ABSTRACT Objectives A novel endoscopic suture anchor (ESA) device has been developed based on the through‐the‐scope clip (TTSC) system. We conducted this preclinical study aiming to comprehensively evaluate its feasibility, safety, and efficacy for full‐thickness defect closure. Methods Ex vivo porcine stomachs ( n = 11) and in vivo Bama porcine models ( n = 8) were used. Endoscopic full‐thickness resection (EFTR) was performed to create an artificial gastric defect, followed by defect closure using the ESA devices. The primary outcome was the closure success rate. Secondary outcomes included the technical success rate, biomechanical testing results (leakage pressure, static tensile force, and pull‐out force), closure time, complete healing rate, and incidence of adverse events (AEs). Results In ex vivo models, both the closure and technical success rates were 90.9%, with one case of suture breakage. The mean leakage pressure, static tensile force, and pull‐out force were (20.67 ± 3.20) mmHg, (4.75 ± 0.60) N, and (9.27 ± 3.42) N, respectively. In in vivo porcine models, both the closure and technical success rates reached 100%. The mean closure time was (18.75 ± 3.99) min. Complete healing was confirmed in all animals by endoscopic and histopathological assessments at the scheduled end‐points, without AEs. Conclusion ESA is feasible, safe, and effective for gastric full‐thickness defect closure and could be a promising device in clinical practice.
ABSTRACT Objectives To compare the risk of acute‐on‐chronic liver failure (ACLF) and short‐term outcomes among cirrhotic patients with single jaundice, acute decompensation (AD) (including ascites, variceal bleeding, hepatic encephalopathy, and/or bacterial infection), and non‐AD non‐jaundice. Methods We analyzed cirrhotic inpatients without obstructive jaundice enrolled from two large multicenter prospective cohorts. Patients were divided at admission into classical AD, single jaundice, or non‐AD non‐jaundice groups. Baseline characteristics, ACLF development, and short‐term outcomes were compared between groups. Results Among 2645 cirrhotic patients, classical AD, single jaundice, and non‐AD non‐jaundice were observed in 2163 (81.78%), 267 (10.09%), and 215 (8.13%), respectively. The 90‐day liver transplant (LT)‐free mortality was comparable between single jaundice patients and classical AD patients (15.09% vs. 17.81%, p = 0.266), but significantly higher than non‐AD non‐jaundice patients (2.45%; p < 0.01). The prevalence of ACLF (16.10% vs. 16.09%, p = 1.000) and pre‐ACLF (9.36% vs. 6.43%, p = 0.094) were comparable between the single jaundice and classical AD groups. Intrahepatic precipitants, particularly hepatitis B flare with hepatitis B virus (HBV) reactivation (odds ratio [OR] 2.69; p = 0.002), spontaneous hepatitis B flare with high HBV‐DNA load (OR 23.75; p < 0.001), superimposed hepatitis A/E virus infection on HBV infection (OR 13.40; p < 0.001) and hepatotoxic drug usage (OR 3.64; p < 0.001) were associated with single jaundice. Conclusions Cirrhotic inpatients with single jaundice show comparably high short‐term mortality and ACLF risk to those with classical AD. Single jaundice shall be considered as an AD event and is predominantly triggered by intrahepatic insults, warranting surveillance equivalent to classical AD and prioritized management of the precipitants.
OBJECTIVE:To quantify the global burden of inflammatory bowel disease (IBD) and IBD-attributable anemia in adults aged ≥ 60 years across 204 countries and territories from 1990 to 2021 and their projected trends through 2045 based on the Global Burden of Disease (GBD) 2021 database. METHODS:Data were extracted from the GBD 2021 database. Age-standardized rates (ASRs) were calculated by age, sex, region, and sociodemographic index (SDI). Joinpoint regression analysis was used to quantify temporal trends. Decomposition analysis assessed drivers of burden change. Concentration index methodology quantified socioeconomic inequalities. And Bayesian age-period-cohort (BAPC) models projected burden through 2045. RESULTS:Prevalent IBD cases among adults aged ≥ 60 years increased by 123% from 573 503 in 1990 to 1 278 194 in 2021, while the age-standardized prevalence rate (ASPR) remained stable. In contrast, the age-standardized incidence rate (ASIR) increased particularly among women (average annual percentage change [AAPC]: 0.31%) than in men (AAPC: 0.26%). IBD-attributable anemia affected 361 157 elder adults in 2021, with a rising ASPR in women. Mortality and disability inequalities widened, with concentration index increasing from 0.07 to 0.23 for mortality and from 0.14 to 0.25 for disability-adjusted life-years (DALYs). By 2045, prevalent cases are projected to reach 2 161 387. CONCLUSIONS:Burdens of IBD and IBD-attributable anemia in adults aged ≥ 60 years have increased substantially, driven predominantly by the demographic expansion of this population. The ASIR continues to rise, particularly among women and in lower-SDI regions, together with widening socioeconomic inequalities, highlighting the need for early diagnosis, anemia screening, frailty assessment, and equitable resource allocation.
