BACKGROUND:The impact of sedation on colonoscopy quality indicators remains debated. We aimed to evaluate how sedation use and type influence adenoma detection rate (ADR) and polyp detection rate (PDR) during colonoscopy. METHODS:We searched MEDLINE, Embase, and the Cochrane Library for studies evaluating the impact of sedation on adenoma and polyp detection during colonoscopy. Primary outcomes were ADR and PDR. Secondary outcomes included advanced adenoma detection rate (AADR), caecal intubation rate (CIR), and colonoscopy withdrawal time (CWT). We used a random-effects meta-analysis to estimate risk ratios (RRs) with corresponding 95% confidence intervals (CIs). RESULTS:A total of 45 studies comprising 878,780 colonoscopies were included in the final analyses. There were no statistically significant differences in ADR between sedated and unsedated colonoscopies (RR 1.04; 95% CI, 0.95-1.14), nor between deep sedation and conscious sedation (RR 1.04; 95% CI, 0.98-1.09). Similarly, PDR did not differ significantly when comparing sedation versus no sedation (RR 0.99; 95% CI, 0.96-1.03) or deep sedation versus conscious sedation (RR 1.04; 95% CI, 0.99-1.09). AADR and colonoscopy withdrawal times were similar across the sedation comparison groups. However, both sedation in general (p = 0.01) and deep sedation (p = 0.02) were associated with a marginal increase in CIR. The certainty of evidence for all outcomes was very low. CONCLUSION:Current observational evidence does not demonstrate a consistent association between the use or depth of sedation and adenoma or polyp detection during colonoscopy. These findings should be interpreted cautiously given substantial between-study heterogeneity and the very low certainty of evidence.
BACKGROUND:Patient selection is central to optimizing outcomes after intestinal transplantation (ITx). Over the past decade, viable intestinal rehabilitation strategies, including autologous intestinal reconstructive surgery, enterohormone therapies, and interventional radiology, have expanded non-transplant options and altered referral patterns. Yet acceptance rates and reasons for non-listing remain poorly characterized. METHODS:We retrospectively reviewed all adult ITx referrals at a comprehensive intestinal rehabilitation and transplant centre between January 2018 and December 2025, examining multidisciplinary team decisions, reasons for non-listing, patient characteristics, and use of non-transplant modalities. RESULTS:Of 55 referred adults, 9 (16%) were transplanted and 46 (84%) were not listed. Groups did not differ significantly in age (median 49 vs 44 years, p = 0.24), sex (52% vs 66% male, p = 0.54), parenteral support-dependence (56% vs 66%, p = 0.82), or comorbidity burden (median CCI 2 vs 3, p = 0.77). The predominant reason for non-listing was absence of current indication (41%), followed by 'too early' assessment (34%) and contraindications (21%). Notably, 6/9 (67%) patients ultimately transplanted were initially deemed 'too early'. Non-transplant alternatives were identified in 72% of non-listed patients, primarily medical optimization (46%) and interventional radiology (37%). One-year survival was comparable between non-listed (81%) and transplanted (78%, p = 0.95) patients. CONCLUSIONS:In the era of effective non-transplant therapies, most referrals were managed without ITx. A dynamic, individualized approach emphasizing reassessment identifies patients for whom transplantation offers the greatest benefit while avoiding unnecessary early listing.
BACKGROUND AND AIMS:This study aimed to investigate the associations between SNPs in CPA1, GGT1, and SPINK1 genes and the clinical characteristics of refractory FD including clinical symptoms, pancreatic enzyme abnormalities, and exocrine pancreatic function. METHODS:97 Patients with FD, 74 refractory FD and 116 control group were recruited. Five pancreatic enzymes were measured. DNA was isolated from blood or duodenal tissue. The SNPs (rs4820599 for GGT1, rs17107315 for SPINK1, and rs77792157 for CPA1) were measured. Endoscopic ultrasonography (EUS) was performed for patients with refractory FD. Pancreatic function was estimated. RESULTS:The distributions of CPA1, GGT1 and SPINK1 genotypes in the refractory FD group were 67GG (90.5%), 7GA (9.5%); 42AA (56.8%), 29AG (39.2%), 3GG (4.0%) and 74AA (100%), respectively. The distributions of CPA1, GGT1 and SPINK1 genotypes in the FD group were 89GG (91.8%), 8GA (8.2%); 53AA (54.6%), 41AG (42.3%), 3GG (3.1%) and 97AA (100%), respectively. There was a numerically significant difference (p = 0.037) in the distribution of CPA1 among the refractory FD, FD, and control group in the view of no correction for three allele distributions. The N-benzoyl-p-aminobenzoic acid (BT-PABA) test, assessed as above or below 60%, showed a numerically significant difference according to GGT1 genotype, with more patients below 60% in the GGT1 AG and GG groups (p = 0.038) considering no correction for three allele distributions. CONCLUSIONS:This study identified a numerically significant association between the CPA1 GA genotype and refractory FD, suggesting a potential role for CPA1 variation in the pathogenesis of refractory FD.
OBJECTIVE:To clarify the longitudinal evolution of endoscopic findings in patients with autoimmune gastritis (AIG). MATERIAL AND METHODS:Among 106 patients diagnosed with AIG between June 2011 and September 2025, 15 with esophagogastroduodenoscopy (EGD) images available for > 10 years were retrospectively analyzed. The extent of atrophic mucosa was assessed using the AIG-atrophic stage (AIG-AS) classification based on the distribution of the residual oxyntic mucosa. The oxyntic gland area was divided into five regions, and the progression of atrophy in each region was analyzed. Early endoscopic findings, including reddish and edematous swelling of the areae gastricae and longitudinally arranged pseudopolyps, were evaluated. Hyperplastic polyps and adherent mucus, which are minor endoscopic findings in the diagnostic criteria for AIG, were also assessed. RESULTS:The median observational period was 14 years (interquartile range: 12-15 years). Early endoscopic findings were observed in 12 of the 15 patients (80.0%) at AIG-AS stages 1-2. Atrophic changes progressed in a heterogeneous manner, predominantly involving the fundus and lesser curvature of the corpus in the early phase. At the time of diagnosis, which represents a median period of 11 years from the initial EGD, 7 patients (46.7%) were classified as having stage 3. Hyperplastic polyps developed in 10 patients (66.7%) during follow-up and regressed in most patients. Adherent mucus was observed in 13 patients (86.7%) and frequently persisted. CONCLUSIONS:Characteristic endoscopic findings may precede typical corpus-dominant atrophy in AIG, highlighting the importance of early diagnosis and longitudinal surveillance.
OBJECTIVE:To evaluate whether combined detection of Helicobacter pylori (HP) infection and Claudin18.2 (CLDN18.2) expression improves risk stratification of gastric precancerous lesions within a county-level gastric cancer screening system. METHODS:A total of 1,642 high-risk individuals who underwent gastroscopy and pathological examination within the Deqing County Medical Community screening system from March 2022 to February 2024 were included. Immunohistochemistry was used to detect HP infection and CLDN18.2 expression. Gastric precancerous lesions were defined as the primary outcome. Associations were analyzed using χ2 test and multivariate logistic regression analysis, and the combined effects of the two markers were evaluated. RESULTS:The gastroscopy completion rate was 86.60%. A total of 391 cases of gastric precancerous lesions (23.81%) and 14 cases of early gastric cancer (0.85%) were detected. Age, history of chronic gastritis, HP infection, and CLDN18.2 positivity were independent risk factors (all p < 0.001). Combined analysis revealed a significant dose-response relationship, and the risk of precancerous lesions increased in proportion to the number of positive markers (P for trend < 0.001). CONCLUSION:Within a county-level screening framework, HP infection and CLDN18.2 expression are independently correlated with gastric precancerous lesions. Their combined detection improves risk stratification and may support more precise and efficient gastric cancer screening strategies.
BACKGROUND:Endoscopic treatment of common bile duct (CBD) stones in patients with surgically altered anatomy is challenging because access to the duodenal papilla is often difficult. Although double balloon endoscopy-assisted ERCP (DB-ERCP) has become widespread, data on outcomes by reconstruction type remain limited. METHODS:A total of 218 patients treated between November 2016 and October 2024 were retrospectively reviewed. Among these, 212 patients were included: 159 with Roux-en-Y reconstruction (R group) and 53 with Billroth II reconstruction (B group). The primary endpoints were single-session complete stone clearance and procedure time. RESULTS:The single-session complete stone clearance rate was 94.8%, with no significant difference between groups. Procedure time was significantly longer in the R group than in the B group (66.0 vs. 50.0 min, p < 0.001). Multivariate analysis identified R group (p < 0.001), age ≥75 years (p = 0.007), and ≥5 stones (p = 0.018) as independent factors for prolonged procedure time. In addition, ≥5 stones independently reduced single-session complete stone clearance (p < 0.001). Adverse events occurred in 2.8%, including one perforation, four bleeding events, and one pancreatitis case. Only one patient required surgery. CONCLUSION:DB-ERCP achieved a high single-session complete stone clearance rate in patients with surgically altered anatomy, with outcomes comparable to those of conventional ERCP in patients with normal anatomy. These findings suggest that DB-ERCP may represent a first-line treatment option for CBD stones in surgically altered anatomy.
BACKGROUND:The number of risk prediction models for inadequate bowel preparation (IBP) before colonoscopy has increased in recent years; however, their methodological quality and clinical applicability remain uncertain. OBJECTIVE:This systematic review and meta-analysis aimed to evaluate the performance, methodological rigor, and applicability of existing IBP prediction models. METHODS:A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted from database inception to December 2025. Data were extracted using the CHARMS checklist. Risk of bias and applicability were assessed with PROBAST. A random-effects meta-analysis was performed to pool the area under the curve (AUC) of validated models, and publication bias was evaluated. RESULTS:Nineteen IBP prediction models were included. Most models (89.5%) were developed used logistic regression. The reported incidence of IBP ranged from 6.3% to 33.0%. Diabetes and constipation were the most frequently identified predictors, whereas behavioral factors related to bowel preparation were rarely incorporated. The AUCs of validated models ranged from 0.621 to 0.895. All studies were judged to have a high risk of bias, primarily due to inadequate reporting in the analysis domain. The pooled AUC of 17 validated models was 0.73 (95% CI: 0.70-0.77), indicating acceptable discrimination. CONCLUSION:Existing IBP prediction models demonstrate moderate discriminatory ability but are limited by substantial methodological bias. Future model development should emphasize stronger analytical rigor and incorporate behavioral factors to improve the identification of high-risk patients and enhance colonoscopy outcomes. REGISTRATION:This study protocol was registered with PROSPERO (registration number: CRD420250654134).
BACKGROUND AND AIM:Bleeding and perforation remain major complications after gastric endoscopic submucosal dissection (ESD). Simple clip-based closure techniques, including the reopenable-clip over-the-line method (ROLM) and the ORIGAMI method, have recently been developed in Japan, but clinical evidence supporting their use is limited. This study evaluated the feasibility and clinical effectiveness of post-ESD gastric ulcer closure using these techniques in a community hospital. METHODS:This single-center retrospective study included patients who underwent gastric ESD between April 2021 and October 2025. Patients treated from May 2023 onward who received endoscopic closure using ROLM or the ORIGAMI method were assigned to the closure group, while those treated earlier without closure comprised the non-closure group. The primary endpoint was ESD-related adverse events within 14 days, including delayed bleeding and perforation. The secondary endpoints were suturing time, number of clips used, and postoperative hospital stay. RESULTS:A total of 137 patients were analyzed (closure group, n = 51; non-closure group, n = 86). Baseline characteristics, including bleeding risk assessed by the BEST-J score, were comparable between groups. The incidence of delayed bleeding or perforation was significantly lower in the closure group than in the non-closure group (2.0% vs. 12.8%, p = 0.0317), and no delayed bleeding occurred in the closure group. Postoperative hospital stay was significantly shorter in the closure group. Endoscopic closure was successfully achieved in nearly all patients using either technique. CONCLUSIONS:Prophylactic closure of gastric ulcers after ESD using ROLM or ORIGAMI with standard clips is feasible in community hospitals and reduces post-ESD complications and hospital stay.
BACKGROUND AND AIMS:Primary sclerosing cholangitis (PSC) is associated with an increased risk of hepatobiliary malignancy, with cholangiocarcinoma (CCA) representing a leading cause of death. We aimed to evaluate characteristics and outcome after liver transplantation (LT) in individuals with PSC who had biliary high-grade dysplasia (HGD), CCA, hepatocellular carcinoma (HCC) or gallbladder carcinoma (GBC) in the liver explants. METHOD:A retrospective cohort study was conducted on individuals with PSC who underwent LT and had HGD, CCA, GBC and HCC identified by explant histology. Individuals were identified through the Nordic Liver Transplant Registry, and the original explant histology was assessed. One hundred (n = 100) individuals with PSC were included, all aged ≥18 years and liver transplanted between 2000 and 2021 at Oslo and Karolinska University Hospitals. Clinicopathological data and outcome were assessed, and survival analyses performed. RESULTS:Out of all transplanted individuals with PSC and primary hepatobiliary neoplasms (n = 100), HGD was diagnosed in 33% (n = 33), CCA in 45% (n = 45), HCC in 17% (n = 17) and GBC in 5% (n = 5) of explants. The 1-, 3- and 5-year survivals for HGD were 97%, 91% and 87%, respectively. Five-year survival was higher for individuals with HCC (82%) and HGD (87%) than for those with CCA (32%). Recurrence of hepatobiliary malignancy was less frequently observed in individuals with HCC than in those with CCA (18% vs. 58%, p = 0.004). CONCLUSION:LT in individuals with PSC-HGD and PSC-HCC, including both preoperatively suspected and incidental cases, is associated with good long-term outcomes. In contrast, the poor survival among transplanted individuals with PSC-CCA underscores the need of earlier cancer detection and optimized oncological therapy.
OBJECTIVES:Upper abdominal symptoms are common, but sex- and age-related differences remain unclear. This study evaluated symptom characteristics and sex- and age-related differences after excluding organic disease using a validated questionnaire. MATERIALS AND METHODS:Outpatients undergoing upper gastrointestinal endoscopy from 2015 to 2022 were enrolled. Eligible patients were analyzed after predefined exclusions. Symptoms were classified into reflux symptom (RS), postprandial distress syndrome-like (PDS-L), and epigastric pain syndrome-like (EPS-L) scores and compared between sexes and age strata. Multivariable linear regression analyses assessed associations of sex, age, BMI, and H. pylori infection status with these scores. RESULTS:Of 52,598 cases, 7,519 patients were analyzed. The most common symptoms were bloating, postprandial fullness, and belching. Females had higher scores for 13 of 14 symptom items, except for the acid reflux item. In contrast, the RS score, calculated from seven reflux-related items, was higher in females. PDS-L and EPS-L scores were higher in females, and all three scores decreased with age. In multivariable analyses, female sex and younger age were independently associated with higher RS, PDS-L, and EPS-L scores. BMI was negatively associated with PDS-L and EPS-L scores, whereas H. pylori infection status was not associated with any of these scores. CONCLUSIONS:Upper abdominal symptoms were more severe in females, except for the acid reflux item. The RS, PDS-L, and EPS-L scores declined with age and remained higher in females across most age groups. These findings suggest that sex and age should be considered when interpreting upper abdominal symptom scores in routine clinical practice.
BACKGROUNDS:To systematically compare the relative efficacy of different therapeutic agents for the induction and maintenance treatment of moderate-to-severe active ulcerative colitis (UC) in adult patients. METHODS:We retrieved RCTs from PubMed, Embase, Scopus and CENTRAL (2020.1.1 - 2026.1.1). A Bayesian random-effects NMA was performed, with treatment efficacy ranked by SUCRA. (Registration No. CRD420261293873). RESULTS:A total of 41 RCTs comprising 22,619 patients with moderate-to-severe active UC were included. Compared with placebo, JAK-STAT inhibitors (RR = 4.5, 95% CI 3.0-7.2), anti-TNF-α biologics (RR = 3.0, 95% CI 1.8-5.3), S1P receptor modulators (RR = 3.0, 95% CI 2.1-4.5), anti-IL-23 biologics (RR = 2.8, 95% CI 2.0-4.0), anti-integrin biologics (RR = 2.2, 95% CI 1.5-3.2) and anti-TL1A biologics (RR = 4.0, 95% CI 2.0-9.0) significantly improved clinical remission during the induction phase. Furthermore, JAK-STAT inhibitors, S1P receptor modulators, anti-IL-23 biologics, anti-TNF-α biologics, and anti-integrin biologics effectively maintained clinical remission. Monotherapy with 5-aminosalicylates (5-ASA) or immunomodulators did not demonstrate a significant benefit over placebo. Based on SUCRA probabilities, the top three regimens for induction of clinical remission were JAK-STAT inhibitors (91.5%), anti-TL1A biologics (82.3%), and anti-TNF-α biologics (70.1%). For the maintenance phase, the top three were JAK-STAT inhibitors (86.3%), S1P receptor modulators (80.5%), and anti-IL-23 biologics (59.4%). CONCLUSIONS:JAK-STAT inhibitors demonstrated optimal efficacy for achieving clinical remission in both the induction and maintenance phases of UC treatment. Additionally, targeted therapies, including anti-TNF-α, anti-IL-23, and S1P receptor modulators, provided substantial therapeutic benefits.
BACKGROUND:Cirrhotic (CPH) and non-cirrhotic portal hypertension (NCPH) can result in severe complications, including variceal bleeding, ascites, and hypersplenism. However, evidence regarding the long-term clinical impact of splenic artery embolization (SAE) in portal hypertension remains limited. PATIENTS AND METHODS:We conducted a retrospective single-center study including consecutive patients who underwent SAE for complications of portal hypertension at Sahlgrenska University Hospital, Gothenburg, Sweden, between January 2016 and December 2024. Clinical, radiological, and laboratory data were collected at baseline and during follow-up. Overall survival, gastrointestinal bleeding, complications, and changes in clinical features of portal hypertension were evaluated. RESULTS:Twenty patients were included (median age 47 years; 60% male), with an equal distribution of CPH and NCPH. The most common indication for SAE was failure of endoscopic treatment for gastroesophageal varices (50%). SAE resulted in a significant reduction in spleen volume (1,325 vs. 1,146 mL, p = 0.024) and splenic vein diameter (14 vs. 12 mm, p = 0.008), while liver function remained stable. Complications occurred in 65% of patients, with post-embolization syndrome being the most frequent (45%). Patients with CPH showed a trend toward poorer overall survival (HR 4.94, 95% CI 0.57-42.7; p = 0.15) and a trend toward a higher risk of gastrointestinal bleeding after SAE (HR 8.02, 95% CI 0.96-66.8; p = 0.054) than those with NCPH. CONCLUSIONS:SAE appears to be a feasible treatment option for portal hypertension-related complications in patients unsuitable for standard therapies, with more favorable outcomes in NCPH than CPH. Larger prospective studies are warranted to better define its role in clinical practice.
OBJECTIVES:We compared healthcare resource utilization (HCRU) and healthcare costs in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) with or without obesity, type 2 diabetes (T2D) or cardiovascular disease (CVD). METHODS:This cohort study included adults with biopsy-confirmed MASLD/MASH from three Swedish university hospitals (1974-2020). Clinical data were linked to national registers to capture long-term outcomes, HCRU and costs. In addition to the overall cohort, patients were stratified into comorbidity-positive and comorbidity-negative subgroups for obesity, T2D and CVD. HCRU outcomes were hospitalizations, length of stay and outpatient visits. Total costs were the sum of direct costs (hospitalizations, outpatient visits, prescribed drugs) and indirect costs (sickness, early retirement benefits). Negative binomial and generalized linear models were used to estimate adjusted annual HCRU and costs, respectively. RESULTS:Among 959 patients, 40%, 25% and 11% were living with obesity, T2D and CVD, respectively. Patients with T2D or CVD had more advanced fibrosis at baseline and a higher incidence of cirrhosis or hepatocellular carcinoma during follow-up (up to 46 years depending on outcome), compared with those without T2D or CVD. T2D and CVD were linked to substantially greater HCRU and costs: mean annual total costs were approximately 76% higher for CVD and 71% higher for T2D compared with subgroups without these comorbidities. CONCLUSIONS:T2D and CVD are linked to an increased economic burden in MASLD/MASH. Holistic, multidisciplinary management is essential to help mitigate disease progression and the associated clinical and economic burden.
OBJECTIVES:M2 macrophage activation contributes to pancreatitis pathophysiology and may drive progression from recurrent acute pancreatitis (RAP) to chronic disease. Evidence is mainly preclinical or cross-sectional, highlighting a need for prospective studies. METHODS:This was an exploratory analysis of a multicenter, randomized, placebo-controlled trial, which included patients with RAP randomized to naldemedine (tablet 0.2 mg daily), a peripherally acting µ-opioid receptor agonist hypothesized to reduce RAP frequency, or placebo for 12 months. Biomarkers of M2 macrophage activation (plasma levels of sCD163 and sCD206) were measured at baseline and trial end. Linear mixed-effects models assessed biomarker changes within and between treatment groups. Spearman correlation assessed associations between biomarker changes and disease activity, defined by RAP attacks and pain flares. RESULTS:Fifty-six patients with paired plasma samples were included (32 naldemedine, 24 placebo) in this exploratory analysis. Despite a numerical reduction in RAP frequency with naldemedine (hazard ratio 0.49; 95% confidence interval: 0.23 to 1.08; p = 0.076), no differences in mean change of sCD163 (-0.07 mg/L, p = 0.652) or sCD206 (0.01 mg/L, p = 0.299) were observed compared to placebo. Change in plasma levels of sCD163 correlated with the frequency of RAP attacks (rho = 0.348, p = 0.009) and pain flares (rho = 0.318, p = 0.017). No associations between disease activity and plasma levels of sCD206 were observed. CONCLUSIONS:Naldemedine did not significantly affect M2 macrophage activation, suggesting limited immunomodulatory effects. However, changes in sCD163 plasma levels correlated with clinical disease activity, highlighting macrophage activation in RAP.
BACKGROUND:To study the performance and efficacy of small bowel capsule endoscopy (SBCE) in a large cohort of patients with surgically altered gastrointestinal anatomy (SAGA). METHODS:We retrospectively reviewed all SBCE studies between January 2000 and August 2025. Patients with SAGA (prior gastrectomy, gastric bypass, small bowel resections, esophagectomy, or Whipple procedures) were matched 1:2 to patients with native gastrointestinal (GI) anatomy. Primary outcome was SBCE completion rate. Secondary outcomes included diagnostic yield, capsule retention, and GI transit times. RESULTS:A total of 102 patients with SAGA were matched to 204 patients with native GI anatomy. Gastric bypass was the most common surgical history among SAGA patients (n = 47; 46%). Use of patency capsule prior to SBCE ingestion was more frequent in the SAGA group (27% vs. 6%, p < 0.01). The most common indication for SBCE was overt GI bleeding (SAGA 43% vs. native 60%, p = 0.01).Completion rates were similar (SAGA 95% vs. native 94%, p = 0.93). Capsule retention requiring endoscopic or surgical retrieval occurred only in the native anatomy group (n = 3). Median total transit time was shorter in the SAGA group (731 vs. 818 min, p < 0.01), while median small bowel transit time was similar between the groups. Overall diagnostic yield was similar between the groups (SAGA: 48% vs. native GI anatomy: 57.4%, p = 0.13). CONCLUSIONS:SBCE is effective in patients with SAGA, demonstrating comparable completion rates and similar diagnostic yield to patients with native GI anatomy.
BACKGROUND AND AIMS:Secondary spontaneous bacterial peritonitis (SBP) prophylaxis has been shown to reduce mortality. Recent evidence, however, suggests that SBP prophylaxis may lead to adverse outcomes such as antibiotic-resistant infections and increased SBP recurrence. Among patients with SBP, we evaluated the proportion who received SBP prophylaxis and its impact on readmission with SBP, readmission with other infections and mortality. METHODS:We conducted a register-based cohort study identifying hospitalized patients in Sweden diagnosed with a first episode of SBP from the Swedish National Patient Register. The primary outcome was rates of rehospitalization due to SBP, and the secondary outcomes were rehospitalization with sepsis, Clostridium difficile and mortality. Logistic regression was used to assess factors associated with receiving SBP prophylaxis and Cox regression was used to assess the association between secondary prophylaxis and subsequent rehospitalizations and mortality. RESULTS:Of 896 patients that met study criteria, 117 (13%) dispensed secondary SBP prophylaxis within 7 days of discharge. Using multivariable Cox regression, we found that receiving SBP prophylaxis was associated with the lower rates of readmission with SBP compared to patients that did not receive prophylaxis (aHR = 0.50, 95%CI = 0.28-0.89), with no significant increase in readmission with sepsis (aHR = 1.00, 95%CI = 0.20-4.93) or Clostridium difficile (aHR = 2.11, 95%CI = 0.71-6.25). No association with mortality was found (aHR = 0.96, 95%CI = 0.73-1.25). CONCLUSIONS:In this cohort, only 13% of patients dispensed secondary antibiotic prophylaxis. These patients may experience lower rates of rehospitalization with SBP; however, no effect on mortality was seen. Further investigation into the impact of secondary SBP prophylaxis is needed.
BACKGROUND:Helicobacter pylori (H.p.) is a very common cause of chronic gastritis. As an acute phase protein, calprotectin (CP) has a significant function during inflammation. The aims were to investigate the difference of fecal CP concentration in adults with and without H.p. infection, the effect of eradication therapy on fecal CP concentration, and to correlate between fecal CP concentration and the grade of activity of chronic gastritis in both groups. METHODS:Patients complaining of abdominal pain, referred to the gastroenterology outpatient clinic, were recruited in this prospective study. They provided stool samples to be tested for fecal CP, H.p. antigen and stool analysis with culture. Upper and lower endoscopies were offered, within 48 h, to all eligible patients with elevated fecal CP concentration irrespective of H.p. infectivity. Patients with H.p. infection received eradication treatment and were asked to provide a new stool sample to test fecal CP and H. pylori antigen. RESULTS:A total of 186 patients (93 males and 93 females) were enrolled and divided into two groups according to their H.p. infectivity: 105 negative- and 81 positive-H.p. infection. Fecal CP concentration was significantly higher in the H.p. positive than negative group (p = 0·004) and significantly decreased (p < 0·0001) after receiving eradication therapy. Fecal CP concentration correlated significantly (r 0·60, p < 0·0001) with the grade of activity of H.p. induced gastritis. CONCLUSION:Fecal CP concentration can be affected by H.p. infection. Helicobacter pylori eradication may improve fecal CP concentration.
BACKGROUND AND AIMS:Textbook outcome (TO) and textbook oncological outcome (TOO) are two multidimensional quality measures designed to evaluate and benchmark the surgical and oncological outcomes following esophagectomy. Most studies on TO and TOO originate from high-volume tertiary centers, whereas less is known about the outcome from low- to medium-sized centers. METHODS:Retrospective national cohort study of patients operated for esophageal cancer with Ivor Lewis or McKeown esophagectomy between 07/2021 and 06/2025. The primary outcome was the fraction of patients achieving TO defined as no 30-days mortality, no Clavien-Dindo complications ≥ III, length of hospital stay < 21 days, R0 resection, no re-admissions within 30 days, ≥ 15 lymph nodes harvested and no intraoperative complications. The main secondary outcome was the proportion of patients achieving TOO, defined as achievement of TO and completed neoadjuvant (radio)chemotherapy. Patients were grouped according to type of resection. RESULTS:A total of 317 patients were included. 97 (31%) of all patients achieved TO and 83 (27%) TOO, with no difference between the two surgical techniques (p = 0.40 and p = 0.94, respectively); 30-day mortality was 1%. No predictive variables of TO were identified, specifically no association was found with the annual procedural center volume, type of resection or the use of robotic-assisted technique. CONCLUSIONS:Less than one in three patients achieved TO or TOO. Neither the annual procedure volume of the individual treatment centers nor the type of resection predicted TO. The lack of a consensus-based definition of TO and TOO makes comparisons across patient series challenging.
BACKGROUND/AIMS:Sigmoid colon perforations during colonoscopy are technically challenging to close endoscopically because of fixed angulation and luminal redundancy. This study compared the endoloop-clip technique with conventional hemoclips for the closure of large sigmoid colon perforations. METHODS:In this prospective, randomized, controlled ex vivo study, 40 standardized full-thickness 3-cm defects were created in fresh porcine sigmoid colon specimens and randomly assigned (1:1) to hemoclip closure (n = 20) or endoloop-clip closure (n = 20). Two experienced endoscopists each performed 10 closures per group. An independent observer recorded total procedure time, ineffective clip placements, and closure outcomes using air insufflation and underwater leak testing. RESULTS:Closure was successfully achieved in most cases, with a technical success rate of 95% in both groups. Procedure time was shorter with endoloop-clip than with hemoclips alone (10.8 ± 2.5 vs 14.5 ± 7.3 min; p = 0.044), and ineffective clip placements per case were fewer (0.05 ± 0.22 vs 0.70 ± 0.98; p = 0.009). The mean number of hemoclips used was not significantly different (7.9 ± 1.7 vs 9.1 ± 2.4; p = 0.083). Complete closure by air insufflation and underwater leak testing was achieved in 65% (13/20) vs 50% (10/20) (p = 0.337). Inter-operator differences in procedure time and clip use were observed in the hemoclip group, although these did not reach statistical significance. CONCLUSION:In a standardized ex vivo porcine model of a 3-cm sigmoid colon perforation, the endoloop-clip technique reduced procedure time and ineffective clip placement while achieving closure outcomes comparable to those of hemoclips alone.
