BACKGROUND Peptic ulcer disease(PUD)is frequently seen in patients with liver cirrhosis.However,current literature lacks data on PUD in non-alcoholic fatty liver disease(NAFLD)hospitalizations.AIM To identify trends a...BACKGROUND Peptic ulcer disease(PUD)is frequently seen in patients with liver cirrhosis.However,current literature lacks data on PUD in non-alcoholic fatty liver disease(NAFLD)hospitalizations.AIM To identify trends and clinical outcomes of PUD in NAFLD hospitalizations in the United States.METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)NAFLD hospitalizations with PUD in the United States from 2009-2019.Hospitalization trends and outcomes were highlighted.Furthermore,a control group of adult PUD hospitalizations without NAFLD was also identified for a comparative analysis to assess the influence of NAFLD on PUD.RESULTS The total number of NAFLD hospitalizations with PUD increased from 3745 in 2009 to 3805 in 2019.We noted an increase in the mean age for the study population from 56 years in 2009 to 63 years in 2019(P<0.001).Racial differences were also prevalent as NAFLD hospitalizations with PUD increased for Whites and Hispanics,while a decline was observed for Blacks and Asians.The all-cause inpatient mortality for NAFLD hospitalizations with PUD increased from 2%in 2009 to 5%in 2019(P<0.001).However,rates of Helicobacter pylori(H.pylori)infection and upper endoscopy decreased from 5%in 2009 to 1%in 2019(P<0.001)and from 60%in 2009 to 19%in 2019(P<0.001),respectively.Interestingly,despite a significantly higher comorbidity burden,we observed lower inpatient mortality(2%vs 3%,P=0.0004),mean length of stay(LOS)(11.6 vs 12.1 d,P<0.001),and mean total healthcare cost(THC)($178598 vs$184727,P<0.001)for NAFLD hospitalizations with PUD compared to non-NAFLD PUD hospitalizations.Perforation of the gastrointestinal tract,coagulopathy,alcohol abuse,malnutrition,and fluid and electrolyte disorders were identified to be independent predictors of inpatient mortality for NAFLD hospitalizations with PUD.CONCLUSION Inpatient mortality for NAFLD hospitalizations with PUD increased for the study period.However,there was a significant decline in the rates of H.pylori infection and upper endoscopy for NAFLD hospitalizations with PUD.After a comparative analysis,NAFLD hospitalizations with PUD had lower inpatient mortality,mean LOS,and mean THC compared to the non-NAFLD cohort.展开更多
BACKGROUND Acute pancreatitis(AP)in liver transplant(LT)recipients may lead to poor clinical outcomes and development of severe complications.AIM We aimed to assess national trends,clinical outcomes,and the healthcare...BACKGROUND Acute pancreatitis(AP)in liver transplant(LT)recipients may lead to poor clinical outcomes and development of severe complications.AIM We aimed to assess national trends,clinical outcomes,and the healthcare burden of LT hospitalizations with AP in the United States(US).METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)LT hospitalizations with AP in the US from 2007–2019.Non-LT AP hospitalizations served as controls for comparative analysis.National trends of hospitalization characteristics,clinical outcomes,complications,and healthcare burden for LT hospitalizations with AP were highlighted.Hospitalization characteristics,clinical outcomes,complications,and healthcare burden were also compared between the LT and non-LT cohorts.Furthermore,predictors of inpatient mortality for LT hospitalizations with AP were identified.All P values≤0.05 were considered statistically significant.RESULTS The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019.There was a rising trend of Hispanic(16.5%in 2007 to 21.1%in 2018,P-trend=0.0009)and Asian(4.3%in 2007 to 7.4%in 2019,p-trend=0.0002)LT hospitalizations with AP,while a decline was noted for Blacks(11%in 2007 to 8.3%in 2019,P-trend=0.0004).Furthermore,LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index(CCI)score≥3 increased from 41.64%in 2007 to 62.30%in 2019(P-trend<0.0001).We did not find statistically significant trends in inpatient mortality,mean length of stay(LOS),and mean total healthcare charge(THC)for LT hospitalizations with AP despite rising trends of complications such as sepsis,acute kidney failure(AKF),acute respiratory failure(ARF),abdominal abscesses,portal vein thrombosis(PVT),and venous thromboembolism(VTE).Between 2007–2019,6863 LT hospitalizations with AP were compared to 5649980 non-LT AP hospitalizations.LT hospitalizations with AP were slightly older(53.5 vs 52.6 years,P=0.017)and had a higher proportion of patients with CCI≥3(51.5%vs 19.8%,P<0.0001)compared to the non-LT cohort.Additionally,LT hospitalizations with AP had a higher proportion of Whites(67.9%vs 64.6%,P<0.0001)and Asians(4%vs 2.3%,P<0.0001),while the non-LT cohort had a higher proportion of Blacks and Hispanics.Interestingly,LT hospitalizations with AP had lower inpatient mortality(1.37%vs 2.16%,P=0.0479)compared to the non-LT cohort despite having a higher mean age,CCI scores,and complications such as AKF,PVT,VTE,and the need for blood transfusion.However,LT hospitalizations with AP had a higher mean THC($59596 vs$50466,P=0.0429)than the non-LT cohort.CONCLUSION In the US,LT hospitalizations with AP were on the rise,particularly for Hispanics and Asians.However,LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.展开更多
The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy,magnification endoscopy,and narrow-band imaging,more recently supplemented by artificia...The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy,magnification endoscopy,and narrow-band imaging,more recently supplemented by artificial intelligence,have enabled wider recognition and detection of various gastric neoplasms including early gastric cancer(EGC)and subepithelial tumors,such as gastrointestinal stromal tumors and neuroendocrine tumors.Over the last decade,the evolution of novel advanced therapeutic endoscopic techniques,such as endoscopic mucosal resection,endoscopic submucosal dissection,endoscopic fullthickness resection,and submucosal tunneling endoscopic resection,along with the advent of a broad array of endoscopic accessories,has provided a promising and yet less invasive strategy for treating gastric neoplasms with the advantage of a reduced need for gastric surgery.Thus,the management algorithms of various gastric tumors in a defined subset of the patient population at low risk of lymph node metastasis and amenable to endoscopic resection,may require revision considering upcoming data given the high success rate of en bloc resection by experienced endoscopists.Moreover,endoscopic surveillance protocols for precancerous gastric lesions will continue to be refined by systematic reviews and meta-analyses of further research.However,the lack of familiarity with subtle endoscopic changes associated with EGC,as well as longer procedural time,evolving resection techniques and tools,a steep learning curve of such high-risk procedures,and lack of coding are issues that do not appeal to many gastroenterologists in the field.This review summarizes recent advances in the endoscopic management of gastric neoplasms,with special emphasis on diagnostic and therapeutic methods and their future prospects.展开更多
Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastr...Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastrointestinal(GI)tract provides a unique opportunity to access multiple vascular structures,especially in the mediastinum and abdomen,thus permitting a variety of EUS-guided vascular interventions.The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract.EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy.EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity,thus,avoiding radiation exposure.EUS-guided techniques also allow real-time microscopic examination after target biopsy.Furthermore,many necessary interventions can be done during the same procedure after diagnosis.This article provides an overview of EUS-guided vascular interventions such as variceal,non-variceal bleeding interventions,EUSguided portal vein(PV)access with the formation of an intrahepatic portosystemic shunt,and techniques related to diagnosis of GI malignancies.Furthermore,we discuss current insights and future outlook of therapeutic modalities like PV embolization,PV sampling,angiography,drug administration,and portal pressure measurement.展开更多
BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitali...BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.METHODS This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and 2018.Patients<18 years,elective,and traumatic hospitalizations were excluded from this study.We identified hospitalization characteristics and readmission rates for each calendar year.Trends of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital factors.Furthermore,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations.Stata®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically significant.RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC.We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions.However,we found an increasing trend of mean THC for UC readmissions.After comparison,there was no statistical difference in the trends for 30 d all-cause readmission rate,inpatient mortality,and mean LOS between CD and UC readmissions.CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.展开更多
文摘BACKGROUND Peptic ulcer disease(PUD)is frequently seen in patients with liver cirrhosis.However,current literature lacks data on PUD in non-alcoholic fatty liver disease(NAFLD)hospitalizations.AIM To identify trends and clinical outcomes of PUD in NAFLD hospitalizations in the United States.METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)NAFLD hospitalizations with PUD in the United States from 2009-2019.Hospitalization trends and outcomes were highlighted.Furthermore,a control group of adult PUD hospitalizations without NAFLD was also identified for a comparative analysis to assess the influence of NAFLD on PUD.RESULTS The total number of NAFLD hospitalizations with PUD increased from 3745 in 2009 to 3805 in 2019.We noted an increase in the mean age for the study population from 56 years in 2009 to 63 years in 2019(P<0.001).Racial differences were also prevalent as NAFLD hospitalizations with PUD increased for Whites and Hispanics,while a decline was observed for Blacks and Asians.The all-cause inpatient mortality for NAFLD hospitalizations with PUD increased from 2%in 2009 to 5%in 2019(P<0.001).However,rates of Helicobacter pylori(H.pylori)infection and upper endoscopy decreased from 5%in 2009 to 1%in 2019(P<0.001)and from 60%in 2009 to 19%in 2019(P<0.001),respectively.Interestingly,despite a significantly higher comorbidity burden,we observed lower inpatient mortality(2%vs 3%,P=0.0004),mean length of stay(LOS)(11.6 vs 12.1 d,P<0.001),and mean total healthcare cost(THC)($178598 vs$184727,P<0.001)for NAFLD hospitalizations with PUD compared to non-NAFLD PUD hospitalizations.Perforation of the gastrointestinal tract,coagulopathy,alcohol abuse,malnutrition,and fluid and electrolyte disorders were identified to be independent predictors of inpatient mortality for NAFLD hospitalizations with PUD.CONCLUSION Inpatient mortality for NAFLD hospitalizations with PUD increased for the study period.However,there was a significant decline in the rates of H.pylori infection and upper endoscopy for NAFLD hospitalizations with PUD.After a comparative analysis,NAFLD hospitalizations with PUD had lower inpatient mortality,mean LOS,and mean THC compared to the non-NAFLD cohort.
文摘BACKGROUND Acute pancreatitis(AP)in liver transplant(LT)recipients may lead to poor clinical outcomes and development of severe complications.AIM We aimed to assess national trends,clinical outcomes,and the healthcare burden of LT hospitalizations with AP in the United States(US).METHODS The National Inpatient Sample was utilized to identify all adult(≥18 years old)LT hospitalizations with AP in the US from 2007–2019.Non-LT AP hospitalizations served as controls for comparative analysis.National trends of hospitalization characteristics,clinical outcomes,complications,and healthcare burden for LT hospitalizations with AP were highlighted.Hospitalization characteristics,clinical outcomes,complications,and healthcare burden were also compared between the LT and non-LT cohorts.Furthermore,predictors of inpatient mortality for LT hospitalizations with AP were identified.All P values≤0.05 were considered statistically significant.RESULTS The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019.There was a rising trend of Hispanic(16.5%in 2007 to 21.1%in 2018,P-trend=0.0009)and Asian(4.3%in 2007 to 7.4%in 2019,p-trend=0.0002)LT hospitalizations with AP,while a decline was noted for Blacks(11%in 2007 to 8.3%in 2019,P-trend=0.0004).Furthermore,LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index(CCI)score≥3 increased from 41.64%in 2007 to 62.30%in 2019(P-trend<0.0001).We did not find statistically significant trends in inpatient mortality,mean length of stay(LOS),and mean total healthcare charge(THC)for LT hospitalizations with AP despite rising trends of complications such as sepsis,acute kidney failure(AKF),acute respiratory failure(ARF),abdominal abscesses,portal vein thrombosis(PVT),and venous thromboembolism(VTE).Between 2007–2019,6863 LT hospitalizations with AP were compared to 5649980 non-LT AP hospitalizations.LT hospitalizations with AP were slightly older(53.5 vs 52.6 years,P=0.017)and had a higher proportion of patients with CCI≥3(51.5%vs 19.8%,P<0.0001)compared to the non-LT cohort.Additionally,LT hospitalizations with AP had a higher proportion of Whites(67.9%vs 64.6%,P<0.0001)and Asians(4%vs 2.3%,P<0.0001),while the non-LT cohort had a higher proportion of Blacks and Hispanics.Interestingly,LT hospitalizations with AP had lower inpatient mortality(1.37%vs 2.16%,P=0.0479)compared to the non-LT cohort despite having a higher mean age,CCI scores,and complications such as AKF,PVT,VTE,and the need for blood transfusion.However,LT hospitalizations with AP had a higher mean THC($59596 vs$50466,P=0.0429)than the non-LT cohort.CONCLUSION In the US,LT hospitalizations with AP were on the rise,particularly for Hispanics and Asians.However,LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.
文摘The development and clinical application of new diagnostic endoscopic technologies such as endoscopic ultrasonography with biopsy,magnification endoscopy,and narrow-band imaging,more recently supplemented by artificial intelligence,have enabled wider recognition and detection of various gastric neoplasms including early gastric cancer(EGC)and subepithelial tumors,such as gastrointestinal stromal tumors and neuroendocrine tumors.Over the last decade,the evolution of novel advanced therapeutic endoscopic techniques,such as endoscopic mucosal resection,endoscopic submucosal dissection,endoscopic fullthickness resection,and submucosal tunneling endoscopic resection,along with the advent of a broad array of endoscopic accessories,has provided a promising and yet less invasive strategy for treating gastric neoplasms with the advantage of a reduced need for gastric surgery.Thus,the management algorithms of various gastric tumors in a defined subset of the patient population at low risk of lymph node metastasis and amenable to endoscopic resection,may require revision considering upcoming data given the high success rate of en bloc resection by experienced endoscopists.Moreover,endoscopic surveillance protocols for precancerous gastric lesions will continue to be refined by systematic reviews and meta-analyses of further research.However,the lack of familiarity with subtle endoscopic changes associated with EGC,as well as longer procedural time,evolving resection techniques and tools,a steep learning curve of such high-risk procedures,and lack of coding are issues that do not appeal to many gastroenterologists in the field.This review summarizes recent advances in the endoscopic management of gastric neoplasms,with special emphasis on diagnostic and therapeutic methods and their future prospects.
文摘Endoscopic ultrasound(EUS)is one of the significant breakthroughs in the field of advanced endoscopy.In the last two decades,EUS has evolved from a diagnostic tool to a real-time therapeutic modality.The luminal gastrointestinal(GI)tract provides a unique opportunity to access multiple vascular structures,especially in the mediastinum and abdomen,thus permitting a variety of EUS-guided vascular interventions.The addition of the doppler and contrast-enhanced capability to EUS has further helped provide real-time visualization of blood flow in vessels through the GI tract.EUS-guided vascular interventions rely on standard endoscopic accessories and interventional tools such as fine-needle aspiration needles and fine-needle biopsy.EUS allows the visualization of various structures in real-time by differentiating tissue densities and vascularity,thus,avoiding radiation exposure.EUS-guided techniques also allow real-time microscopic examination after target biopsy.Furthermore,many necessary interventions can be done during the same procedure after diagnosis.This article provides an overview of EUS-guided vascular interventions such as variceal,non-variceal bleeding interventions,EUSguided portal vein(PV)access with the formation of an intrahepatic portosystemic shunt,and techniques related to diagnosis of GI malignancies.Furthermore,we discuss current insights and future outlook of therapeutic modalities like PV embolization,PV sampling,angiography,drug administration,and portal pressure measurement.
文摘BACKGROUND The prevalence of Crohn’s disease(CD)and ulcerative colitis(UC)is on the rise worldwide.This rising prevalence is concerning as patients with CD and UC may frequently relapse leading to recurrent hospitalizations and increased healthcare utilization.AIM To identify trends and adverse outcomes for 30 d readmissions for CD and UC.METHODS This was a retrospective,interrupted trends study involving all adult(≥18 years)30 d readmissions of CD and UC from the National Readmission Database(NRD)between 2008 and 2018.Patients<18 years,elective,and traumatic hospitalizations were excluded from this study.We identified hospitalization characteristics and readmission rates for each calendar year.Trends of inpatient mortality,mean length of hospital stay(LOS)and mean total hospital cost(THC)were calculated using a multivariate logistic trend analysis adjusting for age,gender,insurance status,comorbidity burden and hospital factors.Furthermore,trends between CD and UC readmissions were compared using regression of the interaction coefficient after adjusting for age and gender to determine relative trends between the two populations.Stata®Version 16 software(StataCorp,TX,United States)was used for statistical analysis and P value≤0.05 were considered statistically significant.RESULTS Total number of 30 d readmissions increased from 6202 in 2010 to 7672 in 2018 for CD and from 3272 in 2010 to 4234 in 2018 for UC.We noted increasing trends for 30-day all-cause readmission rate of CD from 14.9%in 2010 to 17.6%in 2018(P-trend<0.001),CD specific readmission rate from 7.1%in 2010 to 8.2%in 2018(P-trend<0.001),30-day all-cause readmission rate of UC from 14.1%in 2010 to 15.7%in 2018(P-trend=0.003),and UC specific readmission rate from 5.2%in 2010 to 5.6%in 2018(P-trend=0.029).There was no change in the risk adjusted trends of inpatient mortality and mean LOS for CD and UC readmissions.However,we found an increasing trend of mean THC for UC readmissions.After comparison,there was no statistical difference in the trends for 30 d all-cause readmission rate,inpatient mortality,and mean LOS between CD and UC readmissions.CONCLUSION There was an increase in total number of 30 d readmissions for CD and UC with a trend towards increasing 30 d all-cause readmission rates.
