type of endoscopic therapy. Length of stay, blood transfusion requirements and terlipressin-related adverse events were additional secondary outcomes.</p><p><strong>Results: </strong>Our comprehensive search strategy and screening process yielded 14 RCTs with 1060 patients (75.1% male): 7 trials used terlipressin, 4 octreotide, and 3 somatostatin. Shortened durations combined with band ligation led to similar rebleeding, with a trend towards less rebleeding when populations with more severe liver disease were excluded. There was greater rebleeding and mortality over an extended period when shorter durations were combined with sclerotherapy. Longer durations were associated with a longer hospital stay and, for terlipressin, more adverse events.</p><p><strong>Conclusions: </strong>Shorter vasoactive drug durations combined with band ligation in selected populations appear safe. Higher powered RCTs are needed, involving patients with different degrees of severity of EVB and liver disease.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"567-578"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characterization of the silent chronic pancreatitis patient: a single-center retrospective cohort study.","authors":"Dominic Amakye, Mark Bundschuh, Vonn Walter, Brandon Headlee, Hadie Razjouyan, Matthew Coates","doi":"10.20524/aog.2024.0908","DOIUrl":"10.20524/aog.2024.0908","url":null,"abstract":"<p><strong>Background: </strong>Silent chronic pancreatitis (SCP) is a poorly understood subtype of chronic pancreatitis (CP) in which individuals describe little to no abdominal pain. The risk factors for SCP are unclear, and it is unknown whether there are differences in the clinical outcomes of SCP and painful CP. We set out to investigate the clinical features of SCP and the risk factors associated with this condition.</p><p><strong>Methods: </strong>This was a retrospective cohort study using data from the Penn State Milton S. Hershey Medical Center from 2019-2022. Two patient groups, the SCP cohort (23 patients) and the painful CP cohort (94 patients), were identified from consecutive clinics. Descriptive statistics and bivariate and logistic regression analyses (including variables with a P-value <0.1 on bivariate analysis) were performed to characterize the study cohort and to evaluate for independent associations with SCP.</p><p><strong>Results: </strong>SCP was independently associated with older age (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.01-1.11; P=0.03) and male sex (OR 5.38, 95%CI 1.38-20.96; P=0.02), and inversely associated with current opioid use (OR 0.18, 95%CI 0.03-0.96; P=0.04). There was no association between SCP and current pain medication or diabetes mellitus.</p><p><strong>Conclusions: </strong>Our study adds to the growing body of literature describing SCP as a condition associated with older age and male sex, and inversely associated with opioid use. We found no greater association of diabetes with SCP. Future larger longitudinal studies are needed to gain a better understanding of SCP.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"618-622"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139064","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":"Accuracy of controlled attenuation parameter for liver steatosis in patients at risk for metabolic dysfunction-associated steatotic liver disease using magnetic resonance imaging: a systematic review and meta-analysis.","authors":"Konstantinos Malandris, Anastasia Katsoula, Aris Liakos, Eleni Bekiari, Thomas Karagiannis, Eleni Theocharidou, Olga Giouleme, Emmanouil Sinakos, Apostolos Tsapas","doi":"10.20524/aog.2024.0910","DOIUrl":"10.20524/aog.2024.0910","url":null,"abstract":"<p><strong>Background: </strong>The controlled attenuation parameter (CAP) enables the noninvasive assessment of liver steatosis. We performed a systematic review and meta-analysis to evaluate the diagnostic accuracy of CAP for identifying liver steatosis in patients at risk for metabolic dysfunction-associated steatotic liver disease (MASLD), using magnetic resonance imaging proton density fat fraction (MRI-PDFF) as the reference standard.</p><p><strong>Methods: </strong>We searched Medline, Embase, Cochrane Library and gray literature sources up to March 2024. We defined MASLD as MRI-PDFF ≥5%. We also assessed the accuracy of CAP for identifying patients with MRI-PDFF ≥10%. We calculated pooled sensitivity and specificity estimates using hierarchical random-effects models. We assessed the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and the certainty in meta-analysis estimates using the Grading of Recommendations Assessment, Development and Evaluation framework.</p><p><strong>Results: </strong>We included 8 studies with 1116 participants. The prevalence of MASLD ranged from 65.2-93.9%. Pooled sensitivity and specificity of CAP for MRI-PDFF ≥5% were 0.84 (95% confidence interval [CI] 0.79-0.88) and 0.77 (95%CI 0.68-0.84), respectively, with an area under the receiver operating characteristic curve (AUROC) of 0.88. The pooled sensitivity and specificity for MRI-PDFF ≥10% were 0.83 (95%CI 0.80-0.87) and 0.72 (95%CI 0.59-0.82), with an AUROC of 0.85. The certainty in our estimates was low to very low because of the high risk of bias, inconsistency and imprecision.</p><p><strong>Conclusions: </strong>CAP has acceptable diagnostic accuracy for both MRI-PDFF ≥5% and MRI-PDFF ≥10%. Adequately powered and rigorously conducted diagnostic accuracy studies are warranted to establish the optimal CAP thresholds.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"579-587"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142310","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":"Analysis of patients with Crohn's disease and intestinal obstruction: a National Inpatient Sample study.","authors":"Sheza Malik, Umer Farooq, David A Schwartz, Douglas G Adler","doi":"10.20524/aog.2024.0911","DOIUrl":"10.20524/aog.2024.0911","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) predisposes patients to intestinal obstruction (IO), a severe complication. This study examined the outcomes and healthcare utilization of patients with CD and IO using data from the National Inpatient Sample (NIS).</p><p><strong>Methods: </strong>This retrospective analysis of NIS data from 2016-2020 compared hospitalized adult CD patients with and without IO. Outcomes studied include in-hospital mortality, length of stay (LOS), hospitalization charges, and the requirement for intervention, using regression models for adjustment.</p><p><strong>Results: </strong>Among the 304,149 CD patients, 27,024 had IO. These patients experienced higher in-hospital mortality (3.9% vs. 1.8% for non-IO, adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI] 1.09-2.89; P=0.02), longer mean LOS (7.23 vs. 4.53 days for non-IO, P<0.001), and higher average hospitalization charges ($71,775 vs. $43,717 for non-IO, P<0.001). Additionally, they had higher odds of requiring admission to the intensive care unit (aOR 1.99, 95%CI 1.45-2.73; P<0.001), intubation (aOR 2.53, 95%CI 1.74-3.68; P<0.001), balloon dilation (aOR 1.50, 95%CI 1.132-1.98; P=0.005), or intestinal resection (aOR 2.29, 95%CI 2.11-2.49; P<0.001).</p><p><strong>Conclusions: </strong>CD patients with IO face considerable challenges, including greater mortality, longer hospital stays, and higher hospitalization costs. The need for intensive care and surgical interventions highlights the urgent need for improved management and treatment strategies to enhance outcomes for these patients.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"543-551"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139062","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":"Micronutrient deficiencies in older patients with inflammatory bowel disease are not associated with worse adverse clinical outcome rates.","authors":"Brendan Andres, Ali Rasool, Garrett Pepich, Chiu-Hsieh Hsu, Sasha Taleban","doi":"10.20524/aog.2024.0900","DOIUrl":"10.20524/aog.2024.0900","url":null,"abstract":"<p><strong>Background: </strong>Micronutrient deficiencies (MNDs) and age have been previously separately associated with adverse clinical outcomes in patients with inflammatory bowel disease (IBD). However, previous clinical outcomes in older patients with MNDs have been poorly described. We examined the age-related rates of adverse clinical outcomes in patients with 1 or more MNDs.</p><p><strong>Methods: </strong>We conducted a single-institution retrospective cohort study of 204 patients with IBD. Patients were divided into age-related cohorts: 1) younger adults aged 18-59; and 2) older adults aged ≥60 years. Patients were further delineated based upon the presence of zinc, vitamin D, vitamin B12, folate, and iron deficiency. We examined the age-related associations between MNDs and adverse clinical outcomes. Primary outcomes included subsequent corticosteroid use, combined intestinal complication (intra-abdominal abscess, intestinal stricture, internal fistula, perianal disease), IBD-related surgery, IBD-related hospitalization, and a composite clinical outcome. Statistical analyses included the Wilcoxon rank-sum test, chi-squared analysis, Fisher's exact test, and logistic regression.</p><p><strong>Results: </strong>Vitamin D (61.5%), iron (46.4%), and zinc (40.5%) deficiencies were common in older IBD patients, but were not significantly more prevalent. Older patients with 1 or more MNDs did not experience increased rates of adverse clinical outcomes. However, vitamin D, iron, and having multiple MNDs were associated with adverse clinical outcomes in the younger cohort.</p><p><strong>Conclusions: </strong>Vitamin D, iron and zinc deficiencies are common in IBD patients. In younger patients, vitamin D, iron, and multiple MNDs were associated with adverse clinical outcomes, but the same trend was not seen with MNDs in older patients.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"536-542"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139000","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 predictive role of autonomic neuropathy in pre- and post-liver transplantation outcomes: a systematic review and meta-analysis.","authors":"Antonia Neonaki, Vasileios Lekakis, Evangelos Cholongitas","doi":"10.20524/aog.2024.0905","DOIUrl":"10.20524/aog.2024.0905","url":null,"abstract":"<p><strong>Background: </strong>Autonomic neuropathy (AN) in cirrhotic patients has been linked to a higher risk of cirrhosis-related complications and worse outcomes before, during or after liver transplantation (LT). However, only a few studies exist with inconsistent results.</p><p><strong>Methods: </strong>We searched for all articles published until September 2023 that described a diagnosis of AN based on cardiovascular autonomic reflex tests (CARTs), assessment of the rate-corrected QT interval (QTc), heart rate variability (HRV), and baroreflex sensitivity (BRS) tests, in order to evaluate the predictive role of AN in cirrhosis and/or peri-/post-LT prognosis.</p><p><strong>Results: </strong>Twenty-five studies were included: 5, 12, 9, and 1 study, respectively, assessed the predictive role of CARTs, prolonged QTc, HRV indices, and BRS in cirrhosis or peri-/post-LT prognosis. In CARTs-based analysis, the pre-LT pooled mortality rate was significantly higher in cirrhotics with AN compared to those without AN (20% vs. 6%; P=0.01). However, no difference was found between patients with and without pre-LT prolonged QTc in the pre-LT pooled mortality rates (41% vs. 18%; P=0.08), pooled peri-transplant risk of major complications (29% vs. 17%; P=0.08) or post-LT pooled mortality rates (15% vs. 12%; P=0.36). In HRV-based analysis, the standard deviation of normal-to-normal intervals was significantly lower in non-survivors, compared to survivors with cirrhosis: standardized mean difference -2.59, 95% confidence interval -4.75 to -0.43; P=0.04.</p><p><strong>Conclusions: </strong>The presence of CARTs- and HRV-based AN was a good predictor of mortality in the pre-LT setting. Preoperative prolonged QTc did not seem to be associated with the outcome before or after LT.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"588-601"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139003","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":"Tunnel-free peroral endoscopic myotomy reduces procedural time and maintains efficacy in Zenker's diverticulum.","authors":"Georgios Mavrogenis, Maria Zachou, Ioannis Tsevgas, Konstantinos Markoglou, Dimitrios Zachariadis, Anna Spanomanoli, Marinos Chatzis, Fateh Bazerbachi","doi":"10.20524/aog.2024.0902","DOIUrl":"10.20524/aog.2024.0902","url":null,"abstract":"<p><strong>Background: </strong>Peroral endoscopic myotomy (Z-POEM) is an effective treatment for Zenker's diverticulum (ZD), but procedural time and safety vary based on technique. Modified Z-POEM approaches incorporating fewer submucosal tunnels may offer advantages.</p><p><strong>Methods: </strong>In this retrospective, single-center study, we compared outcomes among 20 patients with ZD undergoing standard Z-POEM (2 tunnels), single-tunnel Z-POEM (ST Z-POEM), or tunnel-free Z-POEM (TF Z-POEM). All procedures included mucosotomy over the septum and deep extension of myotomy into the esophagus (2 cm). Primary endpoints were procedural time, clinical success, and adverse events.</p><p><strong>Results: </strong>Patients had a mean age of 67.3±12.2 years, and 70% presented with respiratory symptoms. Mean procedure times were 45 min (standard Z-POEM), 33 min (ST Z-POEM), and 30 min (TF Z-POEM), with a statistically significant difference between the standard and TF Z-POEM groups (P=0.014). Technical success was 100%, and the mean hospital stay was 1.3±1.3 days. One adverse event (5%) occurred. Clinical success, defined as improvement in dysphagia score (3 to 0.05, P<0.001) and resolution of respiratory symptoms, was achieved in all patients.</p><p><strong>Conclusions: </strong>In this study, modified Z-POEM techniques utilizing single-tunnel or tunnel-free approaches, combined with over-the-septum mucosotomy and deep esophageal myotomy (2 cm), demonstrated feasibility, safety and a significantly shorter procedural time compared to standard Z-POEM. These findings suggest potential benefits for ZD treatment, warranting further investigation in larger prospective studies.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"509-513"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139005","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":"Frailty in elderly patients with acute colonic diverticulitis is associated with worse in-hospital outcomes: a nationwide analysis.","authors":"Waqas Rasheed, Anass Dweik, Gnanashree Dharmarpandi, Aamir Saeed, Amir Humza Sohail, Mohammad Baseem Shaikh, Hassam Ali, Sherif E Elhanafi","doi":"10.20524/aog.2024.0904","DOIUrl":"10.20524/aog.2024.0904","url":null,"abstract":"<p><strong>Background: </strong>Frailty has been identified as an independent predictor of mortality in the elderly. We investigated the effects of frailty status on in-hospital outcomes of acute colonic diverticulitis (ACD) in the elderly, using the Hospital Frailty Risk Score.</p><p><strong>Methods: </strong>We used the National Inpatient Sample (NIS) databases from 2016-2020 to identify patients aged ≥75 years hospitalized with ACD. Using a 1:1 matching method, we created propensity-matched cohorts of frail (Hospital Frailty Risk Score ≥5) and non-frail (Hospital Frailty Risk Score ≤4) patients within the ACD population.</p><p><strong>Results: </strong>We identified 53.3% ACD patients as frail. We matched 21,720 frail ACD patients to an equal number of non-frail ACD patients using propensity score matching. Frail patients exhibited significantly higher mortality rates, longer hospital stays, and greater median inpatient costs. Frail patients also experienced a greater number of complications, including abscess formation, intestinal perforation, gastrointestinal fistula formation, sepsis without shock, sepsis with shock, acute kidney injury, hypovolemic or hemorrhagic shock, need for blood transfusion, cardiac arrest, and need for intensive care (all P-values <0.001). Additionally, frail patients underwent open colectomy and colostomy procedures more frequently, while laparoscopic colectomies were performed less frequently (all P-values <0.001).</p><p><strong>Conclusions: </strong>In this nationwide analysis, frailty in ACD is strongly associated with worse mortality, longer hospital stays and higher costs, as well as a greater incidence of local and systemic complications. Furthermore, frailty is linked to a greater need for open colectomy and colostomy procedures.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 5","pages":"552-558"},"PeriodicalIF":2.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139066","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}