Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation?

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is associated with a variety of adverse events(AEs).One of the most important AEs is post-ERCP pancreatitis(PEP),which is most common in cases of difficult biliary cannulation.Although the precut technique has been reported as a PEP risk factor,recent studies indicate that early precut could reduce PEP,and that precut itself is not a risk factor.AIM To evaluate the safety of the precut technique,especially in terms of PEP.METHODS We conducted a retrospective study,spanning the period from November 2011 through December 2021.It included 1556 patients,aged≥20 years,who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center.We compared the PEP risk between the early precut and the delayed precut group.RESULTS The PEP incidence rate did not significantly differ between the precut and nonprecut groups.However,the PEP incidence was significantly lower in the early precut group than the delayed precut group(3.5%vs 10.5%;P=0.02).The PEP incidence in the delayed precut group without pancreatic stent insertion(17.3%)was significantly higher compared to other cases(P<0.01).CONCLUSION Our findings indicate that early precut may reduce PEP incidence.If the precut decision is delayed,a pancreatic stent should be inserted to prevent PEP.

Combination of type Ⅳ collagen 7S, albumin concentrations, and platelet count predicts prognosis of non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease and affects approximately 25%of the general global adult population.The prognosis of NAFLD patients with advanced liver fibrosis is known to be poor.It is difficult to assess disease progression in all patients with NAFLD;thus,it is necessary to identify patients who will show poor prognosis.AIM To investigate the efficacy of non-invasive biomarkers for predicting disease progression in patients with NAFLD.METHODS We investigated biomarkers associated with mortality in patients with NAFLD who visited the Kawasaki Medical School General Medical Center from 1996 to 2018 and underwent liver biopsy and had been followed-up for>1 year.Cumulative overall mortality and liver-related events during follow-up were calculated using the Kaplan-Meier analysis and compared using log-rank testing.We calculated the odds ratio and performed receiver operating characteristic curve analysis with logistic regression analysis to determine the optimal cut-off value with the highest prognostic ability.RESULTS We enrolled 489 patients who were followed-up for a period of 1-22.2 years.In total,13 patients died(2.7%of total patients enrolled);7 patients died due to liverrelated causes.Poor prognosis was associated with liver fibrosis on histological examination but not with inflammation or steatosis.Blood biomarkers associated with mortality were platelet counts,albumin levels,and type IV collagen 7S levels.The optimal cutoff index for predicting total mortality was a platelet count of 15×10^(4)/μL,albumin level of 3.5 g/dL,and type IV collagen 7S level of 5 mg/dL.In particular,only one-factor patients with NAFLD presenting with platelet counts≤15×10^(4)/μL,albumin levels≤3.5 g/dL,or type IV collagen 7S≥5 mg/dL showed 5-year,10-year,and 15-year survival rates of 99.7%,98.3%,and 94%,respectively.However,patients with two factors had lower 5-year and 10-year survival rates of 98%and 43%,respectively.Similarly,patients with all three factors showed the lowest 5-year and 10-year survival rates of 53%and 26%,respectively.CONCLUSION A combination of the three non-invasive biomarkers is a useful predictor of NAFLD prognosis and can help identify patients with NAFLD who are at a high risk of all-cause mortality.