OBJECTIVES: An increased gradient of alcohol intake distinguished distinct clinical outcome risks across steatotic liver disease (SLD) subcategories, including metabolic dysfunction-associated steatotic liver disease (MA...OBJECTIVES: An increased gradient of alcohol intake distinguished distinct clinical outcome risks across steatotic liver disease (SLD) subcategories, including metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol liver disease (ALD). However, association between alcohol intake and pre-sarcopenia risk was not studied. METHODS: All adult participants with complete data of alcohol intake, controlled transient elastography and dual-energy X-ray absorptiometry were collected from the National Health and Nutrition Examination Survey 2017-2018. The pre-sarcopenia burden was compared between SLD and non-SLD, also across SLD subcategories. Association between alcohol intake and pre-sarcopenia risk was evaluated by logistic regression and restricted cubic spline analysis. RESULTS: Among 1506 evaluable participants, there were 836 non-SLD participants, 354 MASLD, 185 MetALD, 115 ALD and 16 cryptogenic SLD participants. The prevalence of pre-sarcopenia in SLD was higher than that in non-SLD (14.93% vs. 5.02%). Regardless of sex, three SLD subcategories had the lower appendicular lean mass index than non-SLD group. The pre-sarcopenia prevalence was only higher among males in SLD subcategories than non-SLD group. An L-shaped negative nonlinear relationship between alcohol intake and pre-sarcopenia was observed in females (0-28 g/day), but not in males. Logistic regression showed physical inactivity, lower creatinine, higher weight-adjusted waist index and sex male were associated with increased pre-sarcopenia risk. CONCLUSION: Regardless of sex, MASLD, MetALD or ALD had a higher pre-sarcopenia burden than non-SLD. A nonlinear relationship between low-moderate alcohol intake and pre-sarcopenia risk was revealed in females.
This meta-analysis aimed to systematically evaluate the efficacy (including improvement of biochemical indicators and clinical outcomes) and safety of the molecular adsorbent recirculating system (MARS) in the treatment...This meta-analysis aimed to systematically evaluate the efficacy (including improvement of biochemical indicators and clinical outcomes) and safety of the molecular adsorbent recirculating system (MARS) in the treatment of hepatic encephalopathy associated with liver failure. PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were systematically searched from inception to April 2024. Predefined inclusion criteria were used to assess study quality, and statistical analyses were performed using RevMan 5.4. Seven studies were included. Results showed that MARS significantly improved hemoglobin [standard mean difference (SMD): -0.81, 95% confidence interval (CI): -1.42 to -0.19, P = 0.01], creatinine (SMD: -0.46, 95% CI: -0.68 to -0.24, P < 0.0001), and international normalized ratio (INR) (SMD: -0.22, 95% CI: -0.43 to -0.01, P = 0.004). However, effects on albumin (SMD: 0.60, 95% CI: -0.22 to 1.41, P = 0.15) and bilirubin (SMD: -0.21, 95% CI: -0.78 to 0.35, P = 0.46) were NS. No significant association was observed between MARS treatment and increased risk of bleeding (risk ratio: 1.23, 95% CI: 0.83 to 1.81, P = 0.30) or infection (risk ratio: 1.23, 95% CI: 0.97 to 1.56, P = 0.09). In conclusion, preliminary analysis suggests that MARS may help improve creatinine and INR levels in hepatic encephalopathy patients without significantly increasing bleeding or infection risks. However, because of the limited number and suboptimal quality of included studies and presence of heterogeneity, current evidence is insufficient. Rigorously designed, adequately powered, high-quality randomized controlled trials are needed to validate the precise efficacy and safety of MARS in hepatic encephalopathy treatment.
BACKGROUND AND AIMS: Patients with cirrhosis may require enteral access; however, the safety of percutaneous gastrostomy tube placement in this population remains unclear. We aimed to evaluate the safety of percutaneous...BACKGROUND AND AIMS: Patients with cirrhosis may require enteral access; however, the safety of percutaneous gastrostomy tube placement in this population remains unclear. We aimed to evaluate the safety of percutaneous gastrostomy tube placement in patients with compensated and decompensated cirrhosis compared with non-cirrhotic controls. METHODS AND RESULTS: Study cohorts were identified using the TriNetX US Collaborative Network database. Adult individuals with cirrhosis who underwent percutaneous gastrostomy placement were categorized as having compensated or decompensated cirrhosis and compared with matched non-cirrhotic controls. We assessed 30-day post-procedural complications. A total of 160 893 patients without cirrhosis, 2279 patients with compensated cirrhosis, and 3564 patients with decompensated cirrhosis who underwent percutaneous gastrostomy placement were identified. After matching, patients with decompensated cirrhosis experienced significantly higher rates of percutaneous gastrostomy-related hemorrhage [adjusted odds ratio (aOR) 2.37 (1.27-4.44)], percutaneous gastrostomy malfunction [aOR 1.68 (1.36-2.07)], peritonitis [aOR 13.67 (8.21-15.79)], sepsis [aOR 2.02 (1.74-2.34)], perforation [aOR 4.44 (2.23-8.84)], and gastrointestinal bleeding [aOR 2.99 (2.27-3.93)] compared with non-cirrhotic controls. However, in the compensated group, there were no significant differences in all complications, except mortality, compared with non-cirrhotic controls. CONCLUSION: In this large real-world cohort study, patients with decompensated cirrhosis were at higher risk of gastrostomy-related complications compared with non-cirrhotic controls. However, gastrostomy tube placement was found to be safe in patients with compensated cirrhosis. These findings highlight the importance of careful risk stratification and patient selection when considering gastrostomy tube placement in patients with cirrhosis.
BACKGROUND: Colorectal cancer is a major global health burden, with most cases arising from adenomatous polyps. Although colonoscopy is the gold standard for detection, its effectiveness is operator-dependent. Artificial...BACKGROUND: Colorectal cancer is a major global health burden, with most cases arising from adenomatous polyps. Although colonoscopy is the gold standard for detection, its effectiveness is operator-dependent. Artificial intelligence-assisted systems have been developed to improve adenoma detection, but their comparative performance remains unclear. METHODS: We performed a systematic review and Bayesian network meta-analysis of randomized controlled trials comparing artificial intelligence-assisted with standard colonoscopy. PubMed, Scopus, and Google Scholar were searched up to 4 November 2025. Eligible studies included adults undergoing colonoscopy and reporting adenoma detection rate (ADR) and adenomas per colonoscopy (APC). Secondary outcomes included withdrawal time and detection of advanced and sessile serrated lesions. Risk of bias was assessed using Cochrane RoB 2.0, and certainty of evidence was evaluated with CINeMA. RESULTS: A total of 48 randomized controlled trials (34 106 participants) were included. Artificial intelligence-assisted colonoscopy significantly improved ADR compared with standard colonoscopy. EndoAngel showed the greatest effect [odds ratio (OR): 1.84, surface under the cumulative ranking curve (SUCRA): 0.9], followed by EndoAID (OR: 1.64, SUCRA: 0.7), CAD-EYE (OR: 1.46, SUCRA: 0.5), and GI Genius (OR: 1.45, SUCRA: 0.5). For APC, EndoAID demonstrated the largest benefit (mean difference: 0.62). EndoAngel modestly increased withdrawal time (mean difference: 1.14 minutes). No system significantly improved detection of advanced or sessile serrated lesions. Heterogeneity was low, and certainty of evidence was moderate. CONCLUSION: Artificial intelligence-assisted colonoscopy improves adenoma detection; however, differences between systems are small, and benefits for high-risk lesions remain uncertain. Further head-to-head trials and cost-effectiveness studies are needed.
BACKGROUND: Persistent heartburn is a common indication for gastroscopy. However, the diagnostic yield and contribution of patient-level factors, including ethnicity, to clinically significant findings (CSFs) remain inco...BACKGROUND: Persistent heartburn is a common indication for gastroscopy. However, the diagnostic yield and contribution of patient-level factors, including ethnicity, to clinically significant findings (CSFs) remain incompletely defined. METHODS: This retrospective cohort included 6813 adults who underwent gastroscopy between 2012 and 2023 for persistent heartburn despite prior acid-suppressive therapy. Arab ( n = 1831) and Jewish ( n = 4982) patients were compared in terms of demographics, treatment history, procedural characteristics, and endoscopic outcomes. Multivariable logistic regression identified independent predictors of CSFs. RESULTS: Arab patients were significantly older than Jewish patients (56.2 ± 18.7 vs. 50.2 ± 14.6 years; P < 0.001), with no difference in sex distribution. Pre-endoscopy treatment differed markedly by ethnicity: Arab patients more frequently received antacids only (17.6 vs. 3.2%) or H2-blockers (18.0 vs. 11.5%), whereas Jewish patients were more likely to receive proton pump inhibitors (PPIs), including high-dose and twice-daily regimens. CSFs were more prevalent among Arabs (18.9 vs. 12.3%; P < 0.001), primarily because of higher rates of Barrett's esophagus and severe reflux esophagitis. Multivariable analysis showed that Arab ethnicity, male sex, older age, and presence of hiatus hernia were independently associated with CSFs, while adequate PPI therapy (particularly prolonged or high-dose regimens) was protective. CONCLUSION: Gastroscopy in patients with persistent heartburn frequently reveals clinically significant esophageal pathology, particularly among Arab patients. Ethnic disparities in pre-endoscopy management and outcomes suggest that tailored therapy may mitigate disease burden and improve endoscopy utilization.
Gastric atrophy is a precursor in the Correa cascade leading to gastric cancer, yet the precise magnitude of risk remains uncertain, particularly in low-incidence Western populations. We performed a systematic review and...Gastric atrophy is a precursor in the Correa cascade leading to gastric cancer, yet the precise magnitude of risk remains uncertain, particularly in low-incidence Western populations. We performed a systematic review and meta-analysis of observational studies published between 2010 and 2024 to evaluate gastric cancer risk in gastric atrophy, with stratification by anatomical distribution. Ten studies comprising 21 006 patients were included. Pooled analysis demonstrated a markedly increased risk of gastric cancer in gastric atrophy, with a standardised incidence ratio of 20.7 (95% confidence interval: 14.0-30.2). Subgroup analysis confirmed significantly higher risk with extensive gastric atrophy compared with antral-predominant disease (pooled odds ratio: 0.27), supporting current guideline stratification. We also reviewed studies excluded from pooled analysis, including several large European cohorts that initially appeared eligible but failed on methodological grounds. Common limitations included inadequate distinction between gastric atrophy and intestinal metaplasia, lack of stratification between autoimmune and Helicobacter pylori-associated atrophy, and use of Operative Link staging systems without atrophy-specific outcomes. These exclusions highlight the fragility of the Western evidence base and its limited ability to inform surveillance recommendations. Our findings extend prior meta-analyses by incorporating topography-specific risk estimates and explicitly identifying evidence gaps in Western populations. Gastric atrophy confers a markedly increased risk of gastric cancer, particularly when extensive. Standardised biopsy mapping and atrophy-specific reporting are needed to refine surveillance strategies and tailor guidelines to regional risk profiles. Current surveillance recommendations for distal gastric atrophy in low-risk Western populations should be applied cautiously, given the evidence and absence of robust prospective data.
OBJECTIVES: To quantify the safety impact of using Microstream capnography monitoring during procedural sedation for gastrointestinal procedures and bronchoscopy and to identify a risk-stratification method. METHODS: A q...OBJECTIVES: To quantify the safety impact of using Microstream capnography monitoring during procedural sedation for gastrointestinal procedures and bronchoscopy and to identify a risk-stratification method. METHODS: A quality improvement initiative at hospitals in Belgium, Canada, Spain, Turkey, and the UK included 6734 procedures in adults undergoing procedural sedation, who received either Microstream capnography monitoring added to standard monitoring, or standard monitoring only. The primary outcome was the incidence of any intraoperative adverse event. Incidence of any severe adverse event was assessed separately. American Society of Anesthesiologists classification, sedatives, procedure time, and procedure type were used to adjust odds ratios (OR) derived from logistic regressions for adverse events and applied in risk stratification. RESULTS: Adverse event incidence decreased from 10.8% standard monitoring to 6.7% using capnography, with a number needed to treat (NNT) of 24. The adjusted ORs were 0.54 (95% confidence interval (CI): 0.44-0.66, P < 0.001) for any adverse event and 0.46 (95% CI: 0.26-0.83, P = 0.01) for any severe adverse event. Procedures were stratified into low- ( N = 1292, 25.6%), medium- ( N = 2383, 47.2%), and high-risk ( N = 1376, 27.2%) groups. Capnography monitoring significantly decreased adverse events in all risk groups with absolute risk reductions (NNT) of 3.8% (26), 4.6% (22), and 6.7% (15) for low- to high-risk groups, respectively. Severe adverse events significantly decreased with capnography in the high-risk group only (3.5% vs. 0.9%; OR 0.25, 95% CI: 0.10-0.60; NNT = 38). The risk stratification model should be considered exploratory and requires further validation. CONCLUSION: Capnography in procedural sedation significantly reduced both any and severe adverse events and should benefit patients in routine practice. We recommend considering American Society of Anesthesiologists level, sedation type, and planned procedure time in future risk stratification evaluations.
Su Y, Wang Q, Sun X
… +4 more, Zhao X, Zhao X, Jia J, Shan S
Eur J Gastroenterol Hepatol
· 2026 Aug · PMID 42065995
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OBJECTIVES: Immunoglobulin G (IgG) elevation is a key laboratory finding of autoimmune hepatitis (AIH). However, the IgG elevation also occurs in patients with cirrhosis due to diverse etiologies. Therefore, we compared...OBJECTIVES: Immunoglobulin G (IgG) elevation is a key laboratory finding of autoimmune hepatitis (AIH). However, the IgG elevation also occurs in patients with cirrhosis due to diverse etiologies. Therefore, we compared serum levels of globulin (GLB) and immunoglobulins among cirrhotic patients and optimized the IgG level to improve its diagnostic accuracy for AIH in the context of cirrhosis. METHODS: In this cross-sectional study, we included age- and gender-matched patients with cirrhosis due to AIH and non-AIH etiologies. Demographic and key laboratory profiles were compared, focusing on the levels of GLB and immunoglobulins. Receiver operating characteristic curves were constructed. Bilateral P < 0.05 and area under receiver operating characteristic curves greater than 0.5 were considered statistically significant. RESULTS: A total of 60 AIH patients and 259 patients with cirrhosis of non-AIH etiologies were analyzed. The AIH group exhibited higher alanine aminotransferase and aspartate aminotransferase levels. Elevations of GLB (9.8-58.3%) and IgG (47.4-97.2%) levels were observed in all groups of cirrhosis, with the highest levels of IgG, immunoglobulin M, and immunoglobulin A occurring in the patients with cirrhosis due to AIH, primary biliary cholangitis, and alcoholic liver disease group, respectively. At a cutoff IgG level of 2000 mg/dl (1.25× upper limit of normal), the sensitivity and specificity for the diagnosis of AIH cirrhosis were 81.7% and 74.1%, respectively, with an area under receiver operating characteristic curves of 0.814 ( P < 0.001). CONCLUSION: Hyperimmunoglobulinemia occurs in patients with cirrhosis due to different etiology. However, the different patterns of immunoglobulin subtype elevation may facilitate the differentiation of the underlying etiology of cirrhosis, with IgG level more than 2000 mg/dl (1.25× upper limit of normal) having a fair diagnostic performance for AIH-related cirrhosis.
Ferrarese A, Russo FP, Senzolo M
… +10 more, Gambato M, Zanetto A, Vivian LM, D'Arcangelo F, Gringeri E, Cillo U, Feltracco P, Pasquato S, Burra P, Germani G
BACKGROUND: Improving equity and fairness in the referral process for liver transplantation remains a critical unmet need. Multilevel barriers continue to limit timely and appropriate access to liver transplantation eval...BACKGROUND: Improving equity and fairness in the referral process for liver transplantation remains a critical unmet need. Multilevel barriers continue to limit timely and appropriate access to liver transplantation evaluation. This study aimed to identify key obstacles to liver transplantation referral and to explore potential strategies to overcome them. METHODS: An online survey was sent to all centers participating in a Hub-and-Spoke liver transplantation referral network in Northern Italy. The survey addressed barriers related to patient, healthcare system, and practice setting-level factors. Healthcare providers (HCPs) were also asked to rate the perceived usefulness of six proposed actions designed to reduce or prevent referral barriers. RESULTS: A total of 58 responses were collected. Nonadherence, lack of a caregiver, and absence of motivation toward liver transplantation (85%, 82%, and 78%, respectively) were perceived as the most impactful patient-related barriers. Lack of real-time technological communication for data sharing and limited social worker availability were identified as major practice setting-related barrier by 77% and 44.5% HCPs. Lack of knowledge about liver transplantation and unclear indications for liver transplantation were perceived significant healthcare-related barriers by 25% and 21% of HCPs, respectively. All six proposed actions to improve the referral process were rated as clinically impactful by at least 60% of HCPs. CONCLUSION: Multilevel barriers may still hinder the referral of potential liver transplantation candidates. Implementation of structured psychosocial support and real-time data sharing between centers could significantly reduce inequities in referral to liver transplantation.
BACKGROUND AND AIMS: Extraintestinal manifestations (EIMs) complicate the management of inflammatory bowel disease, and their epidemiology in Chinese patients remains unclear. We aimed to determine their prevalence and e...BACKGROUND AND AIMS: Extraintestinal manifestations (EIMs) complicate the management of inflammatory bowel disease, and their epidemiology in Chinese patients remains unclear. We aimed to determine their prevalence and examine associated risk factors and clinical outcomes. METHODS: We conducted a cross-sectional study of over 44 000 patients of all ages in eastern China using data from the China National Healthcare Big Data (East) Center (2019-2024). We examined diverse EIMs (articular, skin, ocular, and oral manifestations, primary sclerosing cholangitis, and autoimmune hepatitis) and compared clinical characteristics of patients with and without EIMs using multivariable logistic regression. RESULTS: The overall prevalence of EIMs was higher in ulcerative colitis (20.46%) than in Crohn's disease (14.64%). Among pediatric patients (<18 years), EIMs were more frequent in Crohn's disease (13.08%) than in ulcerative colitis (10.18%). EIM prevalence increased progressively across the four age groups (<18, 18-40, 40-65, and >65 years; P < 0.001). Risk factors included older age (P < 0.001), female sex in ulcerative colitis (P = 0.002), and pancolitis (P = 0.041), whereas in pediatric patients, EIMs were linked to younger age (P = 0.015). EIMs were also associated with corticosteroid use (P < 0.001), all-cause hospitalization (P = 0.044 in Crohn's disease; P < 0.001 in ulcerative colitis), and other adverse clinical outcomes. A total of 1.9% of Crohn's disease and 3.5% of ulcerative colitis patients had multiple EIMs, most commonly involving peripheral arthritis. CONCLUSION: This first large-scale study of Chinese inflammatory bowel disease patients evaluates EIMs, revealing age-specific and population-specific patterns that inform risk identification and individualized management.
BACKGROUND AND AIMS: Modified endoscopic mucosal resection (EMR) techniques using a snare tip, precutting EMR (P-EMR) and anchoring EMR (A-EMR), have been developed for the effective resection of nonpedunculated colorect...BACKGROUND AND AIMS: Modified endoscopic mucosal resection (EMR) techniques using a snare tip, precutting EMR (P-EMR) and anchoring EMR (A-EMR), have been developed for the effective resection of nonpedunculated colorectal polyps measuring 10-25 mm. Although previous studies have compared either P-EMR or A-EMR with conventional EMR, no study has directly compared these two snare tip-assisted techniques within modified EMR. This study aimed to evaluate P-EMR and A-EMR in terms of the R0 resection rate and procedure duration. METHODS: This prospective randomized controlled trial enrolled patients with nonpedunculated colorectal polyps measuring 10-25 mm. The patients were randomly assigned to the P-EMR or A-EMR groups. The primary outcome was R0 resection rate, defined as en bloc resection with histologically tumor-free margins. Secondary outcomes included the injection-to-snaring time, total procedure time, and adverse events. RESULTS: Each group included 63 polyps, of which 126 were analyzed in the final evaluation. Both groups achieved high R0 resection rates (93.7% for P-EMR and 88.9% for A-EMR), with no significant difference (P = 0.344). However, the A-EMR group demonstrated significantly shorter injection-to-snaring time (181.8 ± 81.9 vs. 320.9 ± 143.5 s, P < 0.001) and total procedure time (259.7 ± 139.7 vs. 479.8 ± 249.0 s, P < 0.001). Adverse events, including intraprocedural and delayed bleeding, were comparable between the groups. CONCLUSION: Both P-EMR and A-EMR demonstrated high R0 resection rates for nonpedunculated polyps measuring 10-25 mm. However, A-EMR achieved these outcomes with a shorter procedure time than P-EMR.
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) has been widely adopted for the management of decompensated portal hypertension in cirrhotic patients. However, TIPS dysfunction remains a critical clinica...BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) has been widely adopted for the management of decompensated portal hypertension in cirrhotic patients. However, TIPS dysfunction remains a critical clinical challenge. This study aimed to identify risk factors for TIPS dysfunction and develop a predictive model to assess this complication. METHODS: A retrospective study was conducted involving cirrhotic patients who underwent TIPS between 2017 and 2024. Among 1052 initially screened patients, 676 were finally included in the analysis. TIPS dysfunction was diagnosed using ultrasound and angiographic evaluations. The dataset was randomly divided into a training set and a validation set at a ratio of 7 : 3. A stepwise logistic regression analysis was performed in the training set to establish a predictive model. Ten-fold cross-validation was used for internal validation, and the validation set was applied for external validation. The predictive discrimination was evaluated using the receiver operating characteristic curve, and the calibration curve was used to assess the consistency. Shapley Additive Explanations analysis was conducted to interpret the model. RESULTS: Independent risk factors for TIPS dysfunction included age, main portal vein thrombosis, platelets, D value, angle β, and the angle between the selected hepatic vein and inferior vena cava. The model showed good predictive performance with an area under the curve of 0.896 (sensitivity 0.804, specificity 0.844, and accuracy 93.2%) for training set and 0.905 (sensitivity 0.870, specificity 0.826, and accuracy 86.5%) for validation set. The calibration curve from the 10-fold cross-validation in the training set also showed good agreement between prediction and observation. Shapley Additive Explanations analysis showed that Beta value is the most important feature affecting prediction, and allows the estimation of the specific risk of TIPS dysfunction for each individual in the model. CONCLUSION: This study developed a valid predictive model for assessing risk factors for TIPS dysfunction in cirrhotic patients. Recognition of these risk factors and optimized TIPS shunt management may contribute to improved outcomes in patients undergoing TIPS procedures.
BACKGROUND: Real-world effectiveness/safety of vedolizumab and ustekinumab as first-line biologics in Crohn's disease were evaluated by disease complexity. METHODS: EVOLVE Expansion (NCT05056441) was a retrospective char...BACKGROUND: Real-world effectiveness/safety of vedolizumab and ustekinumab as first-line biologics in Crohn's disease were evaluated by disease complexity. METHODS: EVOLVE Expansion (NCT05056441) was a retrospective chart review in Australia, Belgium, and Switzerland. Biologic-naive patients with Crohn's disease (≥18 years) initiated first-line biologic treatment with vedolizumab or ustekinumab. Complex Crohn's disease was defined as active fistula at treatment initiation, any prior Crohn's disease-related surgery since, or any Crohn's disease-related hospitalization within 12 months prior to treatment initiation. Baseline characteristics were balanced using inverse probability of treatment weighting. Cumulative rates of clinical response, remission, mucosal healing, and treatment persistence were estimated over 36 months. Serious adverse events (SAEs), serious infections, and health care resource use (HCRU) were evaluated. RESULTS: Overall, 427 patients had noncomplicated Crohn's disease (vedolizumab, n = 245; ustekinumab, n = 182) and 196 had complex Crohn's disease (vedolizumab, n = 102; ustekinumab, n = 94). In both subgroups, cumulative rates (vedolizumab vs. ustekinumab) of clinical response (noncomplicated, 85.1 vs. 85.7%; complex, 79.7 vs. 81.3%), clinical remission (noncomplicated, 93.5 vs. 91.3%; complex, 82.9 vs. 80.8%), mucosal healing (noncomplicated, 91.1 vs. 91.5%; complex, 87.8 vs. 80.2%), and treatment persistence (noncomplicated, 72.2 vs. 83.7%; complex, 71.8 vs. 71.3%) over 36 months were not significantly different in patients who initiated vedolizumab or ustekinumab. In both subgroups, the risks of SAEs, Crohn's disease exacerbations, Crohn's disease-related surgeries, and Crohn's disease-related hospitalizations were similar between patients treated with vedolizumab or ustekinumab during 36 months. CONCLUSION: Vedolizumab and ustekinumab demonstrated similar rates of clinical outcomes, treatment persistence, safety, and HCRU in patients with complex and noncomplicated Crohn's disease during 36 months of treatment.