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2020| July-August | Volume 26 | Issue 4
Online since
July 29, 2020
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ORIGINAL ARTICLES
Biliary anatomy and pancreatic duct variations: A cross-sectional study
Murad Aljiffry, Mohammad Abbas, Mohammad A. M. Wazzan, Ahmed H Abduljabbar, Safiyah Aloufi, Emad Aljahdli
July-August 2020, 26(4):188-193
DOI
:10.4103/sjg.SJG_573_19
PMID
:32461381
Background/Aim:
Biliary tree and pancreatic duct can appear in different variations whose proper understanding is obligatory for surgeons. Magnetic resonance cholangiopancreatography (MRCP) is considered a safe and accurate tool for evaluating biliary tree and pancreatic duct. Typical anatomy for right hepatic duct (RHD) and left hepatic duct (LHD) is reported as 57% and 63%, respectively. The most common (4-10%) pancreatic anomaly is divisum. In the present study, we evaluated and determined the prevalence of biliary tree and pancreatic duct variations among patients at a university hospital.
Materials and Methods:
The MRCP records of 370 patients from 2015 to 2017 were obtained for cross-sectional study. Images were retrospectively reviewed for variations by two independent senior radiologists. Demographic data were obtained for all the patients. Huang
et al
. classification was used for RHD and LHD variations. The cystic duct was reported based on its course and insertion pattern. The pancreatic duct was observed for the presence of divisum, its course, and configuration.
Results:
Three hundred and twenty-five patients were included in the final study. Most commonly observed variant for RHD were A1 (34.2%) and A2 (32.2%). For LHD, B1 (71.4%) was the most common variant. Cystic duct insertion was commonly seen as right lateral insertion (27.7%). Pancreatic divisum was observed in 0.6% of cases. Nationality, origin, and gender-specific variations were obtained.
Conclusion:
Variations in biliary anatomy and pancreatic duct are very diverse and extend from the intrahepatic biliary system down to the pancreas. Performing a similar study on a larger population is mandatory to illustrate the range of variations present within the community.
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3
Risk of neutropenia in inflammatory bowel disease patients treated with TNF inhibitors: A single-center, retrospective cohort study
Dimah AlAskar, Mais AlSardi, Eman Al Sulais, Mahmoud Mosli, Turki AlAmeel
July-August 2020, 26(4):210-215
DOI
:10.4103/sjg.SJG_41_20
PMID
:32496224
Background/Aim:
Tumor necrosis factor inhibitors (TNFi) have become the mainstay of treatment in moderate-to-severe cases of inflammatory bowel disease (IBD). Neutropenia has been reported in patients receiving TNFi for IBD and other diseases. In this study, we aimed to ascertain the relationship between the use of TNFi and the development of neutropenia in patients with IBD.
Patients and Methods:
This is a retrospective cohort study including all adult patients with IBD receiving TNFi at a tertiary care center over an 11-year period. The primary outcome was the development of any neutropenic episode after starting a TNFi. For our secondary outcomes, we evaluated the impact of concomitant use of 5-aminosalicylic acid (5-ASA) or an immunomodulator on the risk of developing neutropenia.
Results:
The final analysis included 281 patients. Of those included, 34.2% developed at least one episode of neutropenia while on a TNFi. The majority of these episodes (67.7%) were mild with ANC between 1000 and 1500/mm
3
. No significant difference was observed in the age, gender, agent used or type of IBD between those who developed neutropenia and those who did not. Concomitant use of azathioprine (OR = 2.32, 95% CI: 1.26–4.28;
P
= 0.007) or 5-ASA (OR = 3.15, 95% CI: 1.55–6.39;
P
= 0.001) were significant independent predictors of developing neutropenia.
Conclusions:
In this study, mild neutropenia was common among patients with IBD on TNFi. Future prospective studies are required to further clarify the significance of neutropenia in patients with IBD receiving TNFi.
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3,262
206
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Development and validation of metric-based-training to proficiency simulation curriculum for upper gastrointestinal endoscopy using a novel assessment checklist
Nahla Azzam, Nehal Khamis, Majid Almadi, Faisal Batwa, Fahad Alsohaibani, Abdulrahman Aljebreen, Ahmad Alharbi, Yasser Alaska, Turki Alameel, Peter Irving, Richard M Satava
July-August 2020, 26(4):179-187
DOI
:10.4103/sjg.SJG_113_20
PMID
:32719238
Background/Aims
: This study aimed to design a structured simulation training curriculum for upper endoscopy and validate a new assessment checklist.
Materials and Methods:
A proficiency-based progression stepwise curriculum was developed consisting of didactic, technical and non-technical components using a virtual reality simulator (VRS). It focused on: scope navigation, anatomical landmarks identification, mucosal inspection, retro-flexion, pathology identification, and targeting biopsy. A total of 5 experienced and 10 novice endoscopists were recruited. All participants performed each of the selected modules twice, and mean and median performance were compared between the two groups. Novices pre-set level of proficiency was set as 2 standard deviations below the mean of experts. Performance was assessed using multiple-choice questions for knowledge, while validated simulator parameters incorporated into a novel checklist; Simulation Endoscopic Skill Assessment Score (SESAS) were used for technical skills.
Results
: The following VRS outcome measures have shown expert vs novice baseline discriminative ability: total procedure time, number of attempts for esophageal intubation and time in red-out. All novice trainees achieved the preset level of proficiency by the end of training. There were no statistically significant differences between experts' and trainees' rate of complications, landmarks identification and patient discomfort. SESAS checklist showed high degree of agreement with the VRS metrices (kappa = 0.83) and the previously validated direct observation of procedural skills tool (kappa = 0.90).
Conclusion
: The Fundamentals of Gastrointestinal Endoscopy simulation training curriculum and its SESAS global assessment tool have been primarily validated and can serve as a valuable addition to the gastroenterology fellowship programs. Follow up study of trainee performance in workplaces is recommended for consequences validation.
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1
Prevalence of biopsy-proven nonalcoholic fatty liver among patients with gallstone disease
Faisal A Alsaif, Sara H Alqahtani, Amani M Alsadoon, Khalid A Alswat, Ayman A Abdo, Mazen M Hassanain, Abdulsalam B Alsharabi, Ghadeer R Aljuhani, Hisham M Alkhalidi, Mohammad S Elsharkawy, Maram A Alotaibi, Faisal M Sanai, Waleed K Al-hamoudi
July-August 2020, 26(4):204-209
DOI
:10.4103/sjg.SJG_29_20
PMID
:32341228
Background/Aim:
Gallstone disease (GD) and nonalcoholic fatty liver disease (NAFLD) are associated with metabolic syndrome. Despite the benign nature of NAFLD, 10% of patients may develop advanced fibrosis and cirrhosis. We aimed to identify the prevalence and factors associated with NAFLD among GD patients in the Saudi population.
Patients and Methods:
This is a single-center, observational cohort study that included patients seen in general surgery clinics at our institution from 2011 to 2017. All liver biopsies were taken at the same time as the cholecystectomy. Demographical and clinical data were prospectively collected from the study population.
Results:
Of the 301 GD patients in the study, 15% had a normal body mass index (BMI), 29% were overweight, and 56% were obese. There were 143 (47.8%) patients with NAFLD, of which 125 (41.8%) showed steatosis and 18 (6%) had nonalcoholic steatohepatitis. There was a significant positive correlation between NAFLD and age (r = 0.243;
P
< 0.0001), and BMI (r = 0.242;
P
< 0.0001). Obese patients with BMI 30–40 kg/m
[2]
were 2.403 (
P
= 0.039) more likely to have NAFLD compared with normal BMI patients, and this value increased to 6.145 (
P
= 0.002) in patients with BMI >40 kg/m
[2]
. Additionally, patients with T2DM were 2.839 times (
P
= 0.015) more likely to have NAFLD compared with those who did not.
Conclusions:
The prevalence of NAFLD among GD patients is high. High BMI and diabetes are independent factors associated with NAFLD in GD patients. The results suggest that there may be a need for routine liver biopsy in selected patients during cholecystectomy.
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2,933
296
2
SYSTEMATIC REVIEW/META-ANALYSIS
The association between SNPs rs1800591 and rs3816873 of the MTTP gene and nonalcoholic fatty liver disease: A meta-analysis
Jie Tan, Jian Zhang, Zhenzhen Zhao, Jie Zhang, Mengzhen Dong, Xuefeng Ma, Shousheng Liu, Yongning Xin
July-August 2020, 26(4):171-178
DOI
:10.4103/sjg.SJG_201_20
PMID
:32719241
Background/Aims
: The role of two polymorphisms rs1800591 and rs3816873 of the microsomal triglyceride transfer protein (MTTP) gene in the development of nonalcoholic fatty liver disease (NAFLD) remains controversial. A meta-analysis was conducted to determine the correlation between these MTTP polymorphisms and NAFLD.
Materials and Methods
: A systematic search was carried out using PubMed, Embase, and Cochrane Library to retrieve English studies that reported the relationship between MTTP polymorphisms (rs1800591 and rs3816873) and NAFLD published before February 18, 2020. Odds ratio (OR) and 95% confidence interval (CI) were used to appraise the risk of MTTP polymorphism in NAFLD.
Results
: A total of 10 case-control studies, including 1388 cases and 1690 healthy subjects, were included. No significant correlation between the rs1800591 (G
vs.
T: OR = 1.08, 95% CI = 0.68–1.70,
P
= 0.76) and rs3816873 (CT + CC
vs.
TT: OR = 1.23, 95% CI = 0.76–2.01,
P
= 0.398) polymorphisms of MTTP and NAFLD was found in any of the models. However, when NASH patients confirmed by liver biopsy were extracted alone for rs1800591 polymorphism analysis, it was found that the G allele significantly increased the risk of NASH under the heterozygote model (GT
vs.
TT: OR = 3.16, 95% CI = 1.13–8.83,
P
= 0.028) and dominant model (GT + GG
vs.
TT: OR = 3.03, 95% CI = 1.13–8.09,
P
= 0.027).
Conclusion:
The present meta-analysis revealed that the rs1800591 and rs3816873 polymorphisms of the MTTP gene are uncommon in NAFLD. However, the G allele of rs1800591 was more likely to be correlated to NASH susceptibility.
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ORIGINAL ARTICLES
Utility of inflammatory markers to predict adverse outcome in acute pancreatitis: A retrospective study in a single academic center
Mohamad Mubder, Banreet Dhindsa, Danny Nguyen, Syed Saghir, Chad Cross, Ranjit Makar, Gordon Ohning
July-August 2020, 26(4):216-221
DOI
:10.4103/sjg.SJG_49_20
PMID
:32719240
Background/Aim:
Acute pancreatitis (AP) is a commonly encountered emergency where early identification of complicated cases is important. Inflammatory markers like lymphocyte to monocyte ratio (LMR) and neutrophil to lymphocyte ratio (NLR) are simple and readily available markers. In this study, we evaluated the utility of these markers in the early identification of patients with complicated AP.
Patients and Methods:
All patients with a diagnosis of AP admitted to the University Medical Center in Las Vegas/Nevada between August 2015 and September 2018 were identified using ICD-10 codes. Medical records were reviewed retrospectively. Epidemiological measures and their associated confidence intervals were calculated using MedCalc (v. 18).
Results:
The LMR showed a significant difference between groups, with the non-complicated cases consistently higher than the complicated cases but without significant temporal differences. The NLR showed a significant difference with a significant temporal relation. Using the bound of the 95% confidence interval separating the two groups, LMR <2 was found to be associated with a complicated case and NLR >10.5 was suggestive of a complicated case. High specificity (85–92%) with low sensitivity (23–69%) was noted; hence, these cut points were very good at discerning non-complicated cases.
Conclusion:
Our data show persistently low LMR that is associated with severe AP and a value of <2.0 can be used clinically to predict severe AP on admission. It also shows that elevated NLR is associated with complicated AP and prolonged hospital stay with a value >10.5 that can be used to predict severe complicated AP and to monitor response to treatment over time.
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EDITORIAL
Training to competency: Are we ready for a radical reform?
Hani Lababidi
July-August 2020, 26(4):169-170
DOI
:10.4103/sjg.SJG_331_20
PMID
:32719242
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1,625
238
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ORIGINAL ARTICLES
LncRNA NEAT1 modulates sorafenib resistance in hepatocellular carcinoma through regulating the miR-149-5p/AKT1 axis
Yuexiang Niu, Gongen Tang, Xiuli Wu, Chaoyu Wu
July-August 2020, 26(4):194-203
DOI
:10.4103/sjg.SJG_4_20
PMID
:32461380
Background/Aims:
The purpose of this study is to explore the expression characteristics of lncRNA NEAT1 in hepatocellular carcinoma (HCC) and the molecular mechanism of its regulation on sorafenib resistance.
Materials and Methods:
This experimental study was performed from June 2013 to June 2019. The level of NEAT1 was determined using RT-PCR in HCC and matched adjacent tissues from 79 HCC patients in Linyi central hospital. The patients were divided into two groups to compare their prognosis based on the median NEAT1 expressions as a cutoff value. HCC cell line HepG2 negative control (HepG2-NC), sorafenib-resistant HepG2 cells (HepG2-SR) were transfected with or without NEAT1 siRNA, followed by subsequent molecular analysis, to determine the function of NEAT1 on sorafenib resistance in HCC cells. The cell transcripts were determined by RNA-sequencing analysis. The binding site of the NEAT1 and microRNA-149-5p (miR-149-5p) was verified by luciferase assay.
Results:
We found that NEAT1 was significantly increased in HCC tissues. Furthermore, NEAT1 expressions were significantly associated with HCC prognosis and chemoresistance patterns against sorafenib. Subsequently, the sorafenib-resistant HCC cell lines, together with the controls, were used to determine the regulatory effect of NEAT1 on HCC cells' progression and sorafenib resistance. NEAT1 targets the miR-149-5p, and therefore, decrease the activity of sorafenib against HCC cells. NEAT1 functions were demonstrated to be triggered by the regulation of miR-149-5p/AKT1 axis.
Conclusions:
NEAT1/miR-149-5p/AKT1 pathway-based therapy might be a potential clinical application for HCC patients.
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12
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© Saudi Journal of Gastroenterology (Official journal of The Saudi Gastroenterology Association) | Published by Wolters Kluwer -
Medknow
Online since 15
th
October, 2006