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Practical Recommendations for Pouchitis Management by AGA

The AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders provides practitioners with recommendations for the prevention and treatment of pouchitis, Crohn’s-like disease of the pouch, and cuffitis. The guideline panel made 9 conditional recommendations, including the use of antibiotics for intermittent pouchitis, probiotics for recurrent pouchitis, and advanced immunosuppressive therapies for chronic antibiotic-dependent or refractory pouchitis. The panel also outlined implementation considerations and identified areas for future research.

Practice Guideline by Barnes EL, Agrawal M (…) Singh S et 9 al. in Gastroenterology

Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Practice Patterns and Factors Associated with Intraoperative Nerve Monitoring in Endocrine Surgery

Among 9,813 patients who underwent parathyroidectomy, intraoperative nerve monitoring was used in 49% of cases. There was a significant increase in parathyroidectomies with intraoperative nerve monitoring from 2014 to 2018, followed by a plateau. Vocal cord dysfunction after parathyroidectomy was not associated with intraoperative nerve monitoring. Surgeons who routinely used intraoperative nerve monitoring during thyroidectomy were more likely to use it during parathyroidectomy. Factors associated with intraoperative nerve monitoring during parathyroidectomy included reoperation, secondary/tertiary hyperparathyroidism, multiglandular disease, and non-localized disease. Further research is needed to identify the patients who may benefit most from intraoperative nerve monitoring in parathyroidectomy.

Journal Article by Conroy PC, Wilhelm A (…) Sosa JA et 6 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Long-Term Impact of Genotype and Surgery in MEN1 Hyperparathyroidism

The study investigated the impact of genotype and surgical approach on long-term postoperative outcomes in patients with primary hyperparathyroidism and multiple endocrine neoplasia type 1 (MEN1). Findings showed that patients with protein-truncating germline pathogenic variants in specific exons of the MEN1 gene had aggressive pancreatic neuroendocrine tumors and earlier onset of primary hyperparathyroidism. The choice of surgical approach also affected disease-free survival, with subtotal parathyroidectomy associated with better outcomes compared to total parathyroidectomy. It is recommended to exercise caution when opting for subtotal parathyroidectomy in patients with specific MEN1 variants.

Journal Article by Shariq OA, Abrantes VB (…) McKenzie TJ et 6 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Endoscopic Resection Shows Promising Results in Treating Gastric Gastrointestinal Stromal Tumors

Endoscopic resection (ER) has shown to be an effective and safe method for treating gastric gastrointestinal stromal tumors (GISTs), as suggested by a retrospective study in a large tertiary hospital in China. With a sample size of over 300 patients and a follow-up period longer than 45 months, the study found an en bloc resection rate of 88.85% and a complication rate of 0.93%. Notably, there were no instances of recurrence, even in cases where GISTs were removed piecemeal.

Journal Article by He Z, Du C (…) Linghu E et 9 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Fluorescent Cholangiography Improves Visualizaton and Surgeon Satisfaction in Laparoscopic Cholecystectomy

Fluorescent cholangiography (nirf-c) was compared with intraoperative cholangiogram (ioc) and critical view of safety in white light (cvs-wl) for laparoscopic cholecystectomy (lc) performed by trainee surgeons. A total of 338 patients were analyzed, with nirf-c group showing higher rates of common hepatic and common bile duct visualization. There were no significant differences in operative time or time to achieve the critical view of safety. The use of nirf-c did not prolong operative time but improved surgeon satisfaction during lc.

Journal Article by Ortenzi M, Corallino D (…) Podda M et 8 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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ERCP in Palestine: Comparable to international standards with low complication rates

The study evaluated the utilization and outcomes of endoscopic retrograde cholangiopancreatography (ERCP) procedures in the first advanced endoscopy center in Palestine. A total of 1909 procedures on 1303 patients were included, with an overall complication rate of 5%. The primary adverse events were post-ERCP pancreatitis (2.3%), infection/cholangitis (1%), bleeding (0.5%), and perforation (0.4%). Risk factors for adverse events included pancreatic duct cannulation and younger age. The study concluded that ERCP in Palestine is comparable to international standards and is considered a safe procedure.

Journal Article by Salama HZ, Alnajjar YA (…) Al-Ashhab H et 4 al. in BMJ Open

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Defecation Symptoms Reflect Dyssynergic Pattern in Constipated Patients

Researchers analyzed retrospective data from high-resolution anorectal manometry and patient-completed bowel habit and symptom diaries to evaluate the usefulness of the diary as a screening tool for disordered rectoanal coordination (DRC). They found that patients with a dyssynergic pattern (DP) during manometry had a higher prevalence of incomplete evacuation with loose or normal stool compared to those without DP. The diary showed potential in stratifying constipated patients for further investigation of suspected DRC.

Journal Article by Ingemansson A, Walter SA, Jones MP and Sjödahl J in J Clin Gastroenterol

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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Rising HCC Hospitalizations and Decreased Mortality Highlight Financial Burden

The study analyzed trends in hospitalizations for hepatocellular carcinoma (HCC) in the United States between 2011 and 2017. The researchers found an increase in HCC-related admissions over the years, with a decrease in inpatient mortality rates. However, there was a significant rise in the financial burden on healthcare due to increasing hospital charges and longer length of stay. The study highlights the need to address the escalating costs associated with HCC treatment.

Journal Article by Wakil A, Wu YC (…) Pyrsopoulos NT et 2 al. in J Clin Gastroenterol

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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Study Finds Similar Mutation Rates in Racial Differences of Stage IV Colorectal Cancer Patients

A retrospective cohort study analyzed molecular profiling and mutation rates in stage IV colorectal cancer (CRC) patients. The study found significant increases in molecular testing rates for microsatellite instability (MSI), KRAS, and BRAF mutations over time. Black patients had higher odds of testing for MSI and BRAF mutations compared to white patients. However, there was no difference in mutation rates between black and white patients. The study highlights increasing accessibility of molecular testing for CRC patients and shows no racial disparity in mutation rates.

Journal Article by Hinshaw TP, Fu Y (…) Snyder RA et 2 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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Intraoperative Parathyroid Hormone Monitoring Predicts Successful Treatment of Parathyroid Carcinoma

A retrospective review of 796 patients undergoing parathyroidectomy with intraoperative parathyroid hormone (iPTH) monitoring for primary hyperparathyroidism identified 18 patients with parathyroid carcinoma. The study found that patients who achieved a >50% decrease in iPTH levels into the normal reference range had a higher rate of operative success compared to those with a >50% decrease alone. This suggests that iPTH monitoring should be used alongside clinical judgment and complete resection for optimal treatment of parathyroid carcinoma.

Journal Article by Armstrong VL, Vaghaiwalla TM (…) Lew JI et 5 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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