A 43-year-old man with a history of heavy alcohol consumption presented with seven episodes of hematochezia within 8 h (50-100 g each), accompanied by vague upper abdominal discomfort. Initial treatment for suspected acu...A 43-year-old man with a history of heavy alcohol consumption presented with seven episodes of hematochezia within 8 h (50-100 g each), accompanied by vague upper abdominal discomfort. Initial treatment for suspected acute gastrointestinal bleeding with esomeprazole and somatostatin was ineffective. Two hours after admission, recurrent hematochezia occurred with hemodynamic deterioration, including hypotension, decreased hemoglobin, pallor, tachycardia, and cold extremities. Contrast-enhanced abdominal CT demonstrated contrast extravasation and blood accumulation in the ileocecal region, suggesting bleeding from the appendiceal and ileocecal arteries. Colonoscopy revealed segmental intraluminal blood and persistent bleeding from the appendiceal orifice despite repeated irrigation. Emergency laparoscopic appendectomy was performed. Histopathology showed thick-walled vascular proliferation consistent with an appendiceal Dieulafoy's lesion. The patient recovered uneventfully without recurrent bleeding during a 6-month follow-up. This case highlights the atypical, rapidly progressive nature of appendiceal Dieulafoy's lesion and the diagnostic value of contrast-enhanced CT and timely endoscopy.
Bhat A, Arham M, Ali Z
… +11 more, Ishtiaq S, Abdul Rehman M, Ahmed A, Chauhan A, Tareen HK, Bakht K, Haider F, Dad A, Creech L, Novikov A, Draganov PV
INTRODUCTION: Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs,...INTRODUCTION: Accurate tissue acquisition (TA) of solid pancreatic lesions is essential for guiding treatment with endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) being the preferred method. Among FNB designs, the three-pronged Franseen-tip needle demonstrates strong diagnostic performance, though direct head-to-head comparisons with other FNB designs remain limited. METHODOLOGY: This meta-analysis was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420251123856). Eligible studies enrolled patients with solid pancreatic lesions who underwent EUS-guided FNB, directly compared the Franseen-tip with other FNB needles. Six databases were systematically searched through July 2025, and study selection, data extraction, and risk of bias assessment (QUADAS-2 tool) were performed independently by two reviewers. Pooled estimates were generated using random-effects and bivariate hierarchical models. RESULTS: Sixteen studies (2,010 Franseen vs. 2,811 comparator) were included. Bivariate analysis showed that sensitivity and specificity of the Franseen needle were comparable to newer-generation comparator needles (sensitivity 91.3% vs. 94.0%; specificity 99.99% vs. 99.15%), whereas older-generation needles demonstrated lower sensitivity (80.8%) and inferior discriminatory performance (Negative Likelihood Ratio [LR⁻] 0.19 vs. 0.09). Diagnostic accuracy was higher with the Franseen needle (RR 1.07, 95% CI 1.01-1.14; I = 69%). Sample adequacy was similar overall (RR 1.04, 95% CI 0.95-1.14) but superior to older-generation needles (RR 1.19, 95% CI 1.02-1.41) and in lesions > 30 mm (RR 1.14, 95% CI 1.02-1.28, I = 81.2%). The Franseen needle achieved nominally strong diagnostic performance (DOR 116.6), although small-study effects were observed. Primary procedural outcomes were comparable between Franseen and comparator needles, including technical success (RR 1.00, 95% CI 0.98-1.02) and histological core procurement (RR 1.04, 95% CI 0.92-1.17). The Franseen needle had fewer low-cellularity samples (RR 0.56, 95% CI 0.45-0.69) and lower specimen bloodiness (RR 0.48, 95% CI 0.25-0.90) but a slightly higher overall adverse event rate (RR 1.29, 95% CI 1.06-1.57). CONCLUSION: The Franseen needle provides superior diagnostic accuracy and sample adequacy compared to older-generation FNB needles with comparable performance to newer-generation designs. It reduces low-cellularity samples and specimen bloodiness, although adverse events are slightly increased, with other primary procedural outcomes remaining comparable. TRIAL REGISTRATION: PROSPERO (Registration No. CRD420251123856).
We report a rare 18-cm splenic tail anomaly presenting with a unique "tadpole" sign on CT hyper-realistic rendering (HRR), which was managed conservatively and identified as a congenital variation to prevent misdiagnosis...We report a rare 18-cm splenic tail anomaly presenting with a unique "tadpole" sign on CT hyper-realistic rendering (HRR), which was managed conservatively and identified as a congenital variation to prevent misdiagnosis and unnecessary invasive procedures.
BACKGROUND AND AIM: Peranal endoscopic myectomy (PAEM), also known as endoscopic intermuscular dissection, enables resection of lower rectal lesions with severe submucosal fibrosis by dissecting the inner circular muscle...BACKGROUND AND AIM: Peranal endoscopic myectomy (PAEM), also known as endoscopic intermuscular dissection, enables resection of lower rectal lesions with severe submucosal fibrosis by dissecting the inner circular muscle. We aimed to evaluate the efficacy and safety of PAEM. METHODS: This retrospective study included patients who underwent PAEM for lower rectal lesions between January 2017 and December 2024 at the Osaka International Cancer Institute. PAEM was performed intentionally after October 2023, whereas unintentional PAEM occurred during endoscopic submucosal dissection (ESD) prior to October 2023. Short-term outcomes were assessed, and negative vertical margin rates were compared between groups. RESULTS: Among 242 consecutive patients who underwent ESD for lower rectal lesions, PAEM was performed in 25 patients (unintentional PAEM, 13; intentional PAEM, 12). The median age was 66 years (range, 38-89 years), and 14 patients (56%) were female. En bloc resection was performed for all 25 lesions. Histological examinations showed 19 adenocarcinomas (pTis, 3; pT1, 11; pT2, 5), 3 other tumors, and 3 non-residual tumors (salvage treatment after endoscopic resection). After PAEM, hematochezia occurred in 14 patients (56%), but most cases were self-limited and one patient had hematochezia requiring prolonged hospitalization. The negative vertical margin rate was higher in the intentional PAEM group than in the unintentional PAEM group, with similar findings observed in an additional analysis excluding salvage cases (88% vs. 33%, P = 0.007). CONCLUSIONS: PAEM was feasible and generally safe. Intentional PAEM may facilitate vertical margin control in selected cases with severe fibrosis.
PURPOSE: Endoscope tip protectors (ETP) are commercially available, but their effect on reducing the number and type of damages to the instruments and the economic impact of reducing repair costs are largely unknown. MET...PURPOSE: Endoscope tip protectors (ETP) are commercially available, but their effect on reducing the number and type of damages to the instruments and the economic impact of reducing repair costs are largely unknown. METHODS: We conducted a prospective, blinded cohort, operational quality improvement study at a large, quaternary endoscopic referral center to assess the frequency and types of endoscope damage as well as analyze the effect on repair costs. A cohort of 21 upper endoscopes, 16 colonoscopes and 11 echoendoscopes was utilized. Phase 1 involved 1,800 procedures without ETP, followed by Phase 2 utilizing the ETP for 1,800 procedures. The endoscope cohort was assessed after each procedure, at the 900-procedure point, and at the end of each phase of the study to ensure the capture of any unidentified damage. A cost per case analysis (CPC) and cost-effectiveness analysis (CEA) were performed using the overall cost of damage repair per volume of procedures, from the perspective of the overall fleet as well as the specific types of endoscopes studied. RESULTS: ETP use was associated with a 36.4% decrease in overall fleet repair costs, from $167.64 to $106.72 per case, with a 48.7%, 64.7% and 28.4% CPC reduction respectively for upper endoscopes, colonoscopes and echoendoscopes. CEA found that the use of ETP dominated non-use for the entire endoscope fleet, upper endoscopes and colonoscopes but not echoendoscopes. CONCLUSIONS: ETP was associated with a decrease in CPC repair costs and was the dominant practice strategy from a CEA standpoint for all endoscope classes except echoendoscopes. ETP use should be considered to reduce endoscope repair costs. Further studies are warranted to validate these findings.
PURPOSE: Non-invasive laboratory-based models have been proposed to estimate portal hypertension severity in patients with compensated advanced chronic liver disease (cACLD), but external validation in diverse population...PURPOSE: Non-invasive laboratory-based models have been proposed to estimate portal hypertension severity in patients with compensated advanced chronic liver disease (cACLD), but external validation in diverse populations remains limited. We aimed to externally validate two such models, originally developed in European cohorts, for predicting clinically significant portal hypertension (CSPH; hepatic venous pressure gradient [HVPG] ≥ 10 mmHg) and severe portal hypertension (HVPG ≥ 16 mmHg) in a U.S.-based cACLD cohort. METHODS: We conducted a retrospective single-center study of adults with cACLD who underwent HVPG measurement between 2014 and 2024. Patients with active hepatic decompensation, hepatocellular carcinoma, or prior transjugular intrahepatic portosystemic shunt were excluded. Model performance of the Vienna laboratory-based model and the FIB-4 plus albumin (FIB4 +) model was evaluated using discrimination (area under the receiver operating characteristic curve [AUROC]) and calibration metrics, including calibration intercepts, slopes, and Brier scores. RESULTS: The cohort included 143 patients (median age 56 years; 54% female), predominantly with metabolic dysfunction-associated steatotic liver disease or alcohol-related liver disease. Median HVPG was 7 mmHg, with CSPH present in 33% and HVPG ≥ 16 mmHg in 11%. Discrimination was modest for both models. The Vienna model achieved AUROCs of 0.71 for HVPG ≥ 10 mmHg and 0.77 for HVPG ≥ 16 mmHg, while the FIB4 + model achieved AUROCs of 0.69 and 0.71, respectively. Both models systematically overestimated risk, demonstrating poor calibration across thresholds. Negative predictive values for HVPG ≥ 16 mmHg exceeded 95% for both models. Predictive performance was weaker in non-viral etiologies. CONCLUSION: In this U.S.-based external validation, laboratory-based models for portal hypertension showed modest discrimination and poor calibration, with systematic risk overestimation. While high negative predictive values suggest potential utility as rule-out tools for severe portal hypertension, recalibration and prospective validation are required before clinical implementation.
BACKGROUND AND AIM: Acute necrotizing pancreatitis (ANP) is associated with pancreatic parenchymal necrosis and may lead to exocrine and endocrine dysfunction. However, the natural course and determinants of pancreatic f...BACKGROUND AND AIM: Acute necrotizing pancreatitis (ANP) is associated with pancreatic parenchymal necrosis and may lead to exocrine and endocrine dysfunction. However, the natural course and determinants of pancreatic functional impairment remain incompletely defined. We prospectively evaluated the pancreatic exocrine and endocrine function in patients with ANP and attempted to identify associated risk factors. METHODS: Patients aged 18-80 years with ANP defined by the Revised Atlanta Classification were enrolled and prospectively followed for 6 months. Exocrine function was assessed using fecal elastase-1 (FE-1), and endocrine function was evaluated using fasting glucose, postprandial glucose, HbA1c, and homeostatic model assessment of insulin resistance (HOMA-IR). Clinical severity, etiology, anatomic distribution of necrosis, infected necrosis, and interventions were analyzed as predictors of dysfunction. RESULTS: Thirty patients completed 6-month follow-up. At 6 months, exocrine insufficiency occurred in 40% of patients (mild 16.7%, severe 23.3%). Endocrine dysfunction was observed in 30% of patients, including diabetes mellitus (6.7%) and prediabetes (23.3%). Necrosis involving the pancreatic head was significantly associated with exocrine insufficiency (p = 0.003). Moderately severe acute pancreatitis independently predicted exocrine dysfunction (p = 0.01). No clinical or radiologic factor predicted endocrine insufficiency. CONCLUSION: Exocrine insufficiency appears to be relatively common following ANP, with a possible association observed in patients with moderately severe disease and head-dominant necrosis; however, these findings require further validation. Endocrine dysfunction was observed in approximately one-third of patients, but no consistent predictors were identified in this cohort.
BACKGROUND: Acute pancreatitis during pregnancy is a rare but potentially severe condition that may adversely affect both maternal and fetal outcomes. Although advances in intensive care have improved prognosis, the impa...BACKGROUND: Acute pancreatitis during pregnancy is a rare but potentially severe condition that may adversely affect both maternal and fetal outcomes. Although advances in intensive care have improved prognosis, the impact of the disease on pregnancy outcomes remains an important clinical concern. AIMS: This study aimed to investigate maternal and fetal outcomes in pregnancies complicated by acute pancreatitis and to evaluate the effect of disease severity on these outcomes. METHODS: This retrospective study was conducted at a tertiary care center and included 25 pregnant women diagnosed with acute pancreatitis and 100 healthy controls between February 2020 and February 2025. Maternal and fetal outcomes were first compared between the acute pancreatitis and control groups. Subsequently, patients with acute pancreatitis were classified into mild and severe subgroups according to disease severity, and subgroup analyses were performed. Clinical, laboratory, and obstetric outcomes were analyzed using appropriate statistical methods. RESULTS: Patients with acute pancreatitis had significantly longer hospital stays and higher rates of maternal intensive care unit admission compared with controls (p < 0.001 for both). Gestational age at delivery was lower and neonatal birth weights were reduced in the acute pancreatitis group (p < 0.001 and p = 0.004, respectively). Neonatal mortality was also higher in this group (p < 0.001). In subgroup analyses, patients with severe acute pancreatitis had higher maternal ICU admission rates (p = 0.001), longer ICU stays (p = 0.005), and increased neonatal ICU admissions (p = 0.022). CONCLUSIONS: Acute pancreatitis during pregnancy is associated with adverse maternal, fetal, and neonatal outcomes, particularly in severe cases. Early recognition and close multidisciplinary management in tertiary centers may help reduce complications and improve pregnancy outcomes.
BACKGROUND: Crohn's disease (CD) management remains challenging, particularly in patients refractory to multiple biologics. Risankizumab (RZB), a selective IL-23 p19 inhibitor, has recently been approved for CD. We perfo...BACKGROUND: Crohn's disease (CD) management remains challenging, particularly in patients refractory to multiple biologics. Risankizumab (RZB), a selective IL-23 p19 inhibitor, has recently been approved for CD. We performed a systematic review and meta-analysis to assess the efficacy and safety of RZB in moderate-to-severe CD using both randomized controlled trials (RCTs) and real-world evidence (RWE). METHODS: We searched PubMed, Scopus, Web of Science, and Embase from inception to April 2025. We included RCTs comparing RZB with placebo and observational studies evaluating RZB in CD. Primary endpoints were clinical remission at induction and maintenance. Secondary endpoints included endoscopic remission and safety outcomes. This study was registered with PROSPERO (CRD420251030978). RESULTS: Five RCTs and nine observational studies (n = 3275) were included. In RCTs, RZB significantly increased clinical remission rates at induction (RR: 1.90, 95% CI [1.63; 2.20]) and maintenance (RR: 1.34, 95% CI [1.15; 1.55]) compared with placebo. Endoscopic remission was also significantly higher with RZB compared to placebo at induction (RR: 3.25, 95% CI [2.43; 4.35]) and maintenance (RR: 2.04, 95% CI [1.22; 3.42]). Pooled RWE demonstrated clinical remission rates of 57% at 12 weeks and 44% at 1 year. Subgroup analyses confirmed efficacy in patients with prior ustekinumab failure. No increased risk of serious adverse events was observed. CONCLUSIONS: Risankizumab demonstrates robust efficacy in inducing and maintaining clinical and endoscopic remission in moderate-to-severe CD. Real-world data confirm its sustained effectiveness and favorable safety profile in refractory populations (defined as patients with prior failure of one or more biologics or advanced therapies), supporting its positioning in the therapeutic landscape.
PURPOSE: Colorectal endoscopic submucosal dissection (ESD) is an essential oncological procedure with challenging optimal resource allocation. A 2018 reimbursement revision in Japan restricted ESD coverage to early color...PURPOSE: Colorectal endoscopic submucosal dissection (ESD) is an essential oncological procedure with challenging optimal resource allocation. A 2018 reimbursement revision in Japan restricted ESD coverage to early colorectal cancer and neuroendocrine tumors. We aimed to describe utilization trends of ESD, endoscopic resection (ER), and diagnostic colonoscopy following this revision, and evaluate real-world endoscopic triage during the early stages of the COVID-19 pandemic. METHODS: Using a large Japanese claims database, we performed an interrupted time-series analysis assessing utilization changes in ESD, ER (stratified into < 2 cm and ≥ 2 cm), and colonoscopy following the 2018 revision and COVID-19 pandemic onset (April 2020). RESULTS: Following the 2018 revision, ESD showed an immediate 31% decline (incidence rate ratio [IRR] 0.69, 95% confidence interval [CI] 0.58-0.81). ER < 2 cm increased by 5% (IRR 1.05, 95%CI 1.03-1.06) and ER ≥ 2 cm increased by 13% (IRR 1.13, 95%CI 1.02-1.24), while diagnostic colonoscopy remained stable. When the COVID-19 pandemic began, ESD showed a non-significant decrease (IRR 0.89, 95%CI 0.74-1.06). Counterfactual analysis revealed suppression of ER < 2 cm (- 23.8%), ER ≥ 2 cm (- 25.0%), and diagnostic colonoscopy (- 27.4%) during April-July 2020, whereas ESD deviated minimally (- 5.8%). CONCLUSION: The 2018 revision was followed by decreased ESD and increased ER utilization. During the early stages of the pandemic, ER and colonoscopy fell markedly below projected trends, whereas ESD deviated minimally. These findings quantitatively document changes in procedure utilization consistent with endoscopic triage, suggesting that advanced oncological procedures were relatively prioritized and preserved during these severe system disruptions.
BACKGROUND: Clinical evidence on whether acute cholangitis accelerates early stent failure via rapid bacterial adhesion and biofilm formation remains limited. We assessed the influence of pre-endoscopic retrograde cholan...BACKGROUND: Clinical evidence on whether acute cholangitis accelerates early stent failure via rapid bacterial adhesion and biofilm formation remains limited. We assessed the influence of pre-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis on time to recurrent biliary obstruction (TRBO) and early post-ERCP infection in patients with distal malignant biliary obstruction (DMBO). METHODS: We retrospectively reviewed consecutive patients with DMBO who underwent their first ERCP-guided stenting at five Japanese centers (January 2020-August 2024). Patients were classified by pre-ERCP cholangitis status and matched at a 2:1 ratio of noncholangitis to cholangitis using propensity scores (PSM). The primary outcome was TRBO; secondary outcomes were post-ERCP infection, clinical success, and RBO rates. TRBO was analyzed using Kaplan-Meier, log-rank, and multivariable Cox analyses; sensitivity analyses yielded concordant results. RESULTS: Of 588 eligible patients, 508 had no cholangitis. PSM yielded 136 and 68 patients in well-balanced groups. The median TRBO was 140 vs. 114 d (p = 0.939). In the Cox models, nonpancreatic etiology lowered RBO risk (hazard ratio [HR]: 0.59, p = 0.04); plastic stents carried a higher risk than metal (HR: 4.71, p < 0.001), and pre-ERCP cholangitis was not associated with RBO (HR: 1.20, p = 0.46). Infections occurred in 9.6 and 4.4% (p = 0.33). Independent infection predictors were dilated bile duct (protective; odds ratio: 0.26, p = 0.02) and prolonged procedures (odds ratio: 3.73, p = 0.03). CONCLUSIONS: Pre-ERCP cholangitis did not reduce stent patency or increase early infection rates in patients with DMBO. TRBO-depended primarily on stent type; nondilated ducts and prolonged procedures were predictive of infection. These findings support possible internal drainage during index ERCP with contemporary periprocedural management.
PURPOSE: We assess racial disparities in the prevalence and incidence of clinical outcomes in alcohol-associated liver disease (ALD) in a diverse US population. METHODS: This is a retrospective multicenter study on patie...PURPOSE: We assess racial disparities in the prevalence and incidence of clinical outcomes in alcohol-associated liver disease (ALD) in a diverse US population. METHODS: This is a retrospective multicenter study on patients aged 18-80 years with ALD in the Banner Health System from 2012 to 2024. Patients with major adverse liver outcomes (MALO) (ascites, hepatic encephalopathy, hepatocellular carcinoma, esophageal variceal bleeding) at baseline were excluded. Primary outcomes included mortality and the incidence of MALO, cardiovascular diseases (CVD) (coronary artery disease (CAD), congestive heart failure (CHF), cerebrovascular accidents (CVA), peripheral artery disease), type II diabetes mellitus (DM), cirrhosis, major adverse cardiovascular events (MACE) (CAD, CHF, CVA, mortality), and all-cause cancer. Competing risk and Cox proportional hazard regression analyses were used for outcome modeling. RESULTS: The cohort included 16,693 patients with ALD. The median age was 50.3 and 67.8% were male. The racial distribution was 66.7% Non-Hispanic White (NHW), 0.4% Asian/Pacific Islander, 3.2% Black, 17.9% Hispanic, and 11.8% Native American/Alaskan (NA). Compared to NHW patients, NA patients had higher mortality (aHR: 1.85, 95% CI: 1.50-2.27) and higher incidence of MALO (aHR: 1.19, 95% CI: 1.04-1.37), cirrhosis (aHR: 1.51, 95% CI: 1.28-1.79) and MACE (aHR: 1.38, 95% CI: 1.20-1.59). CONCLUSION: NA patients with ALD had higher mortality and incidence of adverse clinical outcomes compared to NHW. Further research is warranted to explore these disparities and develop tailored interventions to improve outcomes.
PURPOSE: Opioid-propofol sedation is standard for gastrointestinal endoscopy but may contribute to postoperative fatigue (POF). This study compared the severity of POF between sufentanil-propofol and alfentanil-propofol...PURPOSE: Opioid-propofol sedation is standard for gastrointestinal endoscopy but may contribute to postoperative fatigue (POF). This study compared the severity of POF between sufentanil-propofol and alfentanil-propofol sedation in patients undergoing gastrointestinal endoscopy. METHODS: In this randomized trial, 248 patients scheduled for esophagogastroduodenoscopy and/or colonoscopy received either alfentanil (7.5-10 μg/kg) or sufentanil (0.1-0.2 μg/kg) combined with propofol for deep sedation. The primary outcome was POF severity assessed by the Christensen Fatigue Scale (CFS) 30 min post-procedure. Secondary outcomes included recovery times (awakening and ambulation), incidence of clinically significant fatigue (CFS ≥ 6), and adverse events. RESULTS: At 30 min post-procedure, the alfentanil group had significantly lower CFS scores than the sufentanil group (mean [standard deviation, SD]: 4.7 [1.0] vs. 5.7 [1.0]; mean difference -1.1, 95% CI -1.3 to -0.8; P < 0.001). The proportion of patients with CFS score ≥ 6 was also lower in the alfentanil group (20.8% vs. 35.7%, P = 0.004). Recovery was faster in the alfentanil group for both awakening (3.0 [2.2] vs. 5.5 [2.8] minutes, P < 0.001) and ambulation (12.8 [2.4] vs. 15.7 [3.4] minutes, P < 0.001). Adverse events including dizziness, nausea, and vomiting were less frequent with alfentanil (15.2% vs. 26.0%, P = 0.035; and 4.8% vs. 12.2%, P = 0.036). CONCLUSIONS: Compared to sufentanil, alfentanil combined with propofol significantly reduced postoperative fatigue and enhanced recovery in patients undergoing deeply sedated gastrointestinal endoscopy. REGISTRATION: Name of trial registry: Chinese Clinical Trial Registry. REGISTRATION NUMBER: ChiCTR2300071429. URL: https://www.chictr.org.cn/showproj.html?proj=186791.
PURPOSE: Treatment for exocrine pancreatic insufficiency (EPI) includes pancreatic enzyme replacement therapy (PERT). Although PERT may improve symptoms, there are currently no EPI symptom measures to monitor PERT treatm...PURPOSE: Treatment for exocrine pancreatic insufficiency (EPI) includes pancreatic enzyme replacement therapy (PERT). Although PERT may improve symptoms, there are currently no EPI symptom measures to monitor PERT treatment. This analysis evaluated the utility of the Pancreatic Exocrine Insufficiency Questionnaire (PEI-Q) in patients with chronic pancreatitis and EPI treated with pancrelipase. METHODS: This prospective, observational study (NCT04949828) included adult patients with chronic pancreatitis and EPI who were recommended pancrelipase 72,000 lipase units per meal and 36,000 lipase units per snack by an independent physician. Outcomes included the change from baseline to 1 month and 3 months after treatment initiation in PEI-Q symptom score, PEI-Q symptom severity categories, and health-related quality of life (HRQoL) as measured by the PEI-Q impact domain score. RESULTS: The per-protocol population included 32 and 29 patients with data at 1 and 3 months after pancrelipase initiation, respectively. A significant reduction in mean PEI-Q symptom scores was observed from baseline to 1 month (- 1.0; p < 0.001) and 3 months (- 1.1; p < 0.001). Despite all patients having moderate/severe EPI symptoms at baseline, 62.5% and 62.1% of patients reported mild/no EPI symptoms after 1 and 3 months, respectively. There was also a significant reduction in mean PEI-Q impact scores from baseline to 1 month (- 1.0; p < 0.001) and 3 months (- 1.2; p < 0.001), indicating improved HRQoL. CONCLUSION: Pancrelipase improved patient-reported EPI symptoms and HRQoL based on the PEI-Q, which may be a useful tool for monitoring PERT treatment in patients with chronic pancreatitis and EPI.
BACKGROUND: Upper gastrointestinal bleeding (UGIB) remains a significant clinical emergency with substantial mortality. Accurate risk stratification is essential for optimal patient triage and management. The ABC score (...BACKGROUND: Upper gastrointestinal bleeding (UGIB) remains a significant clinical emergency with substantial mortality. Accurate risk stratification is essential for optimal patient triage and management. The ABC score (Age, Blood tests, Comorbidities) and AIMS65 score are prominent pre-endoscopy risk stratification tools, yet direct comparative studies within diverse United States healthcare populations remain limited. AIMS: To compare the predictive accuracy of ABC and AIMS65 scores for in-hospital mortality and secondary clinical outcomes in patients with acute UGIB. METHODS: This retrospective cohort study analyzed 2,009 adult patients admitted with acute UGIB across multiple Northwell Health hospitals between January 2019 and January 2024. Both ABC and AIMS65 scores were calculated for each patient using structured EMR data, ICD-10 diagnosis codes, and anesthesiology procedure documentation. Primary outcomes included in-hospital mortality and 30-day readmission. Secondary outcomes encompassed hospital length of stay, ICU admission, development of complications (shock, sepsis, acute kidney injury), vasopressor use, and need for mechanical ventilation. Univariable logistic regression models assessed predictive accuracy using area under the receiver operating characteristic curve (AUC), with bootstrap internal validation (10,000 resamples) confirming negligible optimism bias. DeLong's test compared discriminative abilities between scores. Sensitivity analyses evaluated score performance across pandemic periods and in a broader AIMS65-computable cohort. RESULTS: Among 2,009 patients (56.1% male; median age 70 years), 97 (4.8%) experienced in-hospital mortality and 59 (2.9%) had 30-day readmission. The ABC score demonstrated significantly superior predictive accuracy for mortality compared to AIMS65 (AUC 0.793 vs. 0.661; p < 0.0001 by DeLong's test; optimism-corrected AUCs: 0.793 and 0.661, respectively). Each one-unit increase in ABC score corresponded to a 50.7% increase in mortality odds (OR 1.507; 95% CI: 1.386-1.638). Neither score significantly predicted 30-day readmission. ABC score showed stronger correlations with secondary outcomes including hospital length of stay (r = 0.47 vs. r = 0.33), ICU length of stay (r = 0.35 vs. r = 0.22), and vasopressor requirements (r = 0.30 vs. r = 0.21). ABC's superiority was consistent across pre-pandemic, peak pandemic, and post-peak subgroups. In the broader AIMS65-computable cohort (n = 6,766), AIMS65 demonstrated an AUC of 0.706, confirming that the cohort restriction modestly attenuated its discrimination but that ABC's advantage persisted. CONCLUSIONS: The ABC score demonstrates significantly superior predictive accuracy for in-hospital mortality compared to AIMS65 in patients with acute UGIB, with consistent advantages across secondary outcomes, pandemic periods, and cohort definitions. These findings support the preferential use of ABC score for risk stratification in clinical practice.