Annals of Gastroenterology最新文献

{"title":"Performance and safety of percutaneous cholangioscopy: a systematic review and meta-analysis.","authors":"Apostolis Papaefthymiou, Paraskevas Gkolfakis, Kirill Basiliya, Antonio Facciorusso, Daryl Ramai, Christian Gerges, Georgios Tziatzios, Simon Phillpotts, George J Webster","doi":"10.20524/aog.2024.0869","DOIUrl":"10.20524/aog.2024.0869","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous cholangioscopy (PerC) offers an alternative for patients with an inaccessible biliary tree. This systematic review and meta-analysis aimed to evaluate the performance of this technique.</p><p><strong>Methods: </strong>A search in Medline, Cochrane and ClinicalTrials.gov databases was performed for studies assessing PerC up to October 2022. The primary outcome was diagnostic success, defined as successful stone identification or stricture workup. Secondary outcomes included therapeutic success (stone extraction, stenting) and complication rate. A subgroup analysis compared previous-generation and modern cholangioscopes. We performed meta-analyses using a random-effects model and the results were reported as percentages with 95% confidence interval (CI).</p><p><strong>Results: </strong>Fourteen studies (682 patients) were eligible for analysis. The rate of diagnostic success was 98.7% (95%CI 97.6-99.8%; <i>I</i>²=31.19%) and therapeutic success was 88.6% (95%CI 82.8-94.3%; <i>I</i>²=74.92%). Adverse events were recorded in 17.1% (95%CI 10.7-23.5%; <i>I</i>²=77.56%), of which 15.9% (95%CI 9.8-21.9%; <i>I</i>²=75.98%) were minor and 0.6% (95%CI 0.1-1.2%; <i>I</i>²=0%) major. The Spyglass system showed null heterogeneity for all outcomes; compared with older-generation endoscopes it offered comparable diagnostic success, but yielded significantly superior therapeutic success (96.1%, 95%CI 90-100%; <i>I</i>²=0% vs. 86.4%, 95%CI 79.2-93.6%; <i>I</i>²=81.41%; P=0.02].</p><p><strong>Conclusion: </strong>PerC, especially using currently available cholangioscopes, is associated with high diagnostic and therapeutic success.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"225-234"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118589","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":"Perioperative nutritional assessment and management of patients undergoing gastrointestinal surgery.","authors":"Aristea Gazouli, Konstantinos Georgiou, Maximos Frountzas, Gerasimos Tsourouflis, Nikola Boyanov, Nikolaos Nikiteas, Maria Gazouli, George E Theodoropoulos","doi":"10.20524/aog.2024.0867","DOIUrl":"10.20524/aog.2024.0867","url":null,"abstract":"<p><p>Malnutrition is a major issue in gastrointestinal perioperative situations, as only 40% of malnourished patients are finally treated. This literature review investigates the inconsistencies regarding the diagnostic approach to both preoperative and postoperative patients and the various underlying causes, as well as the efficiency of the various therapeutic regimens. A literature search was conducted until August 2023 in MEDLINE and Scopus. Clinical studies involving perioperative nutritional assessment in adult gastrointestinal surgery patients during the last 10 years were included in the present review. Finally, 19 articles were included in the study. Preoperative nutritional therapy is increasingly recognized as a key component of surgical care. Malnourished patients who are hospitalized and operated on, have significantly worse clinical results. Gastrointestinal postoperative malnutrition coexists with metabolic stress, as patients usually suffer from minor chronic inflammations; therefore, postoperative malnutrition is the result of a combination of the effects of inflammation and a lack of food intake. Postoperative malnutrition leads to prolonged hospitalizations and hospital complications and therefore the need to treat it is essential. There are many recognized tools for detecting malnutrition. However, all tools showed inconsistent results regarding their validity. <i>Per os</i> feeding after surgery, and dietary supplements when necessary, have been recommended. Therefore, it is very important to reduce malnutrition and define clear strategies towards that direction.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"142-154"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118590","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":"Gut microbiota in celiac disease.","authors":"Nehal Yemula","doi":"10.20524/aog.2024.0862","DOIUrl":"10.20524/aog.2024.0862","url":null,"abstract":"<p><p>Celiac disease (CD) is an autoimmune gastrointestinal disease triggered by dietary gluten, occurring in genetically predisposed individuals. Currently, a gluten-free diet is the only current evidenced-based treatment for CD. With the growing prevalence of this condition worldwide, adjuvant therapies are needed. We understand that there are several factors that influence the pathogenesis of the condition. There is a complex interplay between genetics, environmental triggers, the immune system and gut microbiota. Recently, there has been a growing focus on the significance of gut microbiota in several autoimmune-based conditions. In particular, there has been much research involving the role of microbial flora and CD. Here, in this mini-review, we highlight the importance of gut microbiota and the symbiotic relationship with the host, introduce key factors that influence the development of the intestinal flora in early colonization, and ultimately explore its role in the pathogenesis of CD.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"125-132"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118555","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":"Artificial intelligence in gastrointestinal endoscopy: a comprehensive review.","authors":"Hassam Ali, Muhammad Ali Muzammil, Dushyant Singh Dahiya, Farishta Ali, Shafay Yasin, Waqar Hanif, Manesh Kumar Gangwani, Muhammad Aziz, Muhammad Khalaf, Debargha Basuli, Mohammad Al-Haddad","doi":"10.20524/aog.2024.0861","DOIUrl":"10.20524/aog.2024.0861","url":null,"abstract":"<p><p>Integrating artificial intelligence (AI) into gastrointestinal (GI) endoscopy heralds a significant leap forward in managing GI disorders. AI-enabled applications, such as computer-aided detection and computer-aided diagnosis, have significantly advanced GI endoscopy, improving early detection, diagnosis and personalized treatment planning. AI algorithms have shown promise in the analysis of endoscopic data, critical in conditions with traditionally low diagnostic sensitivity, such as indeterminate biliary strictures and pancreatic cancer. Convolutional neural networks can markedly improve the diagnostic process when integrated with cholangioscopy or endoscopic ultrasound, especially in the detection of malignant biliary strictures and cholangiocarcinoma. AI's capacity to analyze complex image data and offer real-time feedback can streamline endoscopic procedures, reduce the need for invasive biopsies, and decrease associated adverse events. However, the clinical implementation of AI faces challenges, including data quality issues and the risk of overfitting, underscoring the need for further research and validation. As the technology matures, AI is poised to become an indispensable tool in the gastroenterologist's arsenal, necessitating the integration of robust, validated AI applications into routine clinical practice. Despite remarkable advances, challenges such as operator-dependent accuracy and the need for intricate examinations persist. This review delves into the transformative role of AI in enhancing endoscopic diagnostic accuracy, particularly highlighting its utility in the early detection and personalized treatment of GI diseases.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"133-141"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118549","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":"Fibrin glue and coats compromise the integrity of colonic anastomosis: an experimental trial on rats.","authors":"Nikolaos Voloudakis, Ioannis Koutelidakis, Emmanouil Christoforidis, Stefanos Atmatzidis, Georgia Kotoreni, Basilios Papaziogas, Dimitrios Schizas, Christos Zavos, Apostolos Papalois, Grigorios Chatzimavroudis","doi":"10.20524/aog.2024.0859","DOIUrl":"10.20524/aog.2024.0859","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak remains a dreaded complication in colorectal surgery. Identifying optimal techniques that minimize its incidence is an active area of investigation. The aim of this experimental study was to evaluate the effect of commonly used hemostatic products on the integrity of colonic anastomoses.</p><p><strong>Methods: </strong>Male Wistar rats were randomized into 4 groups. In the control group (A), the anastomosis was performed using the standard hand-sewn technique in the ascending colon. In group B the hand-sewn technique was reinforced with a collagen-fibrinogen patch, in group C with fibrin glue, and in group D with a polyethylene glycol (PEG)-coated oxidized cellulose patch. On the 7^th postoperative day, anastomotic bursting pressure measurements were obtained. A specimen surrounding the anastomosis was retrieved for histopathologic evaluation.</p><p><strong>Results: </strong>Of the 19 rats, 17 survived and 15 were included in the analysis (5 in each of groups A, B and C). Testing in group D was discontinued following adverse events in the preliminary experiments. The mean bursting pressure of the anastomosis was significantly higher in the control group (A: 221±19.41 mmHg, B: 151±14.42 mmHg, and C: 112±13.57 mmHg; P=0.001). Anastomotic healing parameters were not different between groups.</p><p><strong>Conclusions: </strong>Although experimental data support the use of sealants in defective anastomoses, in this study the reinforcement of colonic anastomosis with fibrin or oxidized cellulose-PEG sealants did not improve either bursting pressure values or anastomotic healing. More data from robust anastomoses of animals and humans are needed before sealing becomes common clinical practice in colorectal surgery.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"216-224"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118554","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 ultrasound-guided lumen-apposing metal stent with or without coaxial plastic stent for pancreatic fluid collections: a systematic review and meta-analysis comparing safety and efficacy.","authors":"Harishankar Gopakumar, Vakya Revanur, Rajanikanth Kandula, Srinivas R Puli","doi":"10.20524/aog.2024.0858","DOIUrl":"10.20524/aog.2024.0858","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound (EUS)-guided lumen-apposing metal stents (LAMS) are preferred for draining symptomatic large pancreatic fluid collections (PFCs). A concurrent coaxial double-pigtail plastic stent (DPPS) is proposed to reduce adverse events associated with LAMS. We aimed to perform a comparative outcome analysis of LAMS with or without DPPS for PFCs.</p><p><strong>Methods: </strong>Electronic databases from January 2005 through July 2023 were searched for studies comparing the use of LAMS with or without DPPS for PFCs. Pooled proportions were calculated using fixed (inverse variance) and random-effects (DerSimonian-Laird) models.</p><p><strong>Results: </strong>After reviewing 1780 studies, we extracted data from 6 studies comprising 348 patients. The weighted odds of overall technical success, using LAMS plus DPPS compared to LAMS alone, were 0.53 (95% confidence interval [CI] 0.15-1.83), and the odds of clinical success were 1.10 (95%CI 0.59-2.05). The weighted odds of total adverse events with LAMS compared to LAMS plus DPPS were 2.21 (95%CI 1.37-3.59). Analysis of individual adverse events showed that the odds of stent occlusion when LAMS alone was used compared to LAMS plus DPPS was 2.36 (95%CI 1.12-4.98). The odds of bleeding were 1.84 (95%CI 0.77-4.38), and the odds of stent migration 0.95 (95%CI 0.40-2.23).</p><p><strong>Conclusions: </strong>EUS-guided LAMS placement is the current standard of care for managing symptomatic large PFCs. Concurrent use of coaxial DPPS can mitigate the overall adverse events observed with LAMS, while maintaining similar technical and clinical success.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 2","pages":"242-250"},"PeriodicalIF":2.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10927631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118552","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":"APRI score is not predictive of post-surgical outcomes in cholangiocarcinoma patients.","authors":"Faaiq N Aslam, Tristan A Loveday, Pedro Luiz Serrano Uson Junior, Mark Truty, Rory Smoot, Tanios Bekaii-Saab, Chee-Chee Stucky, Hani Babiker, Mitesh J Borad","doi":"10.20524/aog.2024.0845","DOIUrl":"10.20524/aog.2024.0845","url":null,"abstract":"<p><strong>Background: </strong>Cholangiocarcinoma is an epithelial malignancy of the intrahepatic or extrahepatic biliary tree, primarily driven by chronic inflammation and fibrosis. Fibrosis has been shown to correlate with malignancy, and the aminotransferase-platelet ratio index (APRI) score, a marker for hepatic fibrosis, has proved useful in prognosticating hepatocellular carcinoma. This study aimed to assess the utility of APRI score in predicting post-surgical outcomes in cholangiocarcinoma patients.</p><p><strong>Methods: </strong>Clinical data from a total of 152 cholangiocarcinoma patients who underwent surgical resection at the Mayo Clinic were collected. The data were subsequently analyzed to determine if there was a relationship between APRI score and the demographic, laboratory, pathologic and outcome data, including overall survival. To determine the relationship between quantitative and qualitative data and the APRI score, a P-value <0.05 was considered as statistically significant.</p><p><strong>Results: </strong>No relationship between APRI score and demographic factors was identified. There were correlations between APRI score and alanine transaminase, albumin and bilirubin, but the remaining laboratory parameters showed no correlation. APRI score did not prove to be useful as a prognostic tool, as it did not correlate with tumor pathology features (tumor grade <i>t</i>-test P=0.86, N stage ANOVA P=0.94, vascular invasion <i>t</i>-test P=0.59, and perineural invasion <i>t</i>-test P=0.14), or with post-surgical recurrence (<i>t</i>-test P=0.22) and mortality (<i>t</i>-test P=0.39).</p><p><strong>Conclusion: </strong>APRI score is not a prognostic tool for post-surgical outcomes in patients with cholangiocarcinoma.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"95-103"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465893","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":"Polymorphisms in <i>CLEC5A</i> and <i>CLEC7A</i> genes modify risk for inflammatory bowel disease.","authors":"Evangelia Legaki, Tilemachos Koutouratsas, Charalampos Theocharopoulos, Vivian Lagkada, Maria Gazouli","doi":"10.20524/aog.2024.0843","DOIUrl":"10.20524/aog.2024.0843","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) seems to arise from an interplay between genetic and environmental factors. <i>CLEC5A</i> and <i>CLEC7A</i> genes code for 2 members of the C-type lectin receptor superfamily, which participate in the immune response against various pathogens, mediating inflammatory signaling. <i>CLEC5A</i> polymorphisms have been linked to the risk of Crohn's disease (CD), whereas <i>CLEC7A</i> has been implicated in fungal dysbiosis, chemically induced colitis in mice and undertreated ulcerative colitis (UC) in humans. This study aimed to explore how specific <i>CLEC5A</i> and <i>CLEC7A</i> polymorphisms contribute to the development of CD and UC.</p><p><strong>Methods: </strong>One hundred twelve CD patients, 94 UC patients and 164 sex- and age- matched healthy individuals were genotyped for the single nucleotide polymorphisms rs2078178 and rs16910631 of the <i>CLEC7A</i> gene, and rs1285933 of the <i>CLEC5A</i> gene.</p><p><strong>Results: </strong>The <i>CLEC7A</i> rs2078178 AA genotype was more frequent in UC patients compared to healthy individuals, The <i>CLEC7A</i> rs16910631 CT genotype was significantly associated with UC risk compared to healthy individuals, while there was no statistical correlation with CD. The <i>CLEC5A</i> rs1285933 GA genotype was found to be protective against UC and CD, and the AA genotype against CD. Carriers of the rs1285933 A allele appeared to have reduced susceptibility to CD, implying that the presence of the A allele could be protective against CD development.</p><p><strong>Conclusions: </strong>This is the first study to correlate the <i>CLEC5A</i> rs1285933 polymorphism with the risk for UC. The rs2078178 AA genotype and the <i>CLEC7A</i> rs16910631 CT could be promising biomarkers for UC susceptibility.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"64-70"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465973","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":"Serial rotational thromboelastometry measurements show worsening hypocoagulability in acute-on-chronic liver failure and are associated with the severity of liver disease.","authors":"George Kampelos, Larisa Vasilieva, Theodoros Alexopoulos, Iliana Mani, Emilia Hadziyannis, Stavroula Giannouli, Sofia Manioudaki, Efrosyni Nomikou, Alexandra Alexopoulou","doi":"10.20524/aog.2024.0847","DOIUrl":"10.20524/aog.2024.0847","url":null,"abstract":"<p><strong>Background: </strong>Viscoelastic tests are used to better understand the complex picture of hemostasis in cirrhosis. Limited data exist regarding the clinical relevance of rotational thromboelastometry (ROTEM) in acute-on-chronic liver failure (ACLF) or acute decompensation (AD). We examined the pattern and role of sequential observations of 9 ROTEM components in both ACLF and AD groups.</p><p><strong>Method: </strong>ROTEM measurements were compared within and between groups at 3 time points: on admission (T1), at 24 h (T2) and 48 h post-admission (T3).</p><p><strong>Results: </strong>Forty-two consecutive patients (22 ACLF, 20 AD) were included. ROTEM determinants exhibited significant hypocoagulable deterioration in ACLF but not in AD over the 3 time points in clot formation time (CFT)_EXTEM (P=0.01), maximum clot firmness_EXTEM (P=0.014), CFT_INTEM (P<0.001), and alpha_INTEM (P=0.028). The sum of hypocoagulable determinants increased from T1 to T3 in ACLF (P=0.029), but remained stable in AD. Five ROTEM variables showed significant differences towards hypocoagulability in ACLF compared to AD at T3. A \"hypocoagulable\" profile was associated with more severe liver disease (P<0.001 for model for end-stage liver disease [MELD] or Child-Pugh scores) and higher 30- and 90-day mortality (log-rank P=0.001 and P=0.013, respectively) but no more bleeding episodes or transfusions. Two ROTEM variables displayed strong correlations with MELD at T1 and 7 at T3 (|r coefficient|>0.5).</p><p><strong>Conclusions: </strong>ROTEM measurements indicated worsening hypocoagulability shortly post-admission compared to baseline in ACLF, but remained stable in AD. The hypocoagulable derangement was mostly correlated with the severity of liver disease and higher short-term mortality, but not more bleeding episodes.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"71-80"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465978","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 papillary large-balloon dilation with sphincterotomy for difficult common bile duct stones ≤12 mm: a prospective study.","authors":"Magdalini Velegraki, Despoina Arna, Pinelopi Nikolaou, Andreas Psistakis, Maria Fragaki, Gregorios Chlouverakis, Emmanouil Vardas, Gregorios Paspatis","doi":"10.20524/aog.2023.0855","DOIUrl":"10.20524/aog.2023.0855","url":null,"abstract":"<p><strong>Background: </strong>Stone recurrence is a significant complication following endoscopic bile duct clearance. Endoscopic papillary large-balloon dilation (EPLBD) with biliary sphincterotomy (EBS) has shown satisfactory results in preventing recurrence of \"large\" common bile duct stones (CBDS). However, data on outcomes after EPLBD+EBS for CBDS ≤12 mm remain scarce. The present study prospectively evaluated the mid- and long-term efficacy of EPLBD+EBS for CBDS recurrence among this group of patients.</p><p><strong>Methods: </strong>Consecutive patients with CBDS ranging from 8-12 mm, treated with EPLBD+EBS from June 2018 through June 2020, were prospectively followed-up for at least 36 months. CBDS recurrence was defined as recurrent stones confirmed by endoscopic retrograde cholangiopancreatography (ERCP) during the follow-up period.</p><p><strong>Results: </strong>Overall, 72 patients (mean age: 67 years, 52.8% male) were included, of whom 22 (30.5%) had multiple (≥3) CBDS, 23 (31.9%) had a history of cholecystectomy, 13 (18.1%) had a periampullary diverticulum and 22 (30.5%) had a previous EBS. The mean CBD diameter was 11.6±1 mm, while a tapered duct was noted in 7 (9.7%). Post-procedural bleeding and cholangitis occurred in 1 and 2 cases respectively. No cases of perforation and post-ERCP pancreatitis were observed. During a mean follow up of 46.4±6.2 months (range 37-60), no mid-term recurrence was observed, whereas CBDS recurred in 2/72 (2.7%) in the long term.</p><p><strong>Conclusions: </strong>EPLBD+EBS in patients with CBDS ≤12 mm was associated with a very low rate of mid- and long-term CBDS recurrence. Our results need to be further investigated with randomized controlled trials.</p>","PeriodicalId":7978,"journal":{"name":"Annals of Gastroenterology","volume":"37 1","pages":"89-94"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10785022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139465958","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}