Year : 2022 | Volume
: 2 | Issue : 2 | Page : 85--86
Department of Medical Gastroenterology, SIMS Institute of Gastroenterology Hepatobiliary Sciences and Liver Transplantation, SRM Institute for Medical Science Hospital, Chennai, Tamil Nadu, India
No 1, Jawaharlal Nehru Salai, 100 Feet Road, Vadapalani, Chennai - 600 026, Tamil Nadu
|How to cite this article:|
Jayaraman K. Gastroenterology elsewhere.Gastroenterol Hepatol Endosc Pract 2022;2:85-86
|How to cite this URL:|
Jayaraman K. Gastroenterology elsewhere. Gastroenterol Hepatol Endosc Pract [serial online] 2022 [cited 2022 Jul 5 ];2:85-86
Available from: http://www.ghepjournal.com/text.asp?2022/2/2/85/340397
Long-term Follow-up of Small Pancreatic Cysts
Nakhaei M, Bligh M, Chernyak V, Bezuidenhout AF, Brook A, Brook OR. Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm. Eur Radiol. 2022 Jan 11. doi: 10.1007/s00330-021-08428-1. Epub ahead of print. PMID: 35013764.
Asymptomatic pancreatic cysts need follow-up, especially if they are presumed to be mucinous/intraductal papillary mucinous forms or cannot be defined. How long and how frequently remains unclear. Fukuoka and European guidelines suggest lifelong surveillance imaging, whereas the American College of Gastroenterology recommends termination of follow-up after 5 years of cyst stability. Authors in this retrospective study compared follow-up of 267 patients with asymptomatic small pancreatic cysts (0.5 to <2 cm in diameter) against 1459 patients with no cysts in terms of the development of pancreatic cancer and mortality. Only two patients (0.7%) in the small pancreatic cyst group developed pancreatic cancer over a mean follow-up of 8.6 years. Moreover, pancreatic cancer occurred in a site different from the cyst. The incidence of pancreatic cancer was 0.9 and 1.8 per 1000 patient-years in “small pancreatic cyst” and “no cyst” groups, respectively (P = 0.6). All-cause mortality was similar in both groups, 21% and 26% (P = 0.09) in the “small pancreatic cyst” and “no cyst group,” respectively. The authors have not mentioned the location of the cysts and whether they could define all the cysts. Nevertheless, this study adds more to the existing knowledge of the natural course of pancreatic cysts, which in future will help tailor surveillance, reducing patient anxiety, and costs.
Safety and Efficacy of Lanifibranor, a Pan-Peroxisome Proliferator-Activated Receptor Agonist
Francque SM, Bedossa P, Ratziu V, Anstee QM, Bugianesi E, Sanyal AJ, et al. A randomized, controlled trial of the Pan-PPAR agonist lanifibranor in NASH. N Engl J Med 2021;385:1547-58.
Lanifibranor is a novel pan-peroxisome proliferator-activated receptor agonist, which supposedly simultaneously targets metabolism, inflammation, and fibrogenesis. This trial is a pharma-funded, phase 2b, placebo-controlled double-blinded randomized study to test the efficacy and safety of the drug in patients with nonalcoholic steatohepatitis (NASH). Two hundred and forty-seven adult patients with biopsy-proven NASH were randomly assigned in a 1:1:1 ratio to receive 1200 mg lanifibranor or 800 mg of lanifibranor or placebo for 24 weeks with follow-up liver biopsies. The primary outcome was a decrease of at least 2 points in the activity part of the steatosis, activity, and fibrosis (SAF) score without worsening fibrosis. From a mean baseline SAF-A score of 3.3, a reduction of at least 2 points was seen in the 1200 mg lanifibranor group (risk ratio in 1200 mg vs. placebo 1.7;95% confidence interval [CI], 1.2–2.3 P = 0.007). Reduction of NASH and regression of fibrosis by at least one point was seen in both doses of lanifibranor, more so in the 1200 mg group. The multipronged drug appears to offer a wide range of benefits across the spectrum of metabolic syndrome, as evident by the reduction in glycated hemoglobin, raised adiponectin, and better lipid profiles in the lanifibranor group.
Cooling the Papilla to Prevent Post ERCP Pancreatitis
Azuma S, Kurita A, Katayama T, Iwano K, Iimori K, Kawai Y, et al. Cooling the papilla with ice water in preventing post-ERCP pancreatitis (ice water challenge study). Surg Endosc. 2022 Jan 3. doi: 10.1007/s00464-021-08924-x. Epub ahead of print. PMID: 34977992.
Papillary edema believed to block the outflow of pancreatic juice is considered a critical mechanism of post ERCP pancreatitis (PEP). Azuma et al. propose that edema can be minimized by lowering the temperature like applying an ice pack over bruises and burns. This study sought the efficacy of the cooling effects to prevent PEP; 100 patients undergoing ERCP received flushing of iced water at the end of the procedure. When compared with a retrospective cohort who had not received iced water therapy, the incidence of PEP was insignificantly lower in the study group (4%) than in the control group (11%). When stratified based on the type of intervention, biliary sphincterotomy was significantly associated with lower rates of PEP (n = 0/46, P = 0.033). An exciting study but limited by the small sample size and study design. More direct, randomized comparative studies are needed to explore this inexpensive option.
Duodenal Mucosal Resurfacing Revisited
Mingrone G, van Baar AC, Devière J, Hopkins D, Moura E, Cercato C, et al. Safety and efficacy of hydrothermal duodenal mucosal resurfacing in patients with type 2 diabetes: The randomised, double-blind, sham-controlled, multicentre REVITA-2 feasibility trial. Gut 2022;71:254-64.
Duodenal mucosal resurfacing (DMR) is a catheter-based, endo-metabolic procedure, using hydrothermal energy to ablate the duodenal mucosa, which is believed to play a role in diabetes through hypertrophy and hyperplasia. Since the advent of this modality, there have been fewer studies and limited evidence to recommend to the larger population. REVITA-2 is a multicentric, randomized, double-blinded, sham-controlled trial to study the safety and efficacy of DMR in Type II diabetic patients over 24 weeks. Because of the heterogeneity of the population, the authors had adopted modified intention to treat analysis in two groups: European (n = 75: DMR 39, Sham 36), Brazilian (n = 33: DMR 17, Sham 16). Efficacy, as assessed by absolute reduction in glycated hemoglobin (HbA1C), was significantly lower (P = 0.03) in the European DMR (-6.6 mmol/mol) over the European sham group (-3.3 mmol/mol) but was similar across the Brazilian groups. For those with high baseline fasting plasma glucose >10 mmol/L significant reductions in glycated hemoglobin and liver magnetic resonance imaging-proton density fat fraction was observed as per the overall per-protocol analysis. The effects were a bit varied among the Brazilian and European cohorts. No serious adverse events were noted. DMR remains a promising and attractive prospect, but data remains scarce, and more clarification is needed to recommend this as a mainstream modality of treatment.
Prevention Remains Better than Cure– Vaccination and COVID-19 in Cirrhosis
John BV, Deng Y, Schwartz KB, Taddei TH, Kaplan DE, Martin P, et al. Post-vaccination COVID-19 infection is associated with reduced mortality in patients with cirrhosis. Hepatology. Accepted Author Manuscript. https://doi.org/10.1002/hep.32337.
Breakthrough coronavirus disease 2019 (COVID 2019) after vaccination against COVID-19 is widely reported, especially in the current Omicron/Delta wave. Generally, cirrhotics respond poorly to vaccines due to immune dysregulation than the rest of the healthy population. This retrospective (March 2020 to June 2021), 1:2 propensity-matched study looks at the outcomes of COVID 19 in vaccinated (n = 254) and unvaccinated patients (n = 508) with cirrhosis. Postvaccination COVID-19 was associated with reduced overall death (Adjusted Hazard ratio, [aHR] 0.21, 95%CI 0.10–0.42, P ≤ 0.0001) and reduced COVID-19-related death (aHR 0.23, 95% CI 0.10–0.53, P = 0.001). The effect was observed in both fully and partially vaccinated patients. Vaccinated status was not associated with a reduction in hospitalization rates but with a reduced need for mechanical ventilation within 60 days (aHR 0.33 95%CI 0.11–0.96, P = 0.04). The vaccines administered were Pfizer, Moderna, and Janssen, and no significant differences in outcomes were seen across the groups. This reassures vaccination helps in cirrhotic cohort, who are prone to respiratory illness.
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