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Takahiro Nagata,Sadahiro Funakoshi,Daisuke Morihara,Satoshi Shakado,Keiji Yokoyama,Kazuhide Takata,Takashi Tanaka,Atsushi Fukunaga,Ryo Yamauchi,Hiromi Fukuda,Hiroki Matsuoka,So Imakiire,Hideto Sakisak 대한장연구학회 2023 Intestinal Research Vol.21 No.4
Background/Aims: The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD.Methods: We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters.Results: Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m<sup>2</sup>), C-reactive protein (CRP; <i>P</i><0.001) and alanine aminotransferase (<i>P</i>=0.018) levels were higher and the albumin level (<i>P</i>=0.005) and prognostic nutritional index (PNI; <i>P</i>=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (<i>P</i><0.001) and the CRP level was negatively correlated (<i>P</i>=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (<i>P</i><0.05) and CRP values (<i>P</i><0.001) were improved over time after CT imaging by continuing IBD treatment.Conclusions: Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.
Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases
Hayato Yamaguchi,Masakatsu Fukuzawa,Takashi Kawai,Takahiro Muramatsu,Taisuke Matsumoto,Kumiko Uchida,Yohei Koyama,Akira Madarame,Takashi Morise,Shin Kono,Sakiko Naito,Naoyoshi Nagata,Mitsushige Sugimo 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.6
Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is per-formed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing per-foration. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of res-cue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group(SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] min-utes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dis-section rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions: RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoid-ing surgery.