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Impact of frailty on endoscopic retrograde cholangiopancreatography outcomes in nonagenarians:A United States national experience

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World Journal of Gastrointestinal Endoscopy 2024年第3期16卷 148-156页

作者： Sanket Dhirubhai Basida Dushyant Singh Dahiya Muhammad Nadeem Yousaf Brinda Basida Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani Hassam Ali Sahib Singh Yash R Shah Daksh Ahluwalia Mihir Prakash Shah Saurabh Chandan Neil R Sharma Shyam Thakkar Department of Internal Medicine University of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States Division of Gastroenterology and Hepatology University of MissouriColumbiaMO 65212United States Department of Rheumatology Medical College of GeorgiaAugusta UniversityNorth AugustaGA 30912United States Department of Internal Medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States Department of Internal Medicine The University of ToledoToledoOH 43606United States Division of Gastroenterology and Hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States Department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Department of Internal Medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of Gastroenterology and Hepatology Creighton University School of MedicineOmahaNE 68131United States Division of Interventional Oncology&Surgical Endoscopy GI Oncology Tumor Site TeamParkview Cancer InstituteParkview HealthFort WayneIN 46845United States Section of Gastroenterology&Hepatology West Virginia University School of MedicineMorgantownWV 26505United States

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential therapeutic tool for biliary and pancreatic *** and elderly patients,especially those aged≥90 years are generally considered a higher-risk population for ERCP-related *** To investigate outcomes of ERCP in the Non-agenarian population(≥90 years)concerning *** This is a cohort study using the 2018-2020 National Readmission *** aged≥90 were identified who underwent ERCP,using the international classification of diseases-10 code with clinical *** Hopkins’s adjusted clinical groups frailty indicator was used to classify patients as frail and *** primary outcome was mortality,and the secondary outcomes were morbidity and the 30 d readmission rate related to *** used univariate and multivariate regression models for *** A total of 9448 patients were admitted for any indications of *** and non-frail patients were 3445(36.46%)and 6003(63.53%)*** for ERCP were Choledocholithiasis(74.84%),Biliary pancreatitis(9.19%),Pancreatico-biliary cancer(7.6%),Biliary stricture(4.84%),and Cholangitis(1.51%).Mortality rates were higher in frail group[adjusted odds ratio(aOR)=1.68,P=0.02].The Intra-procedural complications were insigni-ficant between the two groups which included bleeding(aOR=0.72,P=0.67),accidental punctures/lacerations(aOR=0.77,P=0.5),and mechanical ventilation rates(aOR=1.19,P=0.6).Post-ERCP complication rate was similar for bleeding(aOR=0.72,P=0.41)and post-ERCP pancreatitis(aOR=1.4,P=0.44).Frail patients had a longer length of stay(6.7 d vs 5.5 d)and higher mean total charges of hospitalization($78807 vs$71392)compared to controls(Phealthcare burden amongst nonagenarian frail patients undergoing ERCP compared

关键词： Endoscopic retrograde cholangiopancreatography Nonagenarians Frailty Mortality healthcare burden

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Impact of glucagon-like peptide receptor agonists on endoscopy and its preoperative management: Guidelines, challenges, and future directions

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 292-296页

作者： Sahib Singh Vishnu Charan Suresh Kumar Ganesh Aswath Department of Internal Medicine Sinai HospitalBaltimoreMD 21215United States Division of Gastroenterology and Hepatology State University of New York Upstate Medical UniversitySyracuseNY 13210United States

Glucagon-like peptide receptor agonists(GLP-1RA)are used to treat type 2 diabetes mellitus and,more recently,have garnered attention for their effect-iveness in promoting weight *** have been associated with several gastrointestinal adverse effects,including nausea and *** side effects are presumed to be due to increased residual gastric *** the potential risk of aspiration and based on limited data,the American Society of Anesthesi-ologists updated the guidelines concerning the preoperative management of patients on GLP-1RA in *** included the duration of mandated cessation of GLP-1RA before sedation and usage of“full stomach”precautions if these medications were not appropriately held before the *** has led to additional challenges,such as extended waiting time,higher costs,and increased risk for *** this editorial,we review the current societal guidelines,clinical practice,and future directions regarding the usage of GLP-1RA in patients undergoing an endoscopic procedure.

关键词： Glucagon-like peptide receptor agonists Endoscopy Adverse events Intubation Aspiration Semaglutide healthcare burden Guidelines

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Racial and Health Disparities among Cirrhosis-related Hospitalizations in the USA

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Journal of Clinical and Translational Hepatology 2022年第3期10卷 398-404页

作者： Ashwani K.Singal Yong-Fang Kuo Juan P.Arab Ramon Bataller Department of Medicine University of SD Sanford School of MedicineSioux FallsSDUSA Division of Transplant Hepatology Avera Transplant InstituteSioux FallsSDUSA Department of Biostatistics University of Texas Medical Branch at GalvestonGalvestonTXUSA Departamento de Gastroenterología Escuela de MedicinaPontificia Universidad Católica de ChileSantiagoChile Division of Gastroenterology and Hepatology University of Pittsburgh Medical CenterPittsburghPAUSA

Background and Aims:Alcohol-associated liver disease(ALD)is the most common cause of advanced liver disease worldwide,including in the *** use and cirrhosis mortality is higher in American Indian/Alaska Native(AI/AN)compared to *** are scanty on ALD as a liver disease etiology in AI/AN compared to other races and ***:The National Inpatient Sample on 199,748 cirrhosis-related hospitalizations,14,241(2,893 AI/AN,2,893 Whites,2,882 Blacks,2,879 Hispanics,and 2,694 Asians or other races)matched 1:1 for race/ethnicity on demographics,insurance,and income quartile of the residence zip code ***:After controlling for geographic location and hospital type,odds ratio(OR)and 95%confidence interval(CI)for ALD as cirrhosis etiology was higher among admissions in AI/AN ***[1.55(1.37–1.75)],***[1.87(1.65–2.11)],***[1.89(1.68–2.13)]and Asians/other races[2.24(1.98–2.53)].OR was also higher for AI/AN *** other races for alcohol-associated hepatitis(AH)as one of the discharge *** findings were similar in a subgroup of 4,649 admissions with decompensated cirrhosis and in a cohort of 350 admissions with acute-on-chronic liver failure as defined by EASL-CLIF *** use disorder diagnosis was present in 38%of admissions in AI/AN vs.24–30%in other races,pburden of advanced ALD among AI/AN individuals.

关键词： American Indians Alaska Natives Native Americans healthcare burden Epidemiology Magnitude Transplant

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