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| GASTROENTEROLOGY ELSEWHERE |
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| Year : 2023 | Volume
: 3
| Issue : 2 | Page : 64-65 |
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Gastroenterology elsewhere
Kayalvizhi Jayaraman
Department of Medical Gastroenterology, SIMS Institute of Gastroenterology Hepatobiliary Sciences and Liver Transplantation, SRM Institute for Medical Science, Chennai, Tamil Nadu, India
| Date of Submission | 05-Feb-2023 |
| Date of Acceptance | 08-Feb-2023 |
| Date of Web Publication | 09-Mar-2023 |
Correspondence Address:
Kayalvizhi Jayaraman
SIMS Institute of Gastroenterology Hepatobiliary Sciences and Liver Transplantation, SRM Institute for Medical Science, No. 1, Jawaharlal Nehru Salai, 100 Feet Road, Vadapalani, Chennai - 600 026, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ghep.ghep_7_23
How to cite this article:
Jayaraman K. Gastroenterology elsewhere. Gastroenterol Hepatol Endosc Pract 2023;3:64-5 |
| Inflammatory Bowel Disease is an Independent Risk Factor for Fatty Liver | |  |
Rodriguez-Duque JC, Calleja JL. Iruzubieta increased risk of MAFLD and liver fibrosis in inflammatory bowel disease independent of classic metabolic risk factors. Clin Gastroenterol Hepatol 2023;21:406-14.e7.
Immune-mediated inflammatory conditions such as psoriasis have been well-known to be associated with fatty liver disease. A similar trend has been reported in patients with inflammatory bowel disease (IBD), but there is marked heterogeneity in the diagnostic methods of fatty liver. Researchers compared 831 patients with IBD to 1718 persons from the general population matched for age, sex, and metabolic parameters. Steatosis was diagnosed with a controlled attenuation parameter >248 dB/m on FibroScan equipment. The prevalence of fatty liver was higher in IBD (42% vs. 32.8%, P < 0.001) despite having significantly lower body mass index (BMI) and lower metabolic parameters than the general population. IBD was an independent risk factor for having a fatty liver (odds ratio [OR]: 1.999, 95% confidence interval [CI]: 1.592–2.511, P < 0.001) and advanced fibrosis (OR: 5.55, 95% CI: 2.687–11.465, P < 0.001). Risk for advanced fibrosis in the IBD group prevailed even in the absence of traditional metabolic factors. Liver biopsies were done in 40 patients in the IBD group and were compared to a second control group of patients with biopsy-proven fatty liver. Mean BMI and the presence of diabetes were lower in patients with IBD. This study garners attention to the role of chronic inflammation elsewhere that contributes to fatty liver besides conventional metabolic factors. It would be valuable to have more research on the long-term outcomes such as IBD disease severity, progression to cirrhosis, and mortality.
| Motorized Spiral Enteroscopy as Good as Double Balloon Enteroscopy | | |
Chan W, Wei LK, Tan T. Motorized spiral enteroscopy versus double-balloon enteroscopy: A case-matched study. Gastrointest Endosc 2023;97:314-324.
Enteroscopy has become an indispensable tool in the evaluation and sometimes treatment of small bowel diseases. With the advent of motorized spiral enteroscopy (MSE), double balloon enteroscopy (DBE) is slowly fading out. Gastroenterologists from Singapore General hospital compare their experiences of using DBE and MSE in their centers. Thirty-one patients who underwent MSE were matched with 62 patients who underwent DBE. Technical success was achieved almost equally in both groups (DBE 98.4% vs. MSE 96.8%, P = 0.62). Diagnostic and therapeutic success was also similar in both groups. An increased frequency of adverse events was noted in the MSE group (n = 9) as compared to the DBE group (n = 1). All major adverse events (laceration and perforation) occurred in the MSE group. Maximal insertion time was shorter in the antegrade DBE (40 min) as compared to MSE (57 min), P = 0.04. This study reflects the past pieces of evidence and is a reminder to be mindful of the adverse events that come along with this innovative technique. The authors suggest caution be taken in those with prior abdominal/pelvic surgeries, significant esophageal pathology, and the presence of colitis.
| Efficacy of Hemostatic Agents in Tumoral Bleed | | |
Karna R, Deliwala S, Ramgopal B. Efficacy of topical hemostatic agents in malignancy-related GI bleeding: A systematic review and meta-analysis. Gastrointest Endosc 2023;97:202-8.e8.
Tumoral bleeds are quite a challenge in the endoscopy room, due to the diffuse and brisk nature of the bleed, with no specific vessel to target. Conventionally managed by surgical or radiological interventions, endoscopic hemostasis has come a long way. Researchers in the systematic review and meta-analysis have analyzed 16 studies including 530 patients with gastrointestinal malignant bleeding. More than half of the tumors were gastric malignancies. Primary hemostasis (varying definitions of 1 min, 3 min, and 4 min) was achieved in 94% of patients. Early rebleeding (<72 h) was observed in 13.9% (7 studies; 95% CI: 9.7–19.4; I2 = 0%) and delayed bleeding (>72 h) in 11.4% (6 studies; 95% CI: 5.8–21.1; I2 = 30.96%). Bleed-related mortality was 5.9% and all-cause mortality was 33%. Overall, the usage of topical hemostatic agents in gastrointestinal tumor bleed appears to be effective in achieving primary hemostasis, though the risk of rebleeding has to be remembered. It gives time to plan for a more definitive strategy.
| Incidence and Risk Factors – Transarterial Chemoembolization Failure Based on Untreatable Progression | | |
Zhang L, Zhang X, Li Q, Makamure J. Transarterial chemoembolization failure in patients with hepatocellular carcinoma: Incidence, manifestation, and risk factors. Clin Res Hepatol Gastroenterol 2023;47:102071.
Conventionally, transarterial chemoembolization (TACE) failure and the decision to stop further TACE sessions have been defined using the Japanese Society of Hepatology criteria. In the past decade, untreatable progression (UP) has gained momentum as it includes impaired liver function and worsening of performance status in addition to classic tumor parameters. In this study, researchers aim to find the incidence, manifestation, and risk factors for TACE failure using UP criteria. Forty-two (20.4%) out of 206 patients with hepatocellular carcinoma undergoing TACE had TACE failure. The median TACE procedure was 2, and the median follow-up days were 97. In multivariate analysis, irregular tumor margins (vs. smooth margin, P = 0.004) and absent/incomplete tumor capsule (vs. complete capsule, P ≤ 0.001) were significantly associated with TACE failure. The authors point out that the response failure of the initial intrahepatic tumor is the predominant manifestation of TACE failure and is dictated largely by the characteristics of the tumor capsule.
| “Pure” Autoimmune Gastritis – Long-Term Follow-Up and Risk of Cancer | | |
Rugge M, Bricca L, Guzzinati S, Sacchi D, Pizzi M, Savarino E, et al. Autoimmune gastritis: Long-term natural history in naïve Helicobacter pylori-negative patients. Gut 2023;72:30-8.
Autoimmune gastritis (AIG) is largely thought of as a preneoplastic condition for intestinal-type gastric neoplasms and Type I gastric carcinoids. Rugge et al., who have done extensive research in autoimmune gastritis, suggest that the increased risk for gastric cancer may have been falsely contributed by Helicobacter pylori. In this cohort of AIG, 211 patients were checked for coexistent H. pylori infection at enrollment and the end of the study (>1 year of follow-up) by serology, histology, and molecular testing. At the end of follow-up (median 7.5 years), almost all patients had persistent atrophy with progression in 11.8% and regression in 8% (P < 0.001). Most patients had operative link on gastritis assessment (OLGA) stage II at enrollment and the end of the study. None had stage IV atrophy at any point in time. OLGA II stage was associated with adenomatoid hyperplasia and Type I neuroendocrine tumor (P = 0.0001) and can be considered a risk factor for carcinoids. Intraepithelial neoplasia was seen in six patients and only two patients had a recurrence. No patient had invasive gastric cancer. There was a slight increase in thyroid malignancies in women. The authors suggest that patients with true AIG are not at an increased risk for intestinal-type gastric cancer. They are in fact at a higher risk for Type I gastric carcinoid and should be screened for the same. In addition, thyroid cancer screening should also be considered.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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